What If the Employer Mandate Is Repealed?

The ACA requires applicable large employers (ALEs) to offer affordable, minimum value health coverage to their full-time employees in order to avoid possible penalties. Because this employer mandate has been criticized as burdensome for employers and an impediment to business growth, it seems likely that its repeal will be part of any Republican plan to repeal and replace the ACA.

If the employer mandate is repealed, many ALEs will likely want to modify their plan designs to go back to pre-ACA eligibility rules (for example, requiring employees to have a 40-hour per week work schedule to be eligible for benefits). […] Read more

DOL Audit Warning Signs

DOL Audits

The Department of Labor (DOL)’s Employee Benefits Security Administration (EBSA) has the authority to conduct audits on benefits plans that are governed by the Employee Retirement Income Security Act (ERISA). DOL audits often focus on violations of ERISA’s fiduciary obligations and reporting and disclosure requirements.

The DOL may also investigate whether an employee benefit plan complies with ERISA’s protections for plan participants, such as the special enrollment rules or mental health parity requirements. Recently, the DOL has been using its investigative authority to enforce compliance with the Affordable Care Act (ACA).

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Affordability Percentages Will Decrease for 2018

On May 5, 2017, the Internal Revenue Service (IRS) issued Revenue Procedure 2017-36 to index the contribution percentages in 2018 for purposes of determining affordability of an employer’s plan under the Affordable Care Act (ACA). For plan years beginning in 2018, employer-sponsored coverage will be considered affordable if the employee’s required contribution for self-only coverage exceeds:

9.56 percent of the employee’s household income for the year, for purposes of both the pay or play rules and premium tax credit eligibility; and
8.05 percent of the employee’s household income for the year, for purposes of an individual mandate exemption (adjusted under separate […] Read more

New video tutorial helps members find the lowest costs for their prescription drugs

The Blue Cross® Blue Shield® of Michigan (BCBSM) mobile app puts the ability to price prescriptions and locate pharmacies in the palm of members’ hands.

In addition to providing access to health and wellness resources, tracking claims and the accumulation of deductibles, cost-sharing, and out-of-pocket maximums, the app features the same powerful functionality as Blue Cross’ member website.




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Audit Reveals Pay or Play Enforcement Issues

On April 7, 2017, the Treasury Inspector General for Tax Administration (TIGTA) released the results of its audit to assess the IRS’s preparations for ensuring compliance with the employer shared responsibility rules and related reporting requirements under the Affordable Care Act.

The TIGTA audit revealed a number of major system and operational problems that have hindered or delayed the IRS’ enforcement of these provisions. As a result, the IRS has been unable to identify the employers potentially subject to an employer shared responsibility penalty or to assess any penalties.

Although no penalties have been assessed under the employer shared responsibility rules […] Read more

House Republicans PASS Amended AHCA

On May 4, 2017, members of the U.S. House of Representatives voted 217-213 to pass the American Health Care Act (AHCA), after it had been amended several times. The AHCA is the proposed legislation to repeal and replace the Affordable Care Act (ACA).

The AHCA needed 216 votes to pass in the House. Ultimately, it passed on a party-line vote, with 217 Republicans and no Democrats voting in favor of the legislation. The AHCA will only need a simple majority vote in the Senate to pass.

If it passes both the House and the Senate, the AHCA would then go to […] Read more