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Compliance Recap for January 2014

Originally posted by United Benefit Advisors (UBA)

Coverage first became available through the health marketplaces/exchanges on January 1, 2014, with a number of temporary provisions in effect to address some of the technical problems experienced in many of the marketplaces. Perhaps as a result of the government’s focus on launching the marketplaces, there was not very much released during January that affects employer’s compliance efforts.


The agencies responsible for implementing the Patient Protection and Affordable Care Act (PPACA) issued another Frequently Asked Questions (FAQ) piece. The FAQ answers commonly asked questions about frequency limits on preventive care, out-of-pocket maximums, expatriate plans, and coordinating the requirements under mental health parity and PPACA requirements. The FAQ also announces that beginning next year, preventive services coverage must include breast cancer risk-reducing medications for high-risk women, and that individual policies that simply pay a fixed amount per service will be allowed if provided in connection with a group health plan. Read more: Additional PPACA Details Released.

Federal Poverty Level (FPL)

The 2014 Federal Poverty Level (FPL) figures have been released. These numbers are used to determine whether a person is eligible for a premium tax credit/subsidy for coverage purchased through the marketplace. (A person is eligible for at least a partial premium tax credit if the person’s family income is not more than 400% of FPL.)Download the 2014 FPL figures.

Volunteer Firefighters

The IRS announced that it will exclude volunteer firefighters from the group of workers that must be offered coverage to avoid employer-shared responsibility (also known as “play or pay”) penalties. The IRS said that details will be provided in the final play or pay regulations. For additional information, see the Treasury Department blog posting:Treasury Ensures Fair Treatment for Volunteer Firefighters and Emergency Responders Under the Affordable Care Act.


Although the “play or pay” regulations have been delayed to 2015, the requirement that eligibility waiting periods be 90 days or less is effective on the first day of the 2014 plan year (January 1, 2014, for calendar year plans). This requirement applies to all plans. UBA has created an FAQ to help employers work through this requirement. Read more: Frequently Asked Questions about Eligibility Waiting Periods.

Plans that offer prescription drug coverage to people who are eligible for Medicare must file a disclosure report with the Centers for Medicare and Medicaid Services (CMS) within 60 days after the end of the plan year (by March 1 for calendar year plans). This report is in addition to the notice of creditable (or non-creditable) coverage that the plan must give by October 14 of each year. The disclosure report also must be filed within 30 days after the plan terminates prescription drug coverage or if the plan’s creditable coverage status changes. The form must be filed online. The disclosure form and instructions are available on the Centers for Medicare & Medicaid Services website.

Question of the Month

Q. I know the employer shared responsibility (play or pay) requirements have been delayed. When do they apply to a non-calendar year plan?

A. It is unclear whether all large employers (those with 50 or more full-time or full-time equivalent employees) will be required to offer coverage to full-time employees beginning January 1, 2015, or pay penalties, or if employers with non-calendar year plans will be allowed to wait until the start of their 2015 plan year. Regulations that will answer this question are expected soon.