Blog

Under the Medical Loss Ratio (MLR) requirements of the Affordable Care Act (ACA), health insurance carriers must spend at least 80 to 85% of the premium dollars they collect each year on medical care and quality improvement or pay affected customers a rebate. For plan year 2018, the Kaiser Family... read more →

Medicare Part D is a voluntary outpatient prescription drug benefit for Medicare beneficiaries, provided through private plans approved by the federal government. Beneficiaries can choose to enroll in a stand-alone prescription drug plan (PDP) each year to supplement traditional Medicare (Parts A and B) and their Supplemental (“Medigap”) medical plan... read more →

On 6/24/19, President Trump signed an executive order directing the of Departments of Labor (DOL), Treasury and Health and Human Services (HHS) to increase healthcare price and quality transparency by issuing guidance that would: require hospitals to disclose information about their negotiated rates in a format that's understandable and usable by patients... read more →

The U.S. Department of Labor (DOL) has increased penalties for violating federal minimum wage, overtime, and posting and safety requirements, effective January 23, 2019. The increased monetary fines apply to penalties assessed under Fair Labor Standards Act (FLSA), Family and Medical Leave Act (FMLA), and Occupational Safety and Health Act... read more →

Employer groups that offer prescription drug coverage to Medicare eligible employees, dependents and/or retirees, need to provide annual creditable disclosures to both their eligible plan participants and the federal Centers for Medicare and Medicaid Services (CMS). “Creditable” plans mean that the coverage provided is as good as, if not better... read more →

Implementation of the "Cadillac Tax," the Affordable Care Act's excise tax on high-cost employer-sponsored health coverage, has been delayed until 2022. Previously, this tax—which would impose a 40% tax on plans that cost more than $10,200 (for self-only coverage) and $27,500 (for family coverage)—was set to become effective in 2020. An... read more →

Important information for prospective individual medical enrollees who did not enroll at open enrollment: Amerihealth (NJ): Coverage effective dates can only be 1st or 15th of the month. For when coverage is ending mid-month, Amerihealth will enroll 1st of that month month, if the application is received prior to the... read more →

The Internal Revenue Service (IRS) has begun enforcing the employer shared responsibility provision (aka "employer mandate" or "pay or play" provision) of the Affordable Care Act (ACA) for the 2015 tax year by sending Letter 226J to tens of thousands of applicable large employers (ALEs).  Here are ten things to keep in... read more →

Effective January 1, 2017, the New Jersey Small Employer Health Coverage Program (SEH Program) aligned its definition of a "Small Employer" for health insurance coverage purposes with the federal definition. This means that the methodology used to determine a small employer’s group size now looks to the total number of full-time... read more →

The Centers for Medicare and Medicaid Services (CMS) is providing relief to certain Medicare beneficiaries enrolled in Medicare Part A and individual coverage bought through a health insurance "exchange" to allow them to enroll in Medicare Part B without penalty through September 30, 2017. CMS is also offering assistance to individuals... read more →