As employer groups with 51-100 employees renew or purchase health insurance coverage in 2016, they must abide by the rules and regulations governing the small group market, including those related to benefit coverage and essential health benefits; actuarial value, and premium rating restrictions, such as adjusted community rating and no medical underwriting.

The small group rules apply to fully insured plans, including those purchased in the Small Business Health Options Program (SHOP) marketplace.

In some markets, the state and insurance carriers may give employers the option to keep their plan for a while longer by:

• Changing their plan year to maximize the time the employer can keep their plan in 2016.
• Taking advantage of transitional relief, which allows employers in some states to keep their current plans through Sept. 30, 2017.

Employers that self-insure (self-funded) are not subject to these requirements.

Options and requirements vary by state, issuer and segment. For more information, please contact us for a consultation at 832-482-2494 or via email through the “contact us” page on our website.

Recently, your health insurance company may have requested your Social Security number, as well as the Social Security numbers of your spouse and your qualifying dependents. Due to a new reporting requirement, you will need to report qualifying health coverage (referred to as “minimum essential coverage”) on your yearly income tax return. This new reporting requirement will begin for the 2015 tax year, and your social security number is required by the Internal Revenue Service (IRS) for Form 1095-B. Here are some common questions you may have regarding this process.

The IRS recently released the final forms and instructions for Section 6055 and 6056 reporting. Additionally, the IRS released Publication 5196, Understanding Employer Reporting Requirements of the Health Care Law, in order to help employers prepare for reporting in 2016.

Forms 6055 and 6056 are not required to be filed for 2014, but employers may choose to voluntarily file in 2015 for 2014 coverage using the released forms and instructions.

For more information on the new reporting forms and instructions, see the IRS’ Q&As on Section 6055 and Q&As on Section 6056.

Here is a video I made that explains how Self Funded Medical Plans work. I’ve used the diagram you’ll see in this video countless times to help people understand the parts of a self-funded program and how the protections help make the plan budget-able and protect claim dollars.

Last Sunday night, CBS’s “60 Minutes” ran a not-to-be-missed expose of something that the Center for Health Transformation has been warning about for months: The unbelievable amount of fraud taxpayers are footing the bill for in the Medicare and Medicaid programs.

“60 Minutes” estimates that an amazing $90 billion in spending on these programs each year is due to fraud. You need to see the whole thing – it gets really interesting at minute 8.

Click to see the video: 60 Minutes on Medicare Fraud