Affordable Care Act Review

Affordable Care Act Review

CBO Updates ACA Impact Estimates

Posted in Affordable Care Act, Coverage Mandates, Exchanges, Taxes

Concurrently with its April 2014 update of February 2014 projections of federal revenues and spending through 2024, the Congressional Budget Office revised its projection of how the Affordable Care Act will change insurance coverage, federal spending and revenues.  The numbers should not shock anyone who has been keeping up, but we found them noteworthy.

ACA Spending and Revenues

Excluding ACA administration and enforcement costs, here are highlights (numbers in billions of dollars, by fiscal year, relative to the baseline annual deficit).

Total Exchange spending (mostly www.healthcare.gov) will rise about 776% – from $17B to $132B – between 2014 and 2024.  This includes premium subsidies, cost-sharing subsidies, and payments to insurers through the reinsurance and risk corridor programs.  The total number jumps from $17B to $77B in just the first three years.  The CBO projects that premium subsidies will far exceed cost-sharing subsidies in every year, starting with $12B of $21B 2014 and rising to $110 of $133B in 2024.  Risk adjustment, reinsurance and risk corridor payments to insurers are expected to run $18B to $19B annually from 2015 through 2024. 

As we guessed, the ACA’s small employer premium tax credit program is not much ado about even less.  Its $1B cost in 2014 is expected only to double by 2024.

Individual mandate penalties are estimated to raise less than half a billion dollars in 2014, but $4B by 2016 and $6B by 2024.  (Apparently, the CBO concedes that some self-employed people who pay quarterly estimates are paying individual mandate taxes during 2014).  Employer penalties are expected to raise $8B starting in 2016, $15B by 2019 (not including the Cadillac tax) and $21B by 2024.  The Cadillac tax alone is expected to yield revenues of $5B in 2018, $10B in 2019 and $30B by 2024.

Health Insurance Coverage

These are projected changes for U.S. residents younger than 65, expressed in millions of people per calendar year.  Numbers may not match due to rounding.

Without the ACA, the CBO guesses that employers would cover 156M people in 2014 and 166M by 2024 – about 10M more people, an increase of about 6.4%.  The ACA reduces employer coverage by a half million or less in 2014, 2M in 2015, and 7M in 2016 and beyond.  It reduces individual coverage by 1M in 2014, rising to 5M in 2024.  Insurance Exchanges (chiefly www.healthcare.gov) are projected to cover 6M in 2014, 13M in 2015, and 24M to 25M in 2016 and beyond.  SHOP purchases by employers are expected to cover about 2M in 2014, 3M in 2015, and 3M to 4M in 2016 and beyond.  Expanded Medicaid is expected to add 7M in 2014, 11M in 2015, and 12M to 13M in 2016 and beyond.  Including illegal immigrants, who are ineligible for affordability programs, the uninsured population is projected to fall by about 11M people, from 42M in 2014 to 31M in 2024.

In every year, the CBO thinks that less than a half million people will receive Exchange subsidies due to unaffordable employer coverage offers.  The average subsidy per enrollee is expected to be $4,140.00 in 2014, rising to $7,170 in 2024.  Just 1M of the estimated 6M enrollees are expected to buy an Exchange QHP without subsidy in 2014, rising to 3M of 13M in 2015, and 5M to 6M of 24M to 25M thereafter.

Measuring the accuracy of these estimates may be difficult.  For example, the U.S. Census Bureau is changing the questions it asks about insurance coverage in ways that, according to 2013 tests, tends to lower the number of uninsured, making before-and-after comparisons unreliable.  Also, keep in mind that CBO estimates assume the continuance and enforcement of current laws and regulations for the entire ten-year period.  That may be the wildest guess of all.

 

Is The Full-Time Employer Mandate Causing Employers to Cut Weekly Work Hours?

Posted in Affordable Care Act, Coverage Mandates, Employee Leasing

Probably not yet, on net, this year, seems to be the correct answer, though temp staffing is trending upward.  Here are three charts that we created from data obtained from the Bureau of Labor Statistics.

