The Affordable Care Act's medical loss ratio (MLR) rules require group health insurance issuers to provide rebates if their MLR—the amount of health insurance premiums spent on health care and activities to improve health care quality—falls short of the applicable standard during a reporting year. Each year's rebates must be issued to plan sponsors by September 30 of the following year. As a result, plan sponsors should be looking for these rebates to arrive in the coming weeks.
The MLR rules provide that issuers must pay any rebates owed to persons covered under a group health plan to the policyholder, who is then responsible for distributing the rebate to eligible plan enrollees. In general, there are several ways rebates may be distributed by plan sponsors to plan enrollees, including:
On May 22, 2018, the IRS published Rev. Proc. 2018-34, which provides the 2019 premium tax credit (PTC) table and the employer contribution percentage requirements applicable for plan years beginning after Dec. 31, 201
The ACA's employer-shared responsibility rules (also known as the "employer mandate") require an employer to provide affordable, minimum value coverage to its full-time employees. The IRS's required contribution percentage is used to determine whether an employer-sponsored health coverage offers an individual "affordable" coverage, and the affordability percentage is adjusted for inflation each year
For 2019, the ACA's affordability percentage will increase to 9.86 percent. This means that an employee's required premium contribution toward single-only coverage under an employer-sponsored group health plan can be no more than 9.86 percent of the federal poverty line or of an employee's W2 income or rate of pay
On May 10, 2018, the IRS released the new Health Savings Account (HSA) index figures for 2019. The 2019 index includes increases to most HSA amounts
CMS has issued an announcement regarding the Medicare Part D benefit parameters for 2019
Employer plan sponsors that offer prescription drug coverage to Part D-eligible individuals must disclose to those individuals and to CMS whether the prescription plan coverage is creditable or non-creditable as compared to Medicare Part D coverage. For coverage to be considered creditable, the actuarial value of the employer's coverage must be, on average, as good or better than standard Medicare prescription drug coverage.
BK Group Benefits automatically reports your plans to CMS after Open Enrollment has closed. Creditable Coverage Letters are also available online in your secure Employee Navigator Portal for easy access throughout the year.
Creditable Coverage Notices need to be sent to employees each year prior to October 15th, but may be supplied throughout the year as needed, such as newly Medicare Part D eligible participants,
The Internal Revenue Service (IRS) has re-established $6,900 as the 2018 health savings account (HSA) contribution limit for individuals with family coverage under a high deductible health plan (HDHP). This limit was previously announced as $6,900 in May 2017, but was revised to $6,850 in March 2018 due to an inflation adjustment provision in the Tax Cuts and Jobs Act. The 2018 health savings account (HSA) contribution limit for individuals with self-only coverage under a HDHP remains unchanged at $3,450.
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Source: HR 360, Inc.
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