Three seemingly minor developments and modifications to the federal Affordable Care Act in recent months could have a large impact on employers.
First, a recent law passed repeals a provision of the ACA that limited deductibles in small group insurance health plans to no more than $2,000 for single coverage and $4,000 for family coverage.
A small group is defined as a company employing an average of 50 or fewer full-time equivalent employees.
In 2016, that definition will change to 100 or fewer staff. The repeal is retroactive to March 23, 2010, the date of the ACA enactment.
Before the repeal, carriers were forbidden from taking into account contributions to business flexible spending accounts or health reimbursement accounts to ascertain compliance with the deductible limits. This forced some small organizations to procure health plans with lower deductibles in order to continue offering coverage, which in most cases significantly increased premiums.
Carriers in certain states were able to circumvent implementing the original ACA deductible limit rules because of various arrangements offered by the Obama administration.
It is unclear how quickly carriers will return to offering policies with deductibles that exceed the repealed $2,000 and $4,000 limits.
Second, corporations are asking questions regarding options for team members who did not get into the exchange.
Although the March 31 deadline for signing up for insurance on the health insurance marketplace has passed, enrollment is still allowed through a special period outside of open enrollment.
In the marketplace, you generally qualify for a special enrollment period of 60 days following certain life events that involve a change in family status -– for example, marriage or birth of a child – or loss of other health coverage.
If you don’t have a special enrollment period, you can’t buy insurance through the marketplace until the next open enrollment period.
Other triggering events include obtaining citizenship, extraordinary events such as natural disasters, or errors, misrepresentations or inaction by an officer, employee or agent of the marketplace or Department of Health and Human Services.
Third, the final rules were issued concerning the 90-day waiting period limitation for health benefits.
A waiting period is defined as any time period under a group health plan that must elapse before coverage will become effective for an associate or dependent.
A group health plan does not have to contain a waiting period, but if it does, the ACA restricts the period to 90 calendar days.
The ACA imposes a penalty of $100 per person, per day, for each day exceeding 90.
The waiting period begins when the worker is eligible to enroll.
The ACA acknowledges that a plan might have practical eligibility conditions that must be met before a laborer is eligible to enroll.
Examples of eligibility conditions include being in an eligible job classification, attaining job-related licensures, or satisfying a reasonable and bona-fide employment-based orientation period.
The ACA defines an orientation period as a time during which standard orientation and training processes begin, and the enterprise and employee evaluate whether the employment situation is satisfactory for each party.
The orientation period is limited to one month.
Eligibility conditions due to the fulfillment of hours of service are allowed if the requirement is one time and does not exceed 1,200 hours.
Employers should contact carriers regarding any new policies with deductibles exceeding the former limits, remain aware of special enrollment periods for employees and ensure compliance regarding orientation policies and waiting periods.
Lynne Haggerman, M.S., is president/owner of Lynne Haggerman & Associates LLC, a Springfield firm specializing in management training, retained search, outplacement and human resources consulting. She can be reached at lynne@lynnehaggerman.com.[[In-content Ad]]
