The ACA requires health insurers to spend a minimum percentage of their premium dollars, or MLR, on medical care and health care quality improvement. Issuers that do not meet these minimum requirements must provide rebates to consumers. This percentage is: 85% for issuers in the large group market; and 80% for issuers in the small and…
2020 has certainly presented more than its share of challenges. Here at SIMA, with gratitude to our dedicated employees and exceptional technology team, we haven’t missed a beat. But, things do look a little different and will continue to do so for some time. And that includes during your company’s open enrollment period. Here’s how…
2018 Final Rule Allows Policies Lasting up to 12 Months On July 17, 2020, a federal appeals court upheld a 2018 final rule expanding short-term, limited-duration insurance (STLDI) for purposes of the Affordable Care Act (ACA). The final rule: Provides a maximum coverage period for STLDI of up to 12 months; and Allows STLDI to continue for…
New Figure Marks Slight Increase from 2020 Under the Affordable Care Act’s employer shared responsibility (pay or play) rules, applicable large employers—generally those who have 50 or more full-time employees (including full-time equivalent employees)—may be subject to a penalty if they do not offer affordable health insurance coverage that provides minimum value to their full-time…
Series of Four Executive Orders Issued On July 24, 2020, President Donald Trump issued the following series of executive orders in an effort to lower drug prices: Executive Order on Lowering Prices for Patients by Eliminating Kickbacks to Middlemen: directs federally qualified health centers to pass along massive discounts on insulin and epinephrine received from…
The Adjusted Penalty Amounts for 2021 are $2,700 and $4,060 Under the Affordable Care Act’s employer shared responsibility (pay or play) rules, applicable large employers—generally those who have 50 or more full-time employees (including full-time equivalent employees)—may be subject to a penalty if they do not offer affordable coverage that provides minimum value to their…
The coronavirus (COVID-19) pandemic has highlighted the importance of health care benefits. Its impact has led to many elective procedures being delayed, and 2021 may look different than previous years. Given the impact of the coronavirus pandemic, many enrollees are increasingly conscious of having appropriate health care coverage. The effects of the pandemic have also…
In response to the COVID-19 pandemic, day cares and schools shut their doors. Months later, child care centers remain closed in many parts of the country, which means that parents are tasked with juggling caregiving and work responsibilities. In fact, according to a survey from Boston Consulting Group (BCG), 60% of U.S. parents report that…
This video series explores the lasting effects the coronavirus pandemic has had on workplaces across the country. This video can help employers identify ways to keep operations running smoothly after reopening their businesses.
In July, the U.S. Supreme Court upheld expanded exemptions to the ACA’s contraceptive mandate. Under these exemptions, plan sponsors that object to providing contraceptive coverage based on sincerely held religious beliefs or moral convictions will not be penalized for failing to include contraceptive coverage in the plan’s benefits. The ACA requires non-grandfathered health plans to…
