2016 Updated Healthcare Reform Timeline (Version 15) & Employer Mandate

2016 Updated Healthcare Reform Timeline (Version 15) & Employer Mandate


PPACAIf you want to see 10 pages of health reform in a 1 page timeline (well, 1 page for Employer and 1 page for Employees) then please visit our website (www.apbenefitadvisors.com/news).  But, if you are looking for details specific to just a certain year or plan, then you can’t do better than this implementation timeline from The Kaiser Family Foundation.

Also, we’ve had several requests for a condensed version of the Employer Mandate rules and examples.  That is included here too.

AP Benefit Advisors’ Timelines & Employer Mandate Details


**Don’t forget that the IRS indexed the Shared Responsibility fines under the Affordable Care Act. (See our 12/21/2015 post for complete details).

Department also update the payments due under ACA’s Shared Responsibility Structure

  • Question 13:  Under § 4980H(c)(5), in the case of any calendar year after 2014, the applicable dollar amounts of $2,000 and $3,000 under § 4980H(c)(1) and (b)(1) are increased based on the premium adjustment percentage as defined in § 1302(c)(4) of the Affordable Care Act (4.213431463 for 2015* and 8.316047520 for 2016**) rounded to the lowest multiple of $10. What are those amounts for calendar years 2015 and 2016?
  • Answer 13:  For calendar year 2015, the adjusted $2,000 amount in §4980H(c)(1) is $2,080 ($2,000 x .04213431463 = $84.27 plus $2,000 rounded down to $2,080), and the adjusted $3,000 amount in §4980H(b)(1) is $3,120 ($3,000 x .04213431463 = $126.40 plus $3,000 rounded down to $3,120).  For calendar year 2016, the adjusted $2,000 amount in §4980H(c)(1) is $2,160 ($2,000 x .08316047520 = $166.32 plus $2,000 rounded down to $2,160), and the adjusted $3,000 amount in §4980H(b)(1) is $3,240 ($3,000 x .08316047520 = $249.48 plus $3,000 rounded down to $3,240). Treasury and IRS anticipate that adjustments for future years will be posted on the IRS.gov website.
  • 2015  Sledge-hammer fine $2,080
  • 2015  Tack-hammer fine $3,120 ($260/month)
  • 2016  Sledge-hammer fine $2,160
  • 2016  Tack-hammer fine $3,240 ($270/month)

Comments (1)

  • PHaynes

    Final Regulations on 2017 Benefit and Payment Parameters: On February 29, the Department of Health and Human Services (HHS) issued final regulations that address a wide range of benefit and payment parameters under the Affordable Care Act (ACA), effective for plan years beginning on or after January 1, 2017. The final regulations include some changes from the proposed rules that were issued in November 2015, and delayed a few provisions contained in the proposed rules until 2018.
    On the same date:
    • The Centers for Medicare and Medicaid Services (CMS) issued an FAQ that clarified the suspension of the 2017 Health Insurance Industry Fee. The moratorium will apply to the Health Insurance Industry Fee that would have been due in the 2017 calendar year based on 2016 data.
    • CMS also issued a bulletin announcing that non-grandfathered individual policies and small group plans may extend their exemption from certain ACA provisions under the previously announced transitional relief. If the applicable state permits, an extension may be granted through December 31, 2017. As of January 1, 2018, these policies and plans will need to comply with all ACA requirements. Earlier guidance had required these policies and plans to end by October 1, 2017.

    Here is an overview of some key regulations in the final 2017 Benefit Payment and Parameters.

    2017 Out-of-Pocket Maximums: The 2017 annual out-of-pocket maximums will be $7,150 for individual coverage and $14,300 for family coverage.