The Affordable Care Act and recent health care reform legislation has significantly altered the landscape for obtaining and providing health care benefits. PPC's Guide to Health Care Reform provides practical, easy-to-understand guidance on the key provisions of the many legislative changes in the last several years that affect nearly all individuals and many employers. You can use this Guide to familiarize yourself with health care legislation's provisions and the thousands of pages of regulations and guidance that have been issued. The Guide will enable you to help your clients capitalize on opportunities and avoid or minimize penalties and other costs brought on by health care reform.
Topics discussed include:
- The mandate requiring employers to offer affordable health insurance coverage that provides minimum value to full-time employees and minimum essential coverage to their dependents or pay a penalty.
- The mandate requiring individuals to have minimum essential health insurance coverage or pay a penalty, including line-by-line guidance on completing Form 8965 and calculating the individual shared responsibility penalty.
- Changes made to the individual mandate by the Tax Cuts and Jobs Act.
- The premium tax credit and cost-sharing reduction subsidy available to help individuals pay for coverage, including line-by-line guidance on completing Form 8962, calculating the premium tax credit, and reconciling advance payments of the credit to the actual credit allowed.
- Numerous notice and reporting requirements placed on employers, plans, plan sponsors, and insurers.
- Guidance on completing Form 1095-B and Form 1095-C that employers must use to report on the health benefits they offer to their employees.
- The market reform provisions affecting health care plans and the benefits they provide, including nondiscrimination requirements for fully insured plans, required coverage for employee's adult children to age 26, prohibition on annual and life-time limits and pre-existing condition exclusions, cost-sharing limits, expanded coverage of preventive services, maximum waiting periods, and specific rules for grandfathered plans.
- Guidance on new plans that can be offered by associations that may benefit small employers.
- Guidance on short-term, limited duration plans that may provide leaner, less expensive coverage for some individuals.
- Coverage of the small employer health insurance credit that allows eligible small employers to offset the cost of providing health insurance coverage to employees, including several worksheets for calculating the credit.
You'll also get real-life examples, worksheets, checklists, filled-in forms, quick reference charts of implementation dates and client letters. The online subscription also includes a newsletter that alerts you to new developments as they occur.
Highlights of the Tax Cuts and Jobs Act (TCJA) coverage includes:
- Individual Mandate. This edition includes guidance on the reduction of the individual shared responsibility payment amount to zero, effective for months beginning after 2018. Also included is the most recent information on how individuals can qualify for a hardship exemption, which will allow them to purchase less costly catastrophic insurance.
- Employer Penalties. The IRS has begun sending letters to employers that may be subject to a Section 4980H penalty. This update includes guidance on steps employers receiving the letters should take, and how to respond to the letters.
- QSEHRAs and the PTC. Employees who are provided a QSEHRA may not qualify to receive a PTC, or if they do qualify, may have a reduced PTC. This edition has an extensive discussion on QSEHRAs based on the most recent IRS guidance. Additionally, information is provided on how the QSEHRA benefit affects the PTC, including how to complete Form 8962, and how the employee can determine if he or she is still entitled to a PTC and the amount of advance payments to accept.
- Special Enrollment Periods. HHS has issued new guidance on when individuals can enroll in marketplace coverage during a special enrollment period. This edition includes updated discussions based on this guidance and a new appendix (Appendix 4B) summarizing when special enrollment periods are available.
Additional substantive changes and additions are listed on this page under the Related Resources tab.