Blogs

A Glitch in PPACA and an IRS Regulatory Fix

May 15, 2013 - 1:38 PM

A year-old Internal Revenue Service (IRS) rule regarding premium tax credits under the Patient Protection and Affordable Care Act (PPACA) faces controversy as it expands premium tax credits to people in states with a Federal Exchange. The rule was issued to address a missing provision in PPACA that would leave individuals in states operating under a federally operated health care Exchange ineligible for premium tax credits and lead to a serious challenge to the Employer Mandate. Now, two courts are hearing challenges to the IRS rule.   
 
To recap,...

Author: Michael Gomes

Recent Congressional Action Evidences Intent to Amend Large Employer Definition and Hourly Requirements under PPACA

May 9, 2013 - 10:24 AM

In recent weeks, Congress has demonstrated an intent to change certain definitions and thresholds under the Patient Protection and Affordable Care Act (PPACA). On March 22, 2013, Senator Susan Collins (R-ME) submitted Amendment 144, which would change the definition of a large employer and remove the 30 hour requirement to be considered a full-time employee under PPACA. The legislative amendment would apply to the Senate Fiscal Year 2014 ...

Author: Michael Gomes

Wellness Programs in PPACA Spotlight

April 30, 2013 - 10:42 AM

Under the Patient Protection and Affordable Care Act (PPACA), wellness is one element of health care reform that is taking center stage. 

Generally, health plans may not discriminate based on a health factor against individual participants with regards to eligibility, benefits, or premiums (health factors include health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability, and disability). However, an exception to this rule allows for premium discounts, rebates, or modifications to otherwise...

Author: Michael Gomes

The Employer Mandate and Controlled Groups

April 25, 2013 - 3:31 PM

The Patient Protection and Affordable Care Act (PPACA) requires large employers – those with 50 or more full-time employees and full-time equivalents – to offer their employees the opportunity to enroll in coverage that is both affordable and provides minimum value. While determining whether an employer is subject to this employer mandate is complicated in its own right, this determination can get even more complex when several employers are commonly owned.

Bundling Multiple Employers

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Author: Michael Gomes

PPACA’s Impact on Insurance Premiums: Actuarial Study Predicts 32% Increase in Costs Over Next Five Years

April 19, 2013 - 9:53 AM

A new report by the Independent Society of Actuaries predicts that individual market health insurers could experience as much as a 32% increase on average in health care costs from 2014 through 2017 due to changes brought on by the Patient Protection and Affordable Care Act (PPACA). This would result in higher premiums as the increased costs are passed on to those who purchase health insurance in the individual markets. 

The report refers to an “average” increase in costs, but the...

Author: Michael Gomes

Proposed Rule Updates Role of Navigators, Non-Navigators in Exchanges

April 17, 2013 - 11:49 AM

The Department of Health and Human Services (HHS) has released an interim final rule that clarifies the role of Navigator and non-Navigator assistance personnel employed by both state and federal health insurance Exchanges as established by the Patient Protection and Affordable Care Act (PPACA). The proposed rule was published in the April 5 Federal Register. 

Navigators are those deemed by PPACA to provide assistance to consumers interested in purchasing health insurance coverage through state-based...

Author: Michael Gomes

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