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PPACA Update – IRS, HHS Release Additional Final Regulations

Originally posted March 7, 2014 by Bill Olson on www.ubabenefits.com.

On March 5, 2014, the Department of the Treasury and the Internal Revenue Service released the final employer-shared responsibility (“play or pay”) reporting rules. The Patient Protection and Affordable Care Act (PPACA) requires reporting in support of the individual and employer-shared responsibility requirements and premium tax credit/subsidy eligibility, under Sections 6055 and 6056 of the Internal Revenue Code. Fully insured employers with fewer than 50 full-time or full-time equivalent employees generally will not need to report. Larger insured plans and all self-funded plans will need to file reports. The final rule will permit use of a single form to fulfill reporting obligations under both parts of the law.

On March 5, 2014, the Department of Health and Human Services (HHS) released a bulletin announcing that it will allow carriers to renew policies through October 1, 2016, that do not include all of PPACA’s market reform requirements.  The extension is available for both individual and small group policies. The extension, which builds on an extension announced in November 2013 for 2014 renewals, is available only if permitted by the applicable state insurance department. Carriers would need to provide notices to policyholders advising the plan is not compliant with PPACA. All newly issued policies must meet all PPACA requirements.

HHS also released the final Notice of Benefit and Payment Parameters for 2015. This rule covers a variety of issues; of greatest interest are:

  • A confirmation that the transitional reinsurance fee for 2015 will be $44 per covered person
  • A confirmation that the fee will be collected in two parts, with the reinsurance contribution due early in the next calendar year and the treasury contribution due late in the fourth quarter of the next calendar year (so the 2014 fee will be due in January 2015 and fourth quarter 2015)
  • The maximum out-of-pocket (for all non-grandfathered plans) for 2015 will be $6,600 for single coverage and $13,200 for family coverage (this is less than originally projected)
  • The maximum deductible (for all non-grandfathered small group plans) for 2015 will be $2,050 for single coverage and $4,100 for family coverage (this is less than originally projected)
  • The maximum out-of-pocket for stand-alone pediatric dental essential health benefit coverage in the Marketplace for 2015 will be $350 for one covered child and $700 for two or more children
  • Open enrollment for the Marketplace for 2015 will be from November 15, 2014, through February 15, 2015