March 7, 2014
Final Rules Released on Information Reporting for Employers and Insurers
On March 5, 2014, the Department of Treasury and the Internal Revenue Service (IRS) released final rules on two provisions: reporting health insurance coverage by large employers, and reporting minimum essential coverage by insurers and employers of self-insured plans. The guidance provides a streamlined process for reporting duplicate information required by both provisions – to both the IRS and respective employees.
While the first reporting will not be required until early 2016 for the 2015 calendar year, employers are encouraged to voluntarily report coverage information in 2015 for the 2014 calendar year.
Who must report to whom?
Employers with 50 or more full-time (including full-time equivalent) employees need to report all of the employees offered coverage throughout the calendar year to the IRS. Respectively, all employees named in this report must also be provided with a statement, and can simply be given a copy of the IRS form.
Minimum essential coverage must also be reported annually to both the IRS and any individual named in the report as having such coverage.
What information must be reported?
The final rules provide for a single, consolidated form to streamline the information being reported. Employers and insurers can complete their respective portions of the form and submit them separately. Large self-funded employers can complete both parts of the combined form for information reporting. This

cialis online form can be used for reporting to both the IRS and employees.
The forms have not yet been provided by the IRS, but will require information to help determine eligibility for the premium tax credit, such as:
• Employer information, including contact information and the number of full-time employees
• The lowest cost employee monthly premium for self-only coverage for minimum value coverage offered to the employee
• Information on each full-time employee to whom coverage was offered and identifying information, such as Social Security Number
The bottom half of the form includes information for insurers or self-insured employers to report, which will help administer compliance of the individual mandate and eligibility of premium tax credits:
• Information about the insurer or entity providing coverage, including contact and other business information
• Which individuals are enrolled, identifying information of those individuals, and the months in which they are enrolled
Special rules to further simplify
Special rules have been provided to further simplify reporting and offer transitional relief for employers that provide a “qualifying offer” to any of their full-time employees. A qualifying offer is two-fold:

1) offering an employee self-only coverage that meets minimum value (60% of costs) and provides self-only coverage at a cost of no more than 9.5% of the Federal Poverty Level, and 2) offering coverage for the employee’s family, including spouses and children.
• Large employers can take advantage of simplified reporting obligations when they extend qualifying offers to employees for all 12 months of the year. They can report basic employee identification data and the fact that they received

a full-year qualifying offer. These employers can also give the named employees a copy of that notice or a standard statement confirming the full-year qualifying offer.
• Large employers who extend a qualifying offer to employees for fewer than 12 months of the year can use a code to report to both the IRS and the named employees. This code indicates that the qualifying offer was made for each of those months.
• A phased-in option for 2015 is available for large employer who can certify they have made a “qualifying offer” to at least 95 percent of their full-time employees and their families (spouses and children). These employers will have simplified reporting method for their entire employee population, and can provide employees a standard statement regarding the coverage offered and potential eligibility for premium tax credits.
• Large employers that can certify they have offered affordable minimum value coverage to at least 98% of the employees named in the report do not have to identify full-time status.
Can employee statements be provided electronically?
The regulations do allow for statements to be provided electronically, but only if an employee agrees in writing to receive them electronically. The electronic statement and consent must satisfy strict requirements and an employee must be permitted to withdraw consent.
When are the first reports and employee statements due?
The first reports to the IRS will be required no later than March 1, 2016 for 2015 calendar-year coverage (February 28 is a Sunday). However, if the report is filed electronically, it will be due no later than March 31, 2016.
The first statements to employees will be required no later than January 31, 2016 for the 2015 calendar year.
For more information, cialis online cheap review the Treasury Fact Sheet.
We encourage you to bookmark Cigna’s health care reform website, InformedOnReform.com, where we will update information as future guidance and final rules are released.

At the same http://www.whereslloyd.com/cls time, HHS released a separate Insurance Standards Bulletin that extends a transition relief policy for canceled health plans for two

additional years. This extended transition relief, which applies for policy years beginning on or before Oct. 1, 2016, gives health insurance issuers the option of renewing policies for current enrollees without adopting Ladbrokes, for instance, took way too lengthy already to merely provide affiliate monitoring for his or her mobile casinos online affiliate marketers. all of the ACA”s market reforms for 2014, if permitted by their states. Thus, individuals and small businesses may be able to keep their non-ACA compliant coverage into 2017, depending on the plan homepage or policy year. Issuers that

renew coverage under the extended transition relief must, for each policy year, provide a notice to affected individuals and small businesses.

San Jose Mercury News by Tracy Seipel –

February 23, 2014:

Lowering costs by forcing doctors and insurers to compete for millions of new patients is a primary goal of the nation”s new health care law, but a group of gastroenterologists in the East Bay and internists near Chico are exposing a fissure in that plan.

There often aren”t enough doctors to go around.