CHANGE IN % OF PART-TIME WORKERS IN TOTAL WORKFORCE (’11-’14)

 

Part-time workers’ share of the total work force has fallen in recent years.  Next, we looked at average weekly work hours.

 AVG. WEEKLY HOURS FOR ALL PRIVATE SECTOR EMPLOYEES

 

If full-time workers’ weekly hours are stable, then we would expect to see average weekly work hours fall as employers rely more on part-time workers.  That has not happened.

NUMBER OF TEMP HELP SERVICES EMPLOYEES (’08-’14) – NOT SEASONALLY ADJUSTED

 

If employers were turning increasingly to part-time workers, we would expect many of them to be leased from temp staffing firms.  The story told by this chart is that temps were the first out the door during the recession and that temp staffing continued to suffer until 2012.  Perhaps the bump upwards in 2013 was due in part to ACA compliance planning.  This may be the second consecutive year of increased temp hiring, and some of that may again relate to the employer mandate.  But, despite some anecdotal evidence, we can’t conclude from the broader data that employers are rushing to replace full-time workers with part-time workers in early 2014.

 

 

Who’s At Risk for Non-Payment During the ACA Subsidy “Grace Period”?

Posted in Affordable Care Act, Exchanges, Insurers and Brokers, Providers - For Profit, Providers - Not-for-Profit

It’s buried deep, in small type, in a set of rules issued almost a year, and thousands of Federal Register pages ago.   Here’s the setup.  Jimmy has a chronic medical problem, and knows it, but he cannot afford insurance payments each month, even with the available subsidy.  So he puts off buying insurance until he needs six months of care, costing a quarter million dollars.  Then, he buys a subsidized QHP through www.healthcare.gov and pays his first monthly premium.  The clinic and the hospital verify his coverage and begin treating Jimmy, who never pays another premium.  Periodically, the clinic and the hospital verify Jimmy’s coverage.  After three months, the insurer notifies them that Jimmy’s coverage has been terminated for non-payment of premiums.

Each insurer that sells a Qualified Health Plan (“QHP”) through an Exchange, such as www.healthcare.gov, must have consistent, non-discriminatory rules for terminating coverage due to non-payment. Those rules must give ACA subsidy recipients who have made the first month’s premium payment a “grace period” of three consecutive months before terminating coverage.  During that grace period, the insurer must:

(1) Pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period;

(2) Notify HHS of such non-payment; and,

(3) Notify providers of the possibility for denied claims when an enrollee is in the second and third months of the grace period.

 45 C.F.R. § 156.270(d), as amended July 15 and August 30, 2013.  Subject to the insurer’s agreement to do better by its network providers, this rule leaves them on the hook for services rendered during the second and third months of the grace period, as long as the insurer notifies them some time before its end of that possibility.

Unless state law says otherwise.  So, the American Medical Association Advocacy Resource Center has circulated among state legislators a model bill, titled, “Physician and Provider Notification of Patients in Health Insurance Exchange Grace Period.”  (Awful, no?  Presumably they did well in chemistry lab and calculus.)  Boiling it down, the bill says that an insurer must disclose that an insured patient is in such a grace period each time a provider inquires about that patient, or the provider is entitled to be paid by the insurer as if the patient were not in such a grace period.

Unless and until legislators solve the problem, the AMA also suggests related collections policies and financial agreement terms to manage this exposure.  The AMA encourages physicians to ask insurers these related questions:

What specific information will be provided?

How, in what format?

When?

How and when will notice be provided if a patient has brought his payments current?

What claims that may be pended under the rule will instead be paid by the insurer?

And, perhaps most importantly:

Where are those assurances found in the provider agreement?

We have seen media reports that some physicians think that they can avoid this problem by refusing to accept insureds who obtained subsidized coverage through an Exchange.  For reasons too detailed to explain in this short space, we caution against doing so without supporting legal advice from a lawyer with good malpractice insurance.

