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Health Reform Questions - Enrolling in the Marketplace this Fall   

According to Department of Community Health officials, the Healthy Michigan Plan—the state’s expanded Medicaid Program—now has a total of 301,645 enrollees as of Wednesday this week.

On June 20, 2014, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (the Departments) released new final regulations on application of the 30-day orientation period under the 90-day waiting period limit.  On February 20, 2014, the Departments had published proposed regulations to address orientation periods under the 90-day waiting period limitation of PHS Act section 2708 when the final regulations on the 90-day waiting period were published.  The following summarizes the provisions of these final regulations. The final regulations contain several clarifications.

On June 4, 2014, the Centers for Medicare and Medicaid Services (CMS) published a report on state Medicaid and Children’s Health Insurance Program (CHIP) enrollment data.

On June 20, 2014, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (the Departments) released new final regulations on application of the 30-day orientation period under the 90-day waiting period limit. On February 20, 2014, the Departments had published proposed regulations to address orientation periods under the 90-day waiting period limitation of PHS Act section 2708 when the final regulations on the 90-day waiting period were published. The following summarizes the provisions of these final regulations. The final regulations contain several clarifications. The Proposed Regulations The proposed regulations had provided that one month would be the maximum allowed length of any reasonable and bona fide employment-based orientation period. The Departments stated that, during an orientation period, they envisioned that an employer and employee could evaluate whether the employment situation was satisfactory for each party, and standard orientation and training processes would begin. Under the proposed regulations, if a group health plan conditions eligibility on an employee's having completed a reasonable and bona fide employment-based orientation period, the eligibility condition would not be considered to be designed to avoid compliance with the 90-day waiting period limitation if the orientation period did not exceed one month and the maximum 90-day waiting period would begin on the first day after the orientation period. The Final Regulations The final regulations continue to provide that one month is the maximum allowed length of an employment-based orientation period. For any period longer than one month that precedes a waiting period, the Departments refer back to the general rule, which provides that the 90-day period begins after an individual is otherwise eligible to enroll under the terms of a group health plan. While a plan may impose substantive eligibility criteria, such as requiring the worker to fit within an eligible job classification or to achieve job-related licensure requirements, it may not impose conditions that are mere subterfuges for the passage of time. These final regulations provide that the one month period would be determined by adding one calendar month and subtracting one calendar day, measured from an employee's start date in a position that is otherwise eligible for coverage. For example, if an employee's start date in an otherwise eligible position is May 3, the last permitted day of the orientation period is June 2. Similarly, if an employee's start date in an otherwise eligible position is October 1, the last permitted day of the orientation period is October 31. If there is not a corresponding date in the next calendar month upon adding a calendar month, the last permitted day of the orientation period is the last day of the next calendar month. For example, if the employee's start date is January 30, the last permitted day of the orientation period is February 28 (or February 29 in a leap year). Similarly, if the employee's start date is August 31, the last permitted day of the orientation period is September 30. The final regulations continue to provide that if a group health plan conditions eligibility on an employee's having completed a reasonable and bona fide employment-based orientation period, the eligibility condition is not considered to be designed to avoid compliance with the 90-day waiting period limitation if the orientation period does not exceed one month and the maximum 90-day waiting period begins on the first day after the orientation period. But compliance with these final regulations is not determinative of compliance with Section 4980H of the Code (employer mandate), under which an applicable large employer may be subject to an assessable payment if it fails to offer affordable minimum value coverage to certain newly-hired full-time employees by the first day of the fourth...

Blue Cross Blue Shield of Michigan issued the following statement regarding the transition of group customers with 50 to 99 employees into ACA-compliant plans:

On May 13, 2014,  the IRS issued Q&A guidance restating the conclusion in Notice 2013-54, that an employer is considered to establish a type of group health plan-called an "employer payment plan"-if it reimburses employees' premiums for individual health insurance policies.

The Obama administration announced updates to model notices informing workers of their eligibility to continue health-care coverage through the Consolidated Omnibus Budget Reconciliation Act. The updates make it clear to workers that if they are eligible for COBRA continuation coverage when leaving a job, they may choose to instead purchase coverage through the Health Insurance Marketplace.

Health Savings Account limits to increase in 2015 - The Internal Revenue Service has released 2015 minimums and maximums for HSAs and related high-deductible health plans.