Each state Exchange is required to create a Small Business Health Options Program (SHOP). 1 HHS has also provided for a federally facilitated SHOP (FF-SHOP) in states that do not establish a state-based Exchange.2 Participation in a SHOP is strictly voluntary for small employers. Beginning in 2014, however, purchasing employer-provided health coverage for employees through a SHOP is the only way for qualified employers to obtain a small business health care tax credit.3
The DOL, HHS, and IRS issued on Apr. 23, 2013 (1) FAQs, Part XIV,1 addressing changes to the summary of benefits and coverage (SBC) effective for coverage beginning on or after January 1, 2014, and before January 1, 2015, (2) an updated SBC template,2 and (3) sample completed SBC.3
Non-grandfathered plans in the small group market (both inside and outside of the Exchanges) must offer essential health benefits (EHBs) beginning in 2014. Grandfathered plans, self-insured group health plans, and health insurance coverage offered in the large group market are not required to offer essential health benefits. Essential health benefits are ten categories of benefits prescribed by federal law, but their application is based state by state on a typical employer plan in each state. As noted in the following information, insurers may vary benefits within each of the ten categories as long as the benefits offered are actuarially equivalent to the state’s EHB benchmark plan.
Final Regulation – Code § 36B Credit for Lower Income Individuals Purchasing Health Insurance on ExchangePosted February 27th, 2013
T.D. 9611, 01/30/2013, Reg. § 1.36B explains the Code § 36B health insurance premium tax credit enacted by healthcare reform. The regulation applies to tax years ending after Dec. 31, 2013, and provides guidance to individuals related to employees who may enroll in eligible employer-sponsored coverage and who wish to enroll in qualified health plans through Affordable Insurance Exchanges and claim the premium tax credit. The regulations extend these tax credits and subsidies to the purchase of health insurance on state created exchanges and federal exchanges created in states without exchanges of their own.
The Code § 36B credit is designed to make health insurance affordable to individuals with modest incomes (i.e., between 100 percent and 400 percent of the federal poverty level, or FPL) who are not eligible for other qualifying coverage, such as Medicare, or “affordable” employer-sponsored health insurance plans. Eligibility for other coverage is determined on a month-by-month basis. The credit applies beginning in 2014.
Healthcare Reform Facts is now available for purchase.
In March 2010, Congress passed and the President Barack Obama signed into law the Affordable Care Act. PPACA is one of the most major pieces of legislation ever passed in the United States, impacting how medical care is delivered and paid for, and expanding coverage.
The Supreme Court of the United States recently upheld the Affordable Care Act, including its individual mandate requiring nearly all Americans to buy health insurance. The laws are extremely complex, constantly developing and changing, and many important provisions will continue to go into effect over the next several years.
Enter Healthcare Reform Facts, the newest addition to The National Underwriter Company’s popular Facts series. With over 350 of the most frequently asked questions on the tax implications of the new health care reform laws, Healthcare Reform Facts helps navigate the rules, regulations, and scores of requirements for both individuals and employers.
There are many less comprehensive discussions written by an assortment of individuals and groups on various aspects of the law. However, there is not yet a definitive, comprehensive, professional work analyzing and explaining the most important aspects of the law as it relates to employers. The book will focus specifically on what employers (large and small) need to know.
Healthcare Reform Facts offers practical, expert guidance to all the questions any business might have about the taxation-related implications of the new laws. Written by Alson Martin, one the most well-recognized tax and health care experts in the country, this book is an essential component of any financial advisor’s arsenal. It is a must have for financial advisors, attorneys, accountants, insurance professionals and small business owners alike.
Please visit http://www.nationalunderwriter.com/reference-bookstore.html to purchase your copy.