 

What Are the Magic Numbers?

Posted in Affordable Care Act, Exchanges, Insurers and Brokers

Some believe, some reject the Administration’s claim that just over seven million people have “enrolled” in a Qualified Health Plan (“QHP”) through the ACA Exchanges, principally www.healthcare.gov.  Veracity is hard to assess because HHS claims inability to distinguish those who only selected a plan from those who also paid the required premium.  We’re given as “enrollment” only the number who selected a plan.  If the Blue Cross and Blue Shield Association is correct, 7 million plan selections indicates about 5.8 million policy purchases.

HHS also claims not to know how many of the plan selectors previously lacked coverage, not to mention how many of them are young healthies.  Seven million plan selections with one set of answers to those component questions might be worse for the risk pool than five million plan selections with a different set of answers to the component questions.  Nevertheless, we know the real magic numbers; they are 11/15/14.  That’s the (delayed) start date for www.healthcare.gov 2015 open enrollment.

Between now and then, group health plan issuers that participated in 2014 will assess the risk pools they underwrote and decide, largely based thereon, whether to try again for 2015 and, if so, how to modify and price their offerings. If they request federal assistance for 2014 losses, if 2015 QHP premiums spike, if cost-sharing features are set at or near the legal limits, if networks are narrow, and if fewer quality, brand name insurers participate, then 2014 open enrollment was a disaster, no matter how many selected a plan.  Insurance executives are murmuring already.

ACA critics will try by every lawful means to get early – i.e., pre-election – access to reinsurance and risk corridor program communications and to the 2015 insurer lists and plan terms for all the Exchanges, most especially www.healthcare.gov.  If their requests are stonewalled, suspicions will be aroused.  On the other hand, if participating insurers pre-announce 2014 profits and stable or improved policy terms, prices and network consistency inside and outside the Exchanges for 2015, ACA opponents may have a hard time arguing with success.

Update:  New, related data summarized here: http://www.thefiscaltimes.com/Columns/2014/04/10/Two-Studies-Raise-Red-Flags-Obamacare-s-First-Round.

 

Small Group Deductible Cap Repeal

Posted in Affordable Care Act, Business Organizations, Coverage Mandates, Exchanges, Grandfathered Status, Insurers and Brokers

On April Fools’ Day, HR 4302 officially became Public Law 113-93.  It was the latest in a long line of so-called “Doc fix” bills, delaying scheduled Medicare reductions of payments to physicians.   Few onlookers noticed this, inserted between provisions on ICD-10 Code set delay and a GAO child health care report mandate:

SEC. 213. ELIMINATION OF LIMITATION ON DEDUCTIBLES FOR EMPLOYER-SPONSORED HEALTH PLANS.

(a) IN GENERAL.—Section 1302(c) of the Patient Protection and Affordable Care Act (Public Law 111–148; 42 U.S.C. 18022(c)) is amended—

(1) by striking paragraph (2); and

(2) in paragraph (4)(A), by striking ‘‘paragraphs (1)(B)(i) and (2)(B)(i)’’ and inserting ‘‘paragraph (1)(B)(i)’’.

(b) CONFORMING AMENDMENT.—Section 2707(b) of the Public Health Service Act (42 U.S.C. 300gg–6(b)) is amended by striking ‘‘paragraphs (1) and (2)’’ and inserting ‘‘paragraph (1)’’.

(c) EFFECTIVE DATE.—The amendments made by this Act shall be effective as if included in the enactment of the Patient Protection and Affordable Care Act (Public Law 111–148).

Shorn of legalese, it says that the ACA’s annual cap on small group health plan deductibles  – $2,000 individual, $4,000 family in 2014 – is repealed, retroactive to the date of the ACA’s passage, as if it had never been in the Act.  Was it just six months ago that our government shut down over failed attempts to repeal various ACA bits and pieces?  Yes.  So why this, why now?  Any why no uproar?