In parts of the state, the shortage of doctors participating in California”s new insurance exchange is providing new leverage for medical providers to hold out for higher reimbursement rates from big insurance companies. And as a game of chicken unfolds behind the scenes between two powerful groups that are key to the law”s success, the insurers are often caving in to the doctors, raising concerns that the trend could catch on and drive up the price of health insurance premiums on the exchange.

Medical costs are the largest component of a health insurance premium, said Darrel Ng, a spokesman for Anthem Blue Cross of California. And the higher those costs go, he said, “the higher the premium will likely be on the exchange in the future.”

Many doctors are upset about the discounted reimbursement rates that insurers have imposed on them to keep premiums low on the Covered California exchange. The new rates — as much as 30 percent lower than those paid by nonexchange plans — took effect Jan. 1, when the new health care plans of hundreds of thousands of Californians kicked in.

The number of doctors who have had their old rates restored is still small compared to the 58,000 physicians that Covered California says are participating in the new marketplace.

Whether these side deals will ultimately raise rates on the new exchange isn”t clear yet. But health care experts wonder what the trend portends for the success of the law, which depends on attracting hordes of consumers

to lower-priced insurance policies.

As more people

sign up for the expanded Medi-Cal program and private plans on Betsafe kasino tarjoaa tutun kattauksen laadukkaita NetEntin casinopeleja vahvistettuna muiden pelitoimittajien peleilla. the exchange, “there will be a surge in the demand for doctors,” said Glenn Melnick, a health economist at the University of Southern California.

But because there”s a fixed supply of physicians, he predicted, many doctors will be able to tell

the insurers: “Wait a second. You delivered us a promise, and I”m busier than ever, and you need me. But I don”t need to agree to a discount anymore.”

Central to the standoff are state regulations that require insurers to provide their customers access to primary care physicians within 15 miles or 30 minutes of their homes. Plans also are required to have a primary care physician-to-patient ratio of 1 to 2,000, and an overall physician-to-patient ratio of 1 to 1,200. If for some reason the health plan does not have a particular type of specialist, the plan must find such a provider.

In many cases, the winners in the doctor-insurer faceoff are physicians in rural regions, where health care services are scarce. But the table-turning has also surfaced in the Bay Area and other metropolitan regions.

“Most doctors want to take care of patients,” said Dr. Richard Thorp, president of the California Medical Association, a lobbying group that represents about 40,000 of the state”s 104,000 licensed physicians. He”s also an internist who belongs to a 12-member group practice in Paradise, near Chico, that was able to reinstate its old fees with Blue Shield of California.

“But they have to make an individual choice based on whether they can afford to service those contracts,” Thorp said. “That is the reality.”

Blue Shield and Anthem Blue Cross, two of the four largest insurers offering Covered California plans, acknowledged that they are reinstating some old rates.

Blue Shield spokesman Steve Shivinsky said the insurer has restored rates for 1,400 California physicians, many of whom practice in rural areas, to ensure adequate medical care is available. Yet he said that”s still “a tiny fraction” of the majority of its 35,000 network physicians who signed new contracts to participate and agreed to accept discounted rates in exchange for more patient volume.

Dr. Mark Kogan, a San Pablo gastroenterologist, is one of the physicians who used the law of supply and demand to make the case for higher rates.

Along with 18 colleagues at Northern California Gastroenterology Consultants, he already sees plenty of patients. So when Blue Shield last year offered the group more business from new Covered California enrollees — but at 30 percent less — the group declined.

“We basically told them, “We cannot do that,” ” Kogan recalled. “We would lose money by seeing those patients.”

That put Blue Shield in a bind. Without access to those 19 gastroenterologists who work out of seven East Bay offices, where would its subscribers go?

By mid-January, Blue Shield backed down and agreed to pay the group of specialists its current rates if the doctors would take on the insurer”s exchange patients.

The issue of discounted fees surfaced at Thursday”s Covered California board meeting after Kim Griffin, chairwoman of Medical Office Managers of the Peninsula, told the board in a letter that because some insurers are discounting fees for exchange customers, “many of us have opted out.”

That doesn”t surprise Thorp and Kogan, who say there is a misconception among the public that access to more patients means more money.

“If you are pricing a service for less than it costs you to provide it,” Thorp said, “you cannot make that up in volume.”

The Hill by Justin Sink –

February 14, 2014:

The White House on Friday said it doesn’t know how many enrollees of the 3.3 million reported enrollees in ObamaCare had paid their premiums.

“The contract between an individual and an insurance company is a private contract,” White House press secretary Jay Carney said. “That is something that is determined by the insurance company and the enrollee. Right now, insurance companies, for that reason, have the most up-to-date, comprehensive and reliable information

on the number of people who have paid their premiums.”

The New York Times http://www.trevorturnbull.com reported that around 20 percent of consumers who selected a plan under ObamaCare did not pay and thus failed to obtain coverage. If 20 percent of the 3.3 million who enrolled failed to make a payment, the number of ObamaCare participants would drop by about 600,000, to 2.7 million.

Critics of ObamaCare have accused the administration of inflating their enrollment figures by including people who had not paid their premiums.

