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Deductibles Limits Repealed! HR 4302 signed by President Obama

Posted by Tom Stonebraker on Apr 1, 2014 5:12:00 PM

Deductible Limits Gone

On Tuesday April 1st President Obama signed HR 4302 commonly known as the "Doc Fix Bill" primarily designed to delay a 24% reduction in Medicare payments to doctors as well as providing a number of other fixes.

One "fix" that will have a significant impact on the small group market is the elimination of the deductible limits of $2,000 for a single and $4,000 for any other plan under the Affordable Care Act. The original limit was outlined in section 1302(c) on page 48.

HR 4302 states:


(a) In General- Section 1302(c) of the Patient Protection and Affordable Care Act (Public Law 111-148; 42 U.S.C. 18022(c)) is amended--

(1) by striking paragraph (2); and

(2) in paragraph (4)(A), by striking ‘paragraphs (1)(B)(i) and (2)(B)(i)’ and inserting ‘paragraph (1)(B)(i)’.

(b) Conforming Amendment- Section 2707(b) of the Public Health Service Act (42 U.S.C. 300gg-6(b)) is amended by striking ‘paragraphs (1) and (2)’ and inserting ‘paragraph (1)’.

(c) Effective Date- The amendments made by this Act shall be effective as if included in the enactment of the Patient Protection and Affordable Care Act (Public Law 111-148).


You can read the full bill here HR 4302.

Most small employers have been very concerned about how they are going to handle the increased premiums that most likely will ocurr from the ACA.  

A simple fact of insurance is that the sooner the insurance company has to write a check to cover services the higher the premium they have to charge to cover those costs.  So the elimination of the deductible limits is very welcome because it gives the employers much needed flexibility to design plans that fit their budgets and fit their employees needs.

To get more information download our Health Care Reform Bulletin.


Talon Benefits is dedicated to bringing our client partners the best solutions and timely information.  We are here to help you navigate the ever changing regulations of health care reform.

Topics: Obamacare, ACA, PPACA, Healthcare Reform, Deductible Limits, HR 4302

Health Care Reform 2013 changes Checklist

Posted by Tom Stonebraker on Dec 3, 2012 10:58:00 AM

In light of the Supreme Court’s June 28, 2012, decision to uphold the health care reform law, or Affordable Care Act (ACA), employers must continue to comply with ACA mandates that are currently in effect. Employers must also prepare to comply with ACA changes that will go into effect in the future. To prepare for upcoming changes, employers need to be aware of the ACA mandates that will go into effect in 2013.  

This Talon Benefits Legislative Brief provides a compliance checklist for employers for 2013. Please contact your Talon Benefits representative for assistance or if you have questions about changes that were required in previous years.

Topics: Obamacare, Affordable Care Act, ACA, PPACA, Healthcare Reform

PPACA is now Law...Individual Mandates what are they?

Posted by Tom Stonebraker on Jul 16, 2012 12:00:00 PM

Patient Protection and Affordable Care Act (PPACA) was upheld by the Supreme Court.  What does that mean...

BenefitMall one of the vendors I work with has created a great report that goes over what the individual mandates look like.

The some of the questions they answer are:

To whom does the Individual Mandate provision apply?

Who is exempted from the Individual Mandate?

What is "Minimum Essential Coverage"?

How much is the flat tax for individuals?

How will income impact the tax rate?

They give us plenty of informtation without overdoing it and there are links to dive deeper into the law.

To download the report click here: Individual Mandates Explained

Topics: Obamacare, PPACA, Healthcare Reform, individual Mandate, Whis is Exempt

U.S. Supreme Court First Day of Healthcare Reform Arguments

Posted by Tom Stonebraker on Mar 26, 2012 1:06:00 PM

Today was the first day of oral arguments for Healthcare Reform.  Today's arguments are in relation to Department of Health and Human Services. v. Florida.  There will be a lot of opinions expressed about the arguments but I wanted to provide the actual testimony. 

For a transcript Monday 3-26 Oral Arguments PDF.

To play the audio hit play below.

Topics: Obamacare, PPACA, Healthcare Reform, US Supreme Court, Department of Health and Human Servs. v. Florida

Types of Coverages Subject to W-2 Reporting

Posted by Tom Stonebraker on Feb 29, 2012 12:00:00 PM

The Patient Protection and Affordable Care Act (PPACA) requires employers to report the aggregate cost of employer-sponsored group health coverage on employees’ Forms W-2. The purpose of the reporting requirement is to inform employees about the cost of their health coverage. The reporting does not cause employees’ health coverage to become taxable to them.

Most employers are more than willing to let their employees know how much their benefits cost but they aren't sure what needs to be reported.  So attached is a "Health Care Reform Legislative Brief" that we provide to our customers so they know the answer to that question.

Click Here for an easy to read and understand chart of what need to be reported.

Topics: Obamacare, PPACA, Healthcare Reform, W-2, W2

United Healthcare Colorado grants help hospitals cut readmissions

Posted by Tom Stonebraker on Aug 25, 2011 3:05:00 PM

United Healthcare ColoradoThe Denver Post (8/25, Booth) reports United Healthcare of Colorado is granting $1.1 million to help hospitals cut expensive and unhealthy readmissions.

The grants will attack an area highlighted by recent Medicare studies and the Affordable Care Act.  Avoidable readmissions of patients who left a hospital less than 30 days before.


Under the new Patient Protection and Affