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Employer's Guide to Health Care Reform, 2018 Edition

By Brian M. Pinheiro , Jean C. Hemphill, Kurt R. Anderson, Christopher W. Welsch
Format
Softcover Book
$405.00

Softcover Book

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Overview

Employer's Guide to Health Care Reform, 2018 Edition is the premier step-by-step practical guide for employers struggling to keep up with the rapid pace of changes affecting their health benefit plans. This practical guide helps you strategize about how to design your employee health plans to satisfy ACA requirements; design your workforce to minimize penalty exposure; achieve significant cost-savings; understand new notice requirements; meet deadlines and take advantage of opportunities to delay implementation; and more!

Specifically Employer's Guide to Health Care Reform will help you:

  • Design your employee health plans to satisfy ACA requirements
  • Design your workforce to minimize penalty exposure
  • Understand new notice requirements that apply in 2015
  • Achieve significant cost savings
  • Meet deadlines and take advantage of opportunities to delay implementation
  • Plan ahead to avoid or minimize Cadillac tax exposure

Employer's Guide to Health Care Reform, 2018 Edition provides in-depth discussion and detailed explanations on critical topics, including:

  • An explanation of the U.S. Supreme Court's watershed decision in King v. Burwell, allowing subsidies to be paid on federally facilitated Exchanges
  • The IRS's efforts to prevent employers from offering low-value "skinny" health plans that provide minimum essential coverage to satisfy ACA requirements, but provide little or no coverage for basic health services
  • The Small Business Health Options Program (SHOP) that allows small businesses to obtain health insurance for employees through an Exchange
  • The new requirement for employers with self-funded health plans and insurers to report information to the IRS on Forms 1094 and 1095
  • The employer's limited ability to offer supplemental coverage that "wraps around" an employee's individual health insurance coverage
  • The penalties that apply to insurers and employers if plan coverage does not satisfy the ACA market reforms
  • Various ACA exemptions for limited scope dental, vision, and long-term care benefits
  • Discussion of the IRS proposed guidance on the Cadillac tax, which will apply to excessive health coverage beginning in 2018
  • And much more

Previous Edition: Employer's Guide to Health Care Reform, ISBN 9781454872689

Last Updated 12/14/2017
Product Line Wolters Kluwer Legal & Regulatory U.S.
ISBN 9781454884354
SKU 10045383-0002
Table of Contents

1. INTRODUCTION

2. INDIVIDUAL MANDATE

  • Individual Mandate (Enroll-or-Pay)
  • Information Reporting on Minimum Essential Coverage

3. EMPLOYER "PAY-OR-PLAY" RULES

  • Applicable Large Employers
  • Counting Full-Time Employees for Pay-or-Play Penalties
  • Penalties
  • Section 6056 Information Reporting for Large Employers

4. HEALTH CARE EXCHANGES

  • Health Care Exchanges
  • Whistleblower Provisions

5. STRATEGIC DECISIONS FOR EMPLOYERS

  • Decision Points for Large Employers
  • Incentives for Small Employers

6. COVERAGE IMPROVEMENTS

  • Prohibitions on Annual and Lifetime Dollar Limits
  • Coverage of Preventive Health Services
  • Extension of Coverage for Children Up to Age 26
  • Mandated Claim and Appeal Process
  • Prohibition on Rescissions
  • Patient Protections
  • Prohibitions on Preexisting-Condition Exclusions
  • Prohibitions on Discrimination Based on Health Status
  • Fair Health Insurance Premiums
  • Guaranteed Availability of Coverage
  • Prohibiting Discrimination Against Health Care Providers
  • Quality Coverage Provisions
  • Limits on Waiting Periods
  • Coverage for Individuals Participating in Approved Clinical Trials

7. HEALTH CARE REFORM EXEMPTIONS

  • Grandfathered Health Plans: "If You Like Your Current Insurance, You Will Keep Your Current Insurance"
  • Collectively Bargained Insured Plans
  • Exemption for Retiree-Only Plans
  • Exemption for Excepted Benefits

8. REPORTING, TRANSPARENCY, AND ACCOUNTABILITY

  • Summary of Benefits and Coverage
  • Transparency: Reporting Cost of Coverage on Form W-2
  • Transparency: Financial and Quality Reporting
  • Containing the Cost of Health Insurance Coverage
  • Ensuring That Consumers Get Value for Their Dollars
  • Empowering Consumers with Information
  • State Health Insurance Consumer Information

9. OPERATIONAL CHANGES FOR EMPLOYERS AND HEALTH PLANS

  • Nondiscrimination Rules Applicable to Insured Health Benefits
  • Auto-Enrollment
  • Additional Electronic Transaction Standards
  • Nursing Mothers
  • Simple Cafeteria Plans for Small Businesses
  • Medicare Part D

10. NEW TAXES AND OTHER REVENUE RAISERS

  • The "Cadillac" Tax
  • Health Flexible Spending Accounts
  • Health Savings Accounts
  • Administrative Fees for Self-Funded and Insured Plans
  • Additional Taxes on High Earners
  • Other Taxes

11. HISTORICAL PROGRAMS

  • Temporary Reinsurance Program for Early Retirees
  • Pre-Existing Condition Insurance Plans

12. LEGAL CHALLENGES TO HEALTH CARE REFORM

  • Constitutionality of the Individual Mandate
  • Federal Government's Taxing Power
  • Federal Government's Commerce Clause Power
  • Religious Challenges to Contraceptive Coverage
  • Challenges to Availability of Premium Tax Credits for Federal Exchange Plan Subscribers

APPENDICES

  • Affordable Care Act Provisions Applicable to Grandfathered Health Plans
  • Tri-Agency Regulations on Grandfathered Health Plans and Amendments
  • IRS Form 8941 and Instructions (Small Employer Tax Credit)
  • Tri-Agency Regulations on Preventive Care Without Cost Sharing
  • Tri-Agency Regulations on Religious Employer Exemption from Contraceptive Services
  • Coverage
  • Tri-Agency Regulations on Extended Coverage for Adult Children
  • Tri-Agency Regulations for Internal Claims and Appeals and External Review Processes
  • Model Notices for Claims and Appeals
  • Tri-Agency Final Regulations on 90-Day Waiting Period
  • Summary of Benefits and Coverage Model and Completed Notices
  • Final Regulations on Employer Pay-or-Play
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