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Compliance Steps for the Final HIPAA Rule
On Jan. 25, 2013, the Department of Health and Human Services (HHS) issued a final rule under HIPAA’s administrative simplification provisions. The final rule updates HIPAA’s privacy, security, enforcement and breach notification requirements, and includes changes required by the Health Information Technology for Economic and Clinical Health Act (HITECH Act). This Legislative Brief provides an overview of key changes made by the final HIPAA rule and outlines compliance steps for health plans. overview The final HIPAA rule creates new requirements for health plans and their business associates. To highlight important changes, the final rule: Makes business associates directly liable for
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“Cadillac” Tax on High-cost Health Coverage
For taxable years beginning in 2018, the Affordable Care Act (ACA) imposes a 40 percent excise tax on high-cost group health coverage. This tax, also known as the “Cadillac tax,” is intended to encourage companies to choose lower-cost health plans for their employees. The Cadillac tax provision, found in Internal Revenue Code (Code) section 49801, taxes the amount, if any, by which the monthly cost of an employee’s applicable employer-sponsored health coverage exceeds the annual limitation (called the employee’s excess benefit). The amount of the tax for each employee’s coverage will be calculated by the employer and paid by the
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Potential Penalties for Employers under the “Pay or Play” Rules
The Affordable Care Act (ACA) brings many changes to employers and health plans. One such change essentially amounts to a requirement for some employers to offer a certain level health care coverage to their employees or face penalties. ACA does not explicitly mandate an employer to offer employees acceptable health insurance. However, beginning in 2014, certain employers with at least 50 full-time equivalent employees will face penalties if one or more of their full-time employees obtains a premium credit through an exchange. As described in greater detail below, an individual may be eligible for a premium credit either because the
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Insurance Market Nondiscrimination Reforms for 2014
Effective for 2014, the Affordable Care Act (or ACA) requires health plans and health insurance issuers to comply with a new set of market reforms related to nondiscrimination. These reforms include: Premium rating restrictions for health insurance issuers in the individual and small group markets; Additional limits regarding discrimination based on a health status-related factor; Prohibition on imposing preexisting condition exclusions; and Expanded guaranteed issue and renewability requirements. This The Horton Group, Inc. Legislative Brief summarizes select ACA insurance market reforms for 2014. Please read below for more information. Premium Rating The ACA creates federal standards for setting insurance premium
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