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October 2013High Debuctible Health Plans May Cover Preventive Serices With No Deductible
Under Health Care Reform, non-grandfathered group health plans are required to cover certain preventive health services with no cost-sharing. New IRS guidance clarifies that a health plan will still qualify as a high deductible health plan (HDHP) even though it provides such preventive services without a deductible. An HDHP is a health plan that satisfies certain requirements with respect to minimum deductibles and maximum out-of-pocket expenses. Generally, an HDHP may not provide benefits for any year until the minimum deductible for that year is satisfied. However, the law provides an exception for certain preventive care. New Guidance on Health Care Reform Rules for HRAs & Other Arrangements A new set of Q&As provides additional guidance regarding how the prohibition on annual dollar limits and the requirement to cover preventive services under Health Care Reform apply to health reimbursement arrangements (HRAs) and certain other employer healthcare arrangements. The following are key highlights that may be of interest to employers: The agency guidance applies for plan years beginning on or after January 1, 2014, with certain exceptions, but may be applied for prior periods. Visit our section on HSAs, FSAs, & Other Tax-Favored Plans for more information on these types of arrangements.
The agency guidance applies for plan years beginning on or after January 1, 2014, with certain exceptions, but may be applied for prior periods. Visit our section on HSAs, FSAs, & Other Tax-Favored Plans for more information on these types of arrangements. SHOP Online Enrollment Delayed Until November Online enrollment for small employers to purchase employee health coverage through the federally- facilitated SHOP Marketplace (Small Business Health Options Program) will not be available until November. Small employers will be able to start the application process and get an overview of available plans and premiums beginning October 1, 2013. For 2014, the federally-facilitated SHOP Marketplace is open to employers with 50 or fewer full-time equivalent employees. According to the U.S. Department of Health and Human Services, all functions for SHOP will be available in November and if employers and employees enroll by December 15, 2013, coverage will begin January 1, 2014.
Reminder: Exchange Notice Requirements After October 1st Following the distribution of notices to current employees (required no later than October 1, 2013), employers must provide the notice to each new employee at the time of hiring, within 14 days of an employee's start date. Although the U.S. Department of Labor announced that there is no fine or penalty under the law for failing to comply, the law still requires that employers provide the notice. Our Summary by Year provides information on other upcoming changes under Health Care Reform. Planning for Workplace Emergencies A workplace emergency is an unforeseen situation that threatens your employees, customers, or the public; disrupts or shuts down your operations; or causes physical or environmental damage. Having an emergency action plan is key to preventing a disorganized evacuation or emergency response that could result in confusion, injury, and property damage.
Developing an Emergency Action Plan
OSHA's Emergency Action Plan Expert System Can Help Note that the OSHA Expert System only provides information based on federal OSHA Emergency Action Plan requirements. If you are covered by a state OSHA plan, you may need to contact your local state OSHA office. Our section on Planning for Workplace Emergencies includes additional information and tips for protecting your employees and business during a disaster.
Benefits for Same-Sex Spouses: Recent Agency Updates Federal agencies continue to issue guidance applying the U.S. Supreme Court decision that invalidated part of the Defense of Marriage Act (DOMA), which denied federal benefits to legally married, same-sex couples. The latest updates include the following:
Legal Same-Sex Marriages Recognized for Purposes of Employee Benefit Plans ERISA is a federal law that sets minimum standards for employee benefit plans in the private sector. Among other requirements, Title I includes the health coverage continuation provisions of COBRA (the Consolidated Omnibus Budget Reconciliation Act) and the portability provisions of HIPAA (the Health Insurance Portability and Accountability Act). Future guidance is expected to address the impact of the decision on specific provisions of ERISA and its regulations. The agency guidance makes clear that the terms "spouse" and "marriage" for purposes of ERISA do not include individuals in domestic partnerships, civil unions, or similar formal relationships recognized under state law, regardless of whether these individuals have the same rights and responsibilities as those who are married under state law.
Guidance on Correcting Overpayments of FICA and Employment Taxes Prior to the DOMA ruling, employers may have withheld and paid employment taxes with respect to certain benefits provided to the same-sex spouse of an employee (e.g., employer-provided health coverage and fringe benefits) because the marriage was not recognized for purposes of federal tax law, and the benefits were not treated as excludable from gross income or wages for federal income or employment tax purposes. For guidance on same-sex marriage laws specific to your state, visit our State Laws section, click on your state, and select "Same-Sex Relationships" from the left-hand navigation menu.
Model HIPAA Notice of Privacy Practices Now Available New model notices are available to help health plans comply with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. The Privacy Rule generally requires covered entities, including health plans, to develop and distribute a notice informing individuals of the entity's privacy practices and of the individual's privacy rights with respect to his or her personal health information (PHI). Note: Group health plans providing benefits only through one or more contracts of insurance with issuers or HMOs, and that do not create or receive PHI--other than summary health information or enrollment information--are not required to develop this notice. The model notices reflect changes made by the HIPAA final omnibus rule that became effective in March. Covered entities were required to revise their notices to reflect those changes by September 23, 2013, and must redistribute the notice as provided in the final omnibus rule. You can visit our HIPAA section for more information. A.M. Best Downgrades Ratings of Tower Group International, Ltd.'s Subsidiaries and Maintains Under Review Status
OLDWICK, N.J., Oct 08, 2013 (BUSINESS WIRE) -- A.M. Best Co. has downgraded the financial strength rating (FSR) to B++ (Good) from A- (Excellent) and issuer credit ratings (ICR) to "bbb" from "a-" of the pooled and reinsured members of the Tower US Pool (Tower). Concurrently, A.M. Best has downgraded the ICR and the debt rating on $145.4 million 5.00% senior convertible notes, due 2014 to "bb" from "bbb-" of the intermediate holding company, Tower Group, Inc. A.M. Best also has downgraded the FSR to B++ (Good) from A- (Excellent) and ICR to "bbb" from "a-" of CastlePoint Reinsurance Company, Ltd. (Bermuda). Additionally, A.M. Best has assigned an ICR of "bb" to the ultimate parent, Tower Group International, Ltd. (Bermuda) [NASDAQ:TWGP]. All companies are under review with negative implications and are headquartered in New York, NY, unless otherwise specified. (See below for detailed listing of the companies and ratings.)
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