enrollment process under the new legislation to assure success and avoid future penalty
TRANSCRIPT
8/13/2019 Enrollment Process Under the New Legislation To Assure Success and Avoid Future Penalty
http://slidepdf.com/reader/full/enrollment-process-under-the-new-legislation-to-assure-success-and-avoid-future 1/1
The Department of Health and Human Services (HHS) and the Treasury Department released newregulatory guidance under the Patient Protection and Affordable Care Act (PPACA) in early 2013. Theserules will come in to effect from January 1, 2014 and will apply to everyone in US. An introduction to theseregulations could mean that a number of individuals in the U.S. will remain uninsured in 2014 and perhapsbeyond.
Two out of the three rules published; focus on the individual shared responsibility or the individual mandate.In specific, it requires that all non exempt individuals must enroll and have Minimum Essential Coverage(MEC) or face a penalty in form of an excise tax.
Enrollment of EmployeesThe MEC covers a broad range of health coverage which will enable an individual to satisfy the obligation toenroll in health coverage and avoid a penalty. The regulation clarifies that an employee is treated as eligiblefor coverage under an employer-sponsored plan for each month of the plan year. Accordingly, an individualeligible to enroll:
in a retiree coverage under an employer-sponsored group health plan is treated as eligible topurchase MEC under the same rules applicable to current employees; andin Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage (or comparable continuationcoverage under state law) is considered eligible to purchase MEC only if the individual actually enrollsin that coverage.
Applicability to Employers
MEC rule does not does not expressly provide that employer-sponsored coverage must be adequate to qualify
as minimum essential coverage for compliance with the individual mandate. However, it affects employers as
part of a broader analysis of health care reform, strategy and compliance.
Those employers who seek to minimize any penalty must offer a group health plan, i.e., a minimum essential
coverage to 95 percent of their full-time employees and their respective children under the age of 26. Coverage
does not have to be offered to a spouse. To avoid or minimize the employer penalty, the group health plan
needs to meet a 60 percent minimum value test and be affordable for the employee-only coverage.
Other Services designated as MEC
On the other hand, the HHS in coordination with the Treasury Department, has the authority to designate other
health benefit coverage as MEC. It has developed a criterion according to which certain substantive and
procedural requirements need to be met. Accordingly, certain additional types of existing health coverage
designated as MEC includes the Medicare Advantage plans, the Foreign Health coverage, the Self-funded
Student Health Insurance plans, the Refugee Medical Assistance and the AmeriCorps coverage offered to
AmeriCorps volunteers (the domestic counterpart to the Peace Corps).
The regulations would also initially designate state high-risk pools as MEC, but HHS intends to review and
monitor the extent and quality of this coverage, and reassess this designation in the future. For other types of health coverage not automatically designated as MEC, the regulation outlines a process under which a
sponsoring organization could apply for MEC recognition.
Under the proposed regulation, an individual is treated as having MEC, for any calendar month, if the
individual is enrolled in and entitled to receive benefits under a program or plan that is MEC for at least one
day during the month.
For additional information regarding their product and services contact Draft n Craft
at [email protected] or 646 367 6958