Employer Health Reform Action Items For
2014/2015
Plan Design Plan Design
Requirements
All Health Plans Non-Grandfathered ...
Employer Health Reform Action Items For
2014/2015
Notice Notice
Requirements
What Employers Must
Provide and When
What Emp...
Employer Health Reform Action Items For
2014/2015
Reporting
Requirements
For Plan Sponsors and
Employers
For Plan Sponsors...
Employer Health Reform Action Items For
2014/2015
Are You A Large Employer for 2015?
99
100
No
Yes
Due By: Due By:
Are You...
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Employer Health Care Reform Action Items for 2014-2015

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Employers can use this clear and concise guide to understand what action steps they need to take (and when) in order to comply with the various requirements of the Affordable Care Act. This includes Plan Design Requirements for both grandfathered and non-grandfathered plans; Notice Requirements; and Reporting Requirements for plan sponsors and employers.

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  • Just in case you are looking for N720 Form, I was able to get a fillable copy through http://goo.gl/H5X82d. It allowed me to e sign and print the document. It’s very easy to use and has a customer support that can be accessed 24/7 in case you need assistance.
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Employer Health Care Reform Action Items for 2014-2015

  1. 1. Employer Health Reform Action Items For 2014/2015 Plan Design Plan Design Requirements All Health Plans Non-Grandfathered Plans Requirements Ban on preexisting condition exclusions imposed on anyone Full implementation of ban on annual limits and the dollar value of essential health benefits (EHB) Guaranteed renewability of coverage 2014 Plan Years beginning on or after: JAN 1 JAN 1 JAN 1 JAN 1 JAN 1 JAN 1 Guaranteed availability of coverage Fair health insurance premiums for small group and individual markets – adjusted community rating (ACR) applies Full implementation of extension of dependent coverage until age 26 2014 Plan Years beginning on or after: Ban on determination against health care providers ("any willing provider" type laws) JAN 1 JAN 1 JAN 1 JAN 1 Coverage for individuals participating in approved clinical trials Increased limit in outcome-based incentives/disincentives permitted in wellness programs from 20 to 30%; or up to 50% for tobacco-free programs Ban on waiting periods exceeding 90 days Cost-sharing limitations for out-of-pocket: applicable to insured plans offered via the Marketplace, and insured and self funded plans offered outside Marketplace; $6,350 for single coverage, $12,700 for coverage for more than oneJAN 1
  2. 2. Employer Health Reform Action Items For 2014/2015 Notice Notice Requirements What Employers Must Provide and When What Employers Must Provide and When Requirements Due By:Due By: Include in all plan communications: Maintenance of Grandfathered Health Plan Status, if applicable, until plan loses GF status Patient Protections Notice: Right to Designate a Primary Care Provider (PCP) and Right to Direct Access to OB/GYN to all affected participants Ongoing Upon Coverage Upon Application Summary of Benefits and Coverage (SBC): from plan sponsor to participants upon application, by the first date of coverage, within 90 days of enrollment by special enrollees, upon contract renewal, upon request Model Wellness Program Disclosure: Notice of Reasonable Alternative Standards for outcome-based health contingent wellness program; to all eligible participants upon enrollment Upon Coverage 30 Days Prior Advanced Notice of Rescission (cancellation) of Coverage: Advance notification by Plan to affected individuals of rescission of coverage New Hires Provide Notice of Marketplace Options to all new hires within 14 days of hire Advanced 60-day notice of change in benefits from Plan Sponsor to Participants not reflected in most recently provided SBC (other than with renewal or re- issuance of coverage) 60 Days Prior Beginning 2016, provide Benefit Statements to employees based on employer reports to IRS via Form 6055 and 6056 Reports on 2015 year JAN 31
  3. 3. Employer Health Reform Action Items For 2014/2015 Reporting Requirements For Plan Sponsors and Employers For Plan Sponsors and Employers Requirements Due By:Due By: Reporting Form M-1 filing due by multiple employer welfare arrangements. Entities filing Form M-1 are required to file Form 5500 (due by last day of 7th month following plan year)MAR 1 Section 6055 and/or 6056 reports to IRS. 2015 calendar year information reporting due 1st quarter 2016 (Due March 31 if filing electronically) JAN 31 FEB 28 Additional Form W-2 Reporting: Aggregate cost of health coverage reported for previous calendar year NOV 15 Transitional Reinsurance Reporting: Number of covered lives due by plan sponsors or insurers by November 15 to HHS NOV 2014 Controlling Health Plan (CHP): Self-funded health plans must obtain a Health Plan Identifier (HPID) by application through CMS; large plans ($5 mil or larger) by Nov 5, 2014, small plans by Nov 5, 2015 Controlling Health Plan (CHP) must certify that it is in compliance with standards for electronic transactionsDEC 2015 JUL 31 PCOR fees are paid annually in connection with IRS Form 720, Quarterly Federal Excise Tax Return. Fee: $1 per covered life (indexed) for plan years ending before 10/1/13; $2 per covered life (indexed) for plan years ending after 9/30/13 and before 10/1/14. For self funded plans, Form 720 is due by July 31st of the calendar year following the plan year end; for insured plans, the insurer files by July 31 following end of policy year
  4. 4. Employer Health Reform Action Items For 2014/2015 Are You A Large Employer for 2015? 99 100 No Yes Due By: Due By: Are You A Large Employer for 2016? 49 50 No Yes #1BenefitsConsulting firm CBIZ is the only benefits consulting firm that brings a fully-integrated service platform to its clients, providing subject- matter expertise in Employee Benefits, Payroll, Actuarial, Accounting, Tax, and Compensation. The information contained herein is not intended to be legal, accounting, or other professional advice, nor are these comments directed to specific situations. The information contained herein is provided as general guidance and may be affected by changes in law or regulation. The information contained herein is not intended to replace or substitute for accounting or other professional advice. Attorneys or tax advisors must be consulted for assistance in specific situations. This information is provided as-is, with no warranties of any kind. CBIZ shall not be liable for any damages whatsoever in connection with its use and assumes no obligation to inform the reader of any changes in laws or other factors that could affect the information contained herein. As required by U.S. Treasury rules, we inform you that, unless expressly stated otherwise, any U.S. federal tax advice contained herein is not intended or written to be used, and cannot be used, by any person for the purpose of avoiding any penalties that may be imposed by the Internal Revenue Service. Begin counting full-time and full-time equivalent employees to determine whether Employer Shared Responsibility will apply. Use any consecutive 6-month period in 2014 for counting employee hoursBegin Now © Copyright 2014 – CBIZ, Inc. NYSE Listed: CBIZ All Rights Reserved Employer employing 100+ Employees: Subject to employer shared responsibility mandate beginning 1/1/15 (transition relief available for non-calendar year plans)2015 Employers employing 50 to 99 full-time employees become subject to shared responsibility mandate on plan anniversary occurring in 2016, if certain criteria are certified2016 For more information, contact your local CBIZ Advisor or call out toll-free help line 1-800-ASK- CBIZ (1-800-275-2249)

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