IRS LOWERS ELECTRONIC FILING THRESHOLD FOR 2023 ACA REPORTING

On October 16, 2023

The Internal Revenue Service IRS issued updated instructions for preparing and submitting ACA health insurance coverage and employer reporting Forms 1094 and 1095 B and 1094 and 1095 C. In previous years, entities filing 250 or more 1095 forms were required to file electronically. Now, entities filing 10 or more of these forms will need to send them into the […]

UPDATE: UPCOMING GAG CLAUSE ATTESTATION REQUIREMENT

On September 25, 2023

The Consolidated Appropriations Act, 2021 (CAA) prohibits the inclusion of “gag clauses” in provider contracts with insurers and group health plans. According to the law, a gag clause is a contract provision that directly or indirectly restricts a plan or issuer from sharing specific cost and quality information with another party. For example, if a […]

Medicare Part D Creditable Coverage Notice deadline October 15th

On September 13, 2023

Each year, group health plans that offer access to pharmacy benefits must notify all plan participants who are eligible for Medicare about whether their benefits are as extensive as the standard Medicare prescription drug plan before Medicare’s annual election period begins on October 15th. If the group plan’s benefits are as generous, it is considered […]

New ACA COVERAGE AFFORDABILITY PERCENTAGE for 2024

On September 7, 2023

The Affordable Care Act’s “affordability percentage” for group health insurance coverage just nose-dived for 2024, and the change will significantly impact both applicable large employers subject to the ACA’s employer shared responsibility requirement (AKA the employer mandate) and their health insurance brokers. Many thought the affordability rate couldn’t go any lower than 2023’s 9.12%. However, […]

Ohio Dental and Vision Dependent Coverage Expanded to Age 26 for 2024

On August 1, 2023

The Ohio operating budget (House Bill 33) for fiscal years 2024 to 2025 was recently signed into law and includes the following amendment impacting dental and vision plans: Expands the requirement that health benefit plans, including health insuring corporations, publicemployee benefit plans, and health benefit plans regulated under the Employee RetirementIncome Security Act of 1974 […]

CAA Gag Clause Attestation: Action May be Required by 12/31

On July 27, 2023

The Consolidated Appropriations Act (CAA) of 2021 prohibits health plans and carriers from entering into agreements with healthcare providers, third-party administrators (TPAs), or other service providers that would prevent disclosures of cost or certain other information to plan participants, plan sponsors, and other entities (the “gag clause prohibition”). The FAQs issued on February 23rd explain […]

FEDERAL DEPARTMENTS ISSUE PROPOSED MENTAL HEALTH PARITY RULES UNDER MHPAEA

On July 26, 2023

The federal government recently released proposed regulations related to the Mental Health Parity and Addiction Equity Act (MHPAEA). The MHPAEA, one of the most misunderstood federal healthcare laws, prohibits “group health plans and health insurance issuers that provide mental health or substance use disorder benefits from imposing less favorable benefit limitations on those benefits than […]

PCORI Fees for Self-Insured Medical Plans

On June 27, 2023

Updated Form 720 Issued | Fees Due 7/31/23 Under the ACA, all medical plans are responsible for paying the Patient-Centered Outcomes Research Institute (PCORI or PCOR) fees to the IRS, based on the average number of plan participants in the reporting plan year. If the medical plan is insured, the insurance carrier pays the fee […]