2014 Out-of-Pocket Limits Set for Essential Health Benefits

Posted on May 15, 2013 in Health Care Reform

$6,350 Individual/$12,700 Family

Non-grandfathered plans that cover essential health benefits (EHBs) must limit member out-of-pocket expenses for EHBs (in-network) to $6,350 for individual plans and $12,700 for family plans. This applies to plan years beginning on or after Jan. 1, 2014.

The Affordable Care Act (ACA) requires that in-network EHB out-of-pocket expenses for non-grandfathered plans not exceed out-of-pocket (OOP) limits set by the IRS for high deductible health plans (HDHPs). These amounts are indexed annually. On May 2, 2013, the IRS officially announced the 2014 HDHP out-of-pocket limits. This established out-of-pocket limits for non-grandfathered plans that cover essential health benefits in 2014.

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Update to the Employer Notice of Health Insurance Exchanges

Posted on May 10, 2013 in Health Care Reform

As part of the Affordable Care Act (ACA), employers are required to notify their employees of the coverage options available through the new Health Insurance Exchanges (“Marketplaces”). Originally, employers were required to notify employees by March 1, 2013. However, the employer ACA Marketplace requirement was delayed in January. Employers are now required to notify employees by October 1, 2013.

On May 8, 2013 the Department of Labor (DOL) issued new guidance on the notice to employees on coverage through the Marketplaces.

What Does the Employer ACA Marketplace Notice Need to Include?
All employers subject to the FLSA must provide notice to all current employees (regardless of part-time or full-time status) by October 1, 2013. For employees hired after October 1, 2013, the information is to be provided at time of hire. Employers are not required to provide a separate notice to dependents. The notice needs to:

  1. Inform employees about the existence of the Marketplace including a description of the services provided by the Marketplace, and how employees may can the Marketplace for assistance.
  2. Notify employees that if their company’s health insurance plan does not offer minimum essential coverage (covers less than 60 percent of costs), that the employee may be eligible for a premium tax credit through the Marketplace.
  3. If the employee purchases a qualified health plan through the Marketplace, the employee may lose the employer contribution (if any) to any health benefits plan offered by the employer and that all or a portion of such contribution may be excludable from income for Federal income tax purposes.

The DOL has released two model notices on their website, one for employers not offering a group health plan and one for employers offering a group health plan. Employers may use these sample notices, or provide their own notice granted it meets the requirements listed above.

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