Category Archives: Health Care Act


It’s time to start planning for 2015!   Consult our updated Compliance Checklist to be sure that you are preparing for the basic compliance elements of the Affordable Care Act.

  • Health Care Reform Legislative Brief: 2015 Compliance Checklist    Document #105375

Government guidance



The Employee Benefits Security Administration of the Dept. of Health and Human Services recently issued a Frequently Asked Questions (FAQ XIX) announcement.  Among the issues discussed in the FAQ, there is significant guidance on COBRA, including updates to both the model general notice and the model election notice.

The following articles provide helpful guidance, including simplified templates for the election notice (health plan and a health FSA).  Touchstone also has reports regarding compliance with state vs federal continuation coverage rules.   The Rhode Island report is included below, as an example.  Please contact us if you’d like to receive a report on your state.

  • Health Care Reform Bulletin:  Agencies Release New COBRA Guidance for Individuals and Employers  Document #103865
  • Benefits Buzz:  New COBRA and CHIPRA Model Notices, and COBRA and Exchange Rules Clarified  Document #94325
  • COBRA Election Notice Template  Document #45260
  • COBRA Election Notice Template – Health FSA  Document #45259
  • COBRA Rhode Island – Comparison of Federal and Rhode Island Continuation Laws    Document #11542

Government guidance



Along with the updated COBRA guidance and notices described above, and clarifications on Out-of-Pocket Limits (described in the following article), FAQ XIX also addressed ACA-mandated preventive services.

FAQ XIX notably addressed coverage for drugs that reduce the risk of breast-cancer.   These must be included in preventive care for plan years beginning 9/24/2014, so plans should check now to be sure that their coverage is in compliance.

Good news in the FAQs included specifics on a safe harbor for tobacco counseling programs.   In the section entitled “Coverage of Preventive Services”, check the response to Q5 for details.

The services which are required to be provided at no cost to the plan participant may change or be more clearly defined over time, so it is important for benefit professionals to refer to the details provided on the website (see links below).

The following articles offer some summary guidance:

  • Health Care Reform Legislative Brief – Preventive Care Coverage Guidelines   Document #43291
  • Health Care Reform Legislative Brief – Recommended Preventive Care Services     Document #57767
  • Health Care Reform Legislative Brief – Preventive Care Guidelines for Women   Document #54187
  • Health Care Reform Legislative Brief – Tobacco Use Surcharge in 2014.    Document #103854

Government guidance



The FAQ XIX released on May 2 clarified how cost-sharing restrictions may be satisfied by health plans.  Responses to Questions 2, 3, and 4 dealt with the following issues regarding out-of-pocket maximums:  balance billing, patient insistence on using brand drugs over generics, and reference-based pricing.

FAQ XVIII issued in January also clarified certain issues regarding the application of out-of-pocket maximums:  as applied to essential health benefits, division of the annual maximum across different categories of benefits, out-of-network payments, and non-covered items.

Briefly, these clarifications are summarized in the following article:

  • Health Care Reform Legislative Brief – Cost-Sharing Limits for Health Plans      Document #78888

Government guidance

  • “FAQs about Affordable Care Act Implementation (Part XIX)”, U.S. Dept. of Labor, Employee Benefits Security Administration:  See “Limitations on Cost Sharing under the Affordable Care Act” and Q2, Q3, and Q4.
  • “FAQs about Affordable Care Act Implementation (Part XVIII) and Mental Health Parity Implementation”, January 9, 2014.  U.S. Dept. of Labor, Employee Benefits Security Administration:  See “Limitations on Cost Sharing”, Q2, 3, 4, and 5.



The Massachusetts Health Care Reform Act’s requirements regarding employers’ provision of health care coverage have been superseded by the requirements of the federal Affordable Care Act (ACA).  Although the Commonwealth no longer imposes the “fair share contribution” on employers, a new “Employer Medical Assistance Contribution” (EMAC) must be paid by most employers, regardless of whether the employer provides any health coverage.

As of January 1, 2014, the Unemployment Health Insurance (UHI) contribution was replaced by EMAC.  Employers are still required to file quarterly wage and employment reports through UI Online, and the applicable EMAC contribution will be calculated based on those filings.

Review the following information.   If you have further questions, contact the Commonwealth’s Department of Unemployment Assistance at 617-626-5075.

  • Massachusetts Finalizes Repeal of Employer Coverage Rules     Document #105804

Government guidance

On Feb. 10, 2014, the U.S. Treasury Department released final regulations implementing the employer shared responsibility provisions of the ACA.  Included in these regulations were additional relief for mid-size employers as well as clarification of the rules for large employers.  The final rules will delay implementation for medium-sized employers that are covered by the employer mandate. Applicable large employers that have fewer than 100 full-time employees will have an additional year, until 2016, to comply with the pay or play rules. 

Thus, the employer shared responsibility provisions will generally apply to:

  • Employers with 100 or more full-time employees starting in 2015; and
  • Employers with 50-99 full-time employees starting in 2016.

To qualify for this delay, the employer must provide an appropriate certification as described in the final rules. 

Further, under the proposed rules, applicable large employers would need to offer coverage to at least 95 percent of their full-time employees to avoid the most significant penalties. The final rule provides transition relief that will phase in this requirement over two years, beginning in 2015.

To avoid a payment for failing to offer health coverage in 2015, applicable large employers will need to offer coverage to 70 percent of their full-time employees.

In 2016 and beyond, applicable large employers will need to offer coverage to 95 percent of their full-time employees to avoid these penalties.

Click here for a link to the whole article.

Beginning in 2014, the Affordable Care Act (ACA) requires health plans offered through an
Exchange, or qualified health plans (QHPs), to meet certain levels of actuarial value. ACA’s
required actuarial value levels are referred to as “metal levels”—bronze, silver, gold and platinum.
ACA’s metal levels are intended to allow consumers to compare plans with similar levels of
coverage in order to help them make informed decisions about their health insurance coverage.
Since coverage will be similar for all plans in a metal tier (for example, all silver plans),
consumers can focus on other plan factors, such as the premium and network of providers,
when selecting a health plan.

QHP issuers must offer at least one plan in the silver level and one plan in the gold level
through the Exchanges. Outside of the Exchanges, non-grandfathered plans in the individual
and small group markets must offer coverage that matches up to the metal levels.

View the PDF to learn more