In ACA §  1302(c), Congress capped non-grandfathered, small group health plan deductibles, but not individual or large group plan deductibles.  That’s why so many of the plans being sold through www.healthcare.gov feature deductibles near the out of pocket maximum limit.  It was either a Congressional drafting error or a poison pill that only Congress could fix.  Part XII of the enforcement agencies’ Frequently Asked Question publications and the proposed rules on the subject (45 CFR § 156.130) effectively said, “It is what it is.”

But imposing similar limits on individual and large group plans probably would have been rejected even by ACA supporters, because www.healthcare.gov sticker shock would be much worse without high deductibles.  And the premium inflation consequences for small group plans contributed to the ACA’s unpopularity in an election year.  So, ACA opponents got a scalp.  ACA defenders hope it was not theirs.

Open Enrollment Overtime: Is There A Buzzer to Beat?

Posted in Affordable Care Act, Exchanges, Insurers and Brokers

On March 26, CMS published two guidance memoranda that, according to most media reports, extended the www.healthcare.gov March 31 open enrollment deadline through April.  Critics cried “foul” immediately.  After all, HHS Secretary Kathleen Sebelius and subordinates had testified before Congress that they lack statutory authority to extend the deadline.  Here’s what CMS actually did, beginning with the crucial context.

ACA § 1311(c)(6) required Secretary Sebelius to set the 2014 open enrollment period by July 1, 2012, and gave her discretion to change it only for later years.  So, HHS executives correctly testified that they lack authority to extend the 2014 open enrollment deadline.  But  HHS already (45 CFR § 155.420) had permitted “special enrollment” after the open enrollment deadline for a long list of reasons, including loss of minimum essential coverage, addition of a dependent (or becoming a dependent), becoming “lawfully present,” erroneous enrollment or non-enrollment, and an insurer violation of its HHS contract.  One of the two CMS memos published March 26, largely ignored by the general media, summarized neatly these ten additional grounds:

Exceptional Circumstances: A consumer faces exceptional circumstances as determined by CMS, such as a natural disaster, medical emergency, and planned system outages that occur on or around plan selection deadlines.

Misinformation, Misrepresentation, or Inaction: Misconduct by individuals or entities providing formal enrollment assistance (like an insurance company, Navigator, certified application counselor, Call Center Representative, or agent or broker) resulted in one of the following:

• A failure to enroll the consumer in a plan;

• Consumers being enrolled in the wrong plan against their wish;

• The consumer did not receive advanced premium tax credits or cost-sharing reductions for which they were eligible.

Enrollment Error: Consumers enrolled through the Marketplace, but the insurance company didn’t get their information due to technical issues.

System errors related to immigration status: An error in the processing of applications submitted by immigrants caused the consumer to get an incorrect eligibility result when they tried to apply for coverage.

Display Errors on Marketplace website: Incorrect plan data was displayed at the time the consumer selected the QHP, such as plan benefit and cost-sharing information.

Medicaid/CHIP – Marketplace transfer: Consumers who were found ineligible for Medicaid or CHIP and their applications weren’t transferred between the State Medicaid or CHIP agency and the Marketplace in time for the consumer to enroll in a plan during open enrollment.

Error messages: A consumer is not able to complete enrollment due to error messages.

Unresolved casework: A consumer is working with a caseworker on an enrollment issue that is not resolved prior to March 31st.

Victims of domestic abuse: A consumer who is married, and is a victim of domestic abuse. Consumers who are in this category can apply and select a plan through May 31, 2014.

Other system errors: Other system errors, as determined by CMS, which hindered enrollment completion.

The other March 26 CMS memo, titled, “Affordable Exchanges Guidance,” seems to add just a few details to that list.   Here are its operative statements:

CMS will provide consumers who tried to enroll during the open enrollment period, but did not complete the process by March 31, a limited amount of additional time to finish the application and enrollment process.

