SilverBlog

Wisdom from our industry experts and our SilverLink magazine.

 
 

Blog Tag: Affordable Care Act

Consider a worker who is 55 and making $50,000 per year. He plans to retire at age 67, at which time Social Security could make up 43% of his retirement income. Assuming he can live on 75% of his pre-retirement income, he would need to make up an additional 32% in retirement savings.

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When it comes to healthcare, we understand that you often get what you pay for, but there is a thin line between accepting price hikes and being a diligent consumer. Fighting the rising costs associated with group medical plans often feels like an uphill battle.

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The Internal Revenue Service (IRS) has finally started to enforce the employer shared responsibility requirement (the “Employer Mandate”) in the Affordable Care Act and is now mailing notices to employers who may owe a penalty for 2015. Because of data quality issues, many employers will be assessed amounts they do not owe.

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Are Your Benefits Leading the Pack?
When you’re in a tight race, it can be a good idea to look around to see how you’re doing. Finding out that you’re leading the pack might provide the encouragement needed to maintain pace and keep a good lead. Discovering that you’re falling behind could also motivate you to work harder and close the gap. Whether you’re running a race or running a business, knowing where you stand against your competitors can be critical to success.

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SilverStone Group believes it is important to keep you updated on the repeal/replace activity as it evolves. House Republicans on the Energy and Commerce Committee and the Ways and Means Committee issued a proposed reconciliation “bill” late in the evening on March 6. It will be marked up this week and voted on very soon. It is slightly different than the summary provided to you last week.

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Since the election of President Trump, there has been widespread speculation on just what format the long-awaited “ACA Repeal and Replace” legislation might take. In that vein, we believe it might be helpful to review some high-level thoughts on the potential impact of the draft Republican Reconciliation Bill, for which the reviewing and scoring process should begin this week.

Please keep in mind that the Bill has not yet passed, and if it passes, it is highly unlikely that it will pass in its exact current format. Again, please keep in mind that these are high-level thoughts only:

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Generally
In 2013, the agencies responsible for implementing the Affordable Care Act (ACA) issued a series of notices, FAQs and other guidance addressing how the ACA applies when an employer pays or reimburses employees for the cost of buying their own individual health insurance policies. The upshot of this guidance was that it became virtually impossible for employers to pay for individual health insurance premiums, either pre tax or post tax, without violating the ACA. On December 13, President Obama signed the 21st Century Cures Act, which created Qualified Small Employer Health Reimbursement Arrangements (QSEHRA). The primary motivation behind these new QSEHRAs is to create a mechanism that would allow for the reimbursement of individual health insurance premiums — but only for certain employers.

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A new regulation will require some employers to make health plan design and administrative changes. While not all employers are subject to this requirement, those who are will need to review their plans and be aware of other obligations these rules impose.

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Generally
The Department of Health and Human Services (“HHS”) Office for Civil Rights (“OCR”) has published a final rule implementing section 1557 of the Patient Protection and Affordable Care Act (“ACA”). This section of the ACA prohibits discrimination in health programs and activities on the basis of race, color, national origin, sex, age or disability. The proposed rule (applicable to a “covered entities”) broadly prohibits discrimination on the basis of sex in health programs, and includes significant requirements related to transgender individuals and the treatments for gender dysphoria.

The rule would generally become effective July 18, 2016, however, to the extent that a group health plan or insurance carrier needs to alter its benefit design to comply with these regulations, then such plan design provisions are applicable on the first day of the plan year beginning on or after January of 2017. (But see Federal Contractor rule effective date below).

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In IRS Notice 2015-87, the agencies provided further clarification on the impact of the Affordable Care Act (ACA) group health plan market reform provisions on account-based plans and much needed guidance on the Section 4980H employer shared responsibility requirements. In many cases, common benefit design practices for employer credits and opt-outs must be revisited prior to the next annual enrollment.

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