Legal Alerts

03 Jul 2013

BREAKING NEWS: Health Care Reform Delay Applies Only to Employer Reporting and Penalties

Yesterday, the Obama administration announced (official guidance will be released within the next week) that it will not enforce the mandatory employer and insurer reporting rules required under, BREAKING NEWS: health care reform until 2015. Such requirements will be voluntary in 2014, and employers will be encouraged to voluntarily report to test the reporting systems during the 2014 transition period. The delay is designed to provide a transition year that will be utilized to simplify required reporting and adapt the new exchange coverage system and reporting systems to be more workable for employers and all reporting entities.

Due to the delay of mandatory reporting until 2015, the employer penalties under the “Play or pay” rule applicable to large employers (employers employing 50 or more full-time or full-time equivalent employees) will not be enforced until 2015.

THIS DELAY AFFECTS ONLY THE EMPLOYER REPORTING AND PENALTIES, AND DOES NOT AFFECT ANY OTHER PROVISION OF THE HEALTH CARE REFORM REQUIREMENTS.

For example, still in effect for 2014:

  • Exchanges will be established and subsidies will be available for coverage through the exchange.
  • The individual penalty will still apply to any individual that does not have health coverage.
  • Waiting periods prior to eligibility for health coverage may not exceed the date 90 days from an employee’s date of hire.
  • Pre-existing condition exclusions will NOT be allowed.
  • Cost-sharing is capped and no annual or lifetime limits on benefits will be allowed.
  • Coverage of adult children to age 26 is required (even if the adult child has other coverage available).

We will know more details regarding the delay and how it applies after official guidance is released, and we will be issuing a more detailed e-alert at that time. In the meantime, this news does not mean you should completely suspend your planning for health care reform compliance. Please contact Dannae Delano with any questions you have about the announced delay or regarding what you need to do for 2014 compliance after the official guidance has been issued on the delay.


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