CMS will process information related to paper applications received by April 7 to capture those consumers who were “in line” with paper applications or whose applications were pending submission or review of supporting documentation on March 31. These consumers will be able to select a plan through April 30 to allow them time to receive an eligibility notice, and the coverage will also be effective May 1.

Consistent with previous CMS guidance, consumers who receive a special enrollment period for being “in line” by March 31 and select new coverage within the timeframes outlined in this guidance will be able to claim a hardship exemption from the shared responsibility payment for the months prior to the effective date of their coverage, because they will be treated as if they had enrolled in coverage by March 31.

Now for the alley-oop.  How will the government distinguish “special” online applicants who were “in line” on March 31 from those who just showed-up late?  Apparently, by taking their word for it.  More specifically, according to Administration officials, the determination will be made by the applicant, not by www.healthcare.gov.  We’ll resist the temptation to post here our concept drawing of the new web page button that applicants will click to apply late, no questions asked.

Even after May 1 (assuming no further “in line” extension), the “special enrollment” window will be open, and it seems to be rather wide.  Group health insurers seeking to identify and underwrite risk pools properly may have to accept an uncomfortably high level of uncertainty.

CMS Rule On Third-Party Premium and Cost-Sharing Payments to Insurers

Posted in Affordable Care Act, Business Organizations, Exchanges, Insurers and Brokers, Providers - For Profit, Providers - Not-for-Profit

Since our post about East v. Blue Cross and Blue Shield of Louisiana, Et Al., M.D. La. 3:14cv00115, CMS has issued more precise guidance on the subject of third-party premium and cost-sharing payments to insurers, in the form of an interim final rule, effective immediately, codified at 45 CFR § 156.1250:

Issuers offering individual market QHP’s, including stand-alone dental plans, must accept premium and cost-sharing payments from the following third-party entities on behalf of plan enrollees:

a)      Ryan White HIV/AIDS Program under title XXVI of the Public Health Service Act;

b)      Indian tribes, tribal organizations or urban Indian national organizations; and

c)      State and Federal Government programs.

The cited authority for this rule does not include ACA § 1557, the non-discrimination statute at the core of the East suit.  That matters.

CMS has decided to treat this as a QHP issuer misconduct problem, remediable by civil money penalties – up to $100 per day per affected individual – if the QHP was sold through an Exchange.  If sold outside an Exchange, like the policy disputed in East, state law provides the remedy, if any.

A court, or another agency, might see this as a § 1557 problem, so the issue remains a live one, complicated by this statement in the preamble to the new CMS rule:

Our new standard does not prevent QHPs and SADPs from having contractual prohibitions on accepting payments of premium and cost sharing from third party payers other than those specified in this interim final regulation. In particular, as stated in our November FAQ, we remain concerned that third party payments of premium and cost sharing provided by hospitals, other healthcare providers, and other commercial entities could skew the insurance risk pool and create an unlevel competitive field in the insurance market. We continue to discourage such third party payments of premiums and cost sharing, and we encourage QHPs and SADPs to reject these payments.

The East plaintiffs argue that disparate impact theory applies to such insurer policy terms.  If so, and if such terms disproportionately burden disabled customers and applicants, then the CMS guidance could conflict with § 1557.

CMS cited no statutory authority for turning its discouragement into an actual rule.  There may be none.  Some insurers are accepting provider and charitable COBRA premium payments without making an issue of it.  But doing so may invite a § 1557 suit if they decide to reject such payments after calculating their risk pool impact.  The overall message to insurers is to bring ACA lawyers, data runs and money, before this hits your fan.

Free Insurance … why, certainly.

Posted in Affordable Care Act, Exchanges, Government Employers, Private Employers, Taxes

On January 24, 2014, we reported on the number of Marketplace applicants through December 28, 2013.  Well, on March 11, 2014, HHS released updated numbers through February 28, 2014.

HHS Market Enrollment data is found at:

http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Mar2014/ib_2014Mar_enrollAddendum.pdf.