But Carney, pointing to the Times report, said a “high percentage of people have in fact paid for their plans”

“I know there is a constant search for less than good news in the HealthCare.gov arena, but if you look at the data reported, it is overwhelmingly positive,” Carney said. “And the predictions of failure and doom and gloom that we saw, understandably, perhaps, given how rocky the start was in October and November, have all come to naught. ”

The White House spokesman said the government was also developing an automated payment processing system that would allow users to immediately pay their premiums — and let the administration to measure how many ObamaCare enrollees had actually gained coverage.

“And there’s an automated payment system that will

be coming online fully in the next several months, which will include in the flow of information, more specific timely data relating to the payment of premiums by enrollees provided by the insurance companies,” Carney said.

Kaiser Health News by Jay Hancock – February 17, 2014: Congratulations. You bought insurance through one of the online Affordable Care Act exchanges, possibly after days or weeks of trying to get the site to work. Don’t relax. Joining the plan is only the first challenge. Now you have to understand it. Policies sold through the online portals — to more than 3 million people so far — cover essential benefits and put a cap on your out-of-pocket medical costs. But you need to follow the rules. And the boilerplate explanation you got from the insurance company may be hard to understand. What do members need to know about these plans that they probably don’t? Carry your membership card everywhere. Make copies. It’ll save huge amounts of hassle if you have an unexpected doctor or hospital visit. Understand your plan’s doctor and hospital network. Insurance companies negotiate participation and payment rates with a network of providers to control costs. “A lot of these exchange plans, in order to stay affordable, have much smaller networks than people cialis online generic are used to,” says Nancy Metcalf, a senior editor for Consumer Reports. For many new members, “just because their friend has a plan and can go to a particular hospital doesn’t mean that they necessarily can.” You can check a plan’s directory — either online or often part of the documents you receive when you enroll — to find out if specific physicians are part of your network. You can call doctors’ offices to confirm, too. Stay in the network! The health law says that, once you join a qualified plan, you won’t pay more out of pocket per year than $6,350 for an individual and $12,700 for a

family. But this applies only to in-network care. Whether you’re in an HMO that pays almost no out-of-network benefits or a PPO that covers some, the pocketbook protections don’t apply if you use a non-network doc or hospital. Non-network providers also frequently bill you far more than what they charge patients in their networks for the same procedure. Try to stay in-network even if it’s for emergency care. Insurance plans do have to pay for non-network emergency visits under the health law. If you’re in a car crash far from home you can’t be picky about which hospital saves your life. But non-network hospitals often

“balance-bill” the difference between what your plan pays and what they charge, which is often much more. Avoid all emergency rooms unless it’s really an emergency. Traditionally, health plans came with a modest copayment for an emergency visit — maybe $150. But many policies sold under the health law, even those in the more expensive “gold” category, not only have ER copays of several hundred dollars but also subject ER charges to the overall deductible. (Copays are flat fees for specific services. Deductibles are what you pay out of pocket before the insurance kicks in.) That means you could be billed for the full cost of an emergency visit — up to the out-of-pocket limit. “This is a huge difference and will really hurt the unsuspecting person,” says John Jaggi, an Illinois insurance broker. “We’re putting a lot more

people into that exposure here.” Broken leg? Head to the hospital. Sprained ankle? Maybe wait until the urgent care center or doctor’s office opens. Pay monthly premiums on time and accurately. “Do not mess around. Pay your premium,” admonishes Karen Pollitz, a consumer specialist at the Kaiser Family Foundation. (KHN is an editorially independent project of the foundation.) “Otherwise that will be the end of you and you won’t get to sign up again

until the next open season.” (Open enrollment for 2014 coverage ends March 31. Open enrollment for 2015 begins Nov. 15.) Even underpaying the premium by a few cents could give the insurance company grounds to kick you off, she said. Insurers allow a brief grace period if you get behind — somewhat longer if you’re receiving premium subsidies — but they will terminate coverage for nonpayment. Register online with your new insurance company. Insurance sites are good for tracking claims. Increasingly they also let you shop around for the best deals on non-emergency treatment. “Your health plan might pay one imaging center half what it pays another imaging center,” Metcalf said. “That’s really important if you’ve got a big deductible.” Save paperwork. Make sure you really owe what doctors and hospitals bill you for. “Now is a good time to become a pack rat,” says Pollitz. “If you’ve got any concern, it really is worth it to make a call and get them to explain what they did.” If you don’t get satisfaction from providers or insurers, try regulators. Check the insurer’s explanation of benefits detailing your claims. It may show a phone number for a consumer assistance program in your state to help deal with medical coverage. Here is a list of consumer assistance programs. This list has contact information for state insurance departments and other regulators. Do read the plan’s summary of benefits and coverage. “Get it and print it out, because that has the details of your plan,” says Metcalf. “How it works. What do you have to pay in order to go to a primary care doctor? Is it

before or after the deductible? “How big is your deductible? How much does it cost to go to the emergency room?” It’s not like reading John Grisham. But the subjects — your health and your money — are really important.