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Group Health Plans that Fail to Cover In-Patient Hospitalization Services

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Category: ACA, Compliance and Regulatory, HHS,

Notice 2014-69

I.  PURPOSE AND OVERVIEW

The Department of Health and Human Services (HHS) and the Department of the Treasury (including the Internal Revenue Service) (collectively, the Departments) have become aware that certain group health plan benefit designs that do not provide coverage for in-patient hospitalization services are being promoted to employers.  A plan that fails to provide substantial coverage for these services would fail to offer fundamental benefits that are nearly universally covered, and historically have been considered integral to coverage, under typical employer-sponsored group health plans. Promoters of these plans contend that the plans satisfy minimum value within the meaning of the Affordable Care Act (including section 36B(c)(2)(C)(ii)of the Internal Revenue Code (Code) and final HHS regulations under section1302(d)(2)(C) of the Affordable Care Act (referred to in this notice as minimum value or MV)), as determined through use of the on-line MV Calculator referred to in final HHS regulations and proposed Treasury regulations.

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DOL and HHS Release Key FAQs on Implementation of The Affordable Care Act

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Category: DOL, Health Care Reform, HHS,

Set out below are additional Frequently Asked Questions (FAQs) regarding implementation of the Affordable Care Act. These FAQs have been prepared jointly by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments). Like previously issued FAQs (available at http://www.dol.gov/ebsa/healthreform/ and http://www.cms.gov/cciio/resources/fact-sheets-and-faqs/index.html), these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended.

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ACA Employer Mandate is Delayed Until 2015

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Category: CDHC, Compliance and Regulatory, DOL, ERISA, Health Care Reform, HHS, PPACA, Taxes,

The Affordable Care Act (ACA) employer mandate provision has been delayed until 2015. This news was announced July 2, 2013 by the ​US Department of the Treasury on behalf of the Administration.

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Clarification by Treasury and IRS Relaxes Election Change Rules

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Category: Cafeteria Plans, CDHC, Compliance and Regulatory, Health Care Reform, HHS, IRS, PPACA, Section 125 Plans,

So employers and employees can take advantage of the health insurance Exchanges starting January 1, 2014, regulators issued some exceptions to the permitted election changes rule for cafeteria plans.

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HIPAA Audits Have Begun


Category: Compliance and Regulatory, HHS, HIPAA, PPACA,

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has begun auditing covered entities for compliance with the Health Insurance Portability and Accountability Act (HIPAA) under the HIPAA Audit Program (Audit Program). The Audit Program is funded by the Health Information Technology for Economic Clinical Health (HITECH) Act and requires HHS to conduct periodic audits to ensure both covered entities and business associates are complying with the HIPAA Privacy and Security Rules, as well as all Breach Notification standards.

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Summary of Benefit Coverage Requirements for Health FSAs and HRAs


Category: Compliance and Regulatory, DOL, ERISA, Flexible Spending, FSA, Health Reimbursement, HHS, HIPAA, HRA, IRS, PPACA, Section 125 Plans,

Does an employer have to provide a copy of the Summary of Benefits and Coverage (“SBC”) to enrollees of Health Flexible Spending Accounts (“Health FSA”) or Health Reimbursement Arrangements (“HRA”)?

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HHS Issues Health Care Exchange Rules


Category: CDHC, Compliance and Regulatory, DOL, Health Care Reform, HHS, IRS, PPACA, State Legislation,

By Joyce Frieden, News Editor, MedPage Today

WASHINGTON — The Department of Health and Human Services has issued the final regulations for implementing the state health insurance exchanges mandated by the Affordable Care Act (ACA).

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