Here is a sampling of data for the states listed below:

State As of 12/28/13 As of 2/28/14 Subsidy certified ‘13 Subsidy certified ‘14
Alabama

28,633

55,034

83%

86%

Arkansas

12,763

27,395

88%

91%

Florida

158,030

442,087

83%

90%

Georgia

58,611

139,371

78%

85%

Louisiana

17,548

45,561

82%

87%

Mississippi

8,045

25,554

87%

93%

Texas

118,532

295,025

74%

82%

 

Subsidy certification rates increased because, as shown below, the most recent enrollments were almost all subsidized.

State

%   of new subsidy certified enrollees

Alabama

89%

Arkansas

94%

Florida

94%

Georgia

90%

Louisiana

90%

Mississippi

96%

Texas

87%

 

You may well ask who is verifying whether the applicants, in fact, qualify for the certified subsidies. The honest answer seems to be that it’s much like ordering-out a kid’s meal on kids eat free night.  You eat free unless someone checks, and that’s not high on the list of needed fixes for www.healthcare.gov. And by using the word “free,” we’re not entirely exaggerating.  One client reported to us an employee’s tale of being approved for a 32 cent monthly premium.

Yes, $.32.  If true, that was an Exchange error.

As we have explained, this has employer compliance and tax consequences.  We suspect that many subsidy certification errors have been made.  Employers must be prepared to appeal them shortly after they get the subsidy notices, hopefully this summer.

 

New FAQ Clarifies Policies Covering Same-Sex Spouses

Posted in Affordable Care Act, Exchanges, Uncategorized

The ACA generally requires issuers of non-grandfathered health insurance coverage offered in the group and individual markets to guarantee availability of coverage. The final regulations related to this requirement equate discrimination in marketing practices or benefit designs with a violation of the guaranteed availability requirement. Specifically, 45 CFR § 147.104(e) states that:

(e) Marketing. A health insurance issuer and its officials, employees, agents and representatives must comply with any applicable state laws and regulations regarding marketing by health insurance issuers and cannot employ marketing practices or benefit designs that will have the effect of discouraging the enrollment of individuals with significant health needs in health insurance coverage or discriminate based on an individual’s race, color, national origin, present or predicted disability, age, sex, gender identity, sexual orientation, expected length of life, degree of medical dependency, quality of life, or other health conditions.

Id. (emphasis added). On March 14, 2014, CMS issued a FAQ to clarify that as the term “sexual orientation” is used in this regulation, an issuer is considered to employ marketing practices or benefit designs that discriminate on the basis of sexual orientation if:

• the issuer offers coverage for an opposite-sex spouse, and

• does not offer coverage on the same terms and conditions to a same-sex spouse, provided

• the same-sex marriage was validly entered into in a jurisdiction where such marriages are legal, regardless of the laws of the jurisdiction where the insurance policy is offered, sold, issued, renewed, in effect, or operated, or where the policyholder resides.

The regulation is not intended to require an issuer to change terms of eligibility for coverage under a plan, or otherwise interfere with a plan sponsor’s ability to define a dependent spouse for purposes of coverage eligibility under the plan. It requires only that if coverage is made available to an opposite-sex spouse, it must also be made available on the same terms and conditions to same-sex spouses.

Enforcement of this nondiscrimination requirement is delayed until plan or policy years beginning on or after January 1, 2015, because CMA “recognize[s] that some issuers may not have understood the prohibition as described [in the FAQ] when designing their policies for the 2014 coverage year.” States also will be expected to enforce the regulation for plan or policy years beginning on or after January 1, 2015.

-         Dorman Walker dwalker@balch.com

ACA Advisor Pop Quiz

Posted in Affordable Care Act, Business Organizations, Coverage Mandates, Employee Leasing, Federal Contractors, Government Employers, Grandfathered Status, Insurers and Brokers, Private Employers, Providers - For Profit, Providers - Not-for-Profit, Taxes

We have been concerned for many months that some of our clients and friends are getting unreliable ACA compliance advice.  This is not a knock on insurance agents, or brokers, or TPA’s or any other class of advisors.  We work with some who are as helpful to our mutual clients as we are to them.  But too many (lawyers included) plainly do not know the subject. 

We have wondered how, unless they have mastered the ACA, executives can distinguish good advice from bad, trustworthy advisors from . . . not so much.  So, we created a pop quiz (below) that any reliable ACA advisor should ace, but that many others will bomb.  Whether you use it, and how, is up to you.  But now you have a tool that you did not have yesterday. 

If you like, we will grade your advisor’s paper, e-mailed to us – acareview@balch.com – without charge, assuming that we have no ethical conflict with that evaluation, and limited to the first 100 requests that we receive. We won’t contact your advisor without your advance, written permission and we won’t shame him or her, on this site or elsewhere; our aim is to help you, not to hurt others.

ACA Employer/Plan Compliance Pop Quiz

Read all questions, then answer each question completely and legibly, in writing.

  1. Do you personally study the ACA and the implementing regulations and guidance documents, or do you rely on someone else to do that and keep you current?  To the extent that you rely on someone else, provide his or her name and contact information.
  2. Provide the URL of a web site where we may read your published writings on ACA compliance.
  3. List the principal ACA federal enforcement agencies and the primary enforcement sub-agencies of each.
  4. What risks does an employer run if it funds an HRA for each employee to use to purchase an individual health insurance policy, through a private exchange or otherwise?
  5. Identify the Fair Labor Standards Act section, added by the ACA, for which no implementing rule has yet been proposed.
  6. State the effective date of the new ACA rules forbidding non-grandfathered, fully insured group health plans to discriminate in favor of the highly compensated.
  7. In a leased employee arrangement, what determines whether the leasing firm or its customer bears the Employer Shared Responsibility Cost obligation to offer coverage to full time employees and their dependents?
  8. Explain how a group health plan may recover its grandfathered status if it has been lost due to a minor error such as a clerical mistake.
  9. What is an employer’s potential exposure for permitting a health care provider to pay group health plan premiums for an employee?
  10. Is each following statement True (T) or False (F)? (Circle one).
A grandfathered group health plan need not comply with the coverage and cost-sharing mandates that the ACA added to the Public Health Service Act.

T

F

A group health plan is grandfathered if it has made no coverage or cost-sharing changes adverse to employees since March 23, 2010.

T

F

The ACA’s Employer Shared Responsibility Cost rules do not apply to state or local government employers.

T

F

An Applicable Large Employer that offers minimum essential coverage to at least 70% of its full time employees and their dependents in 2015 will be exempt from assessments under Code § 4980H for 2015 coverage months.

T

F

To determine whether an employer is an Applicable Large Employer subject to the Employer Shared Responsibility Cost rules beginning in January 2015, the employer should count its number of full time employees in each month of 2015 and determine whether it employed, on average, at least 50 full time employees per month.

T

F

For purposes of the preceding statement, a full time employee is one who works at least 130 hours per month (equivalent to 30 per week).

T

F

Self-funded group health plans are not required to pay annual PCORI fees unless they are required to file an annual Form 5500.

T

F

Self-funded group health plans are not required to remit annual reinsurance fees to HHS.

T

F

An employer that receives an erroneous employee subsidy certification notice from the Federally Facilitated Exchange will have 60 days to appeal the error.

T

F

The penalty for a fully-insured group health plan’s discrimination in favor of the highly compensated is taxability of plan benefits to the highly compensated employee.

T

F

Group health plan changes that an employer makes in order to comply with the ACA are not mandatory subjects of bargaining with the affected employees’ union representatives.

T

F

Because employees who have lost their jobs are eligible for immediate Exchange enrollment, employers no longer need to provide COBRA notices.

T

F

Employees who believe that they have suffered employer retaliation for their exercise of an ACA right may file an EEOC Charge to obtain relief.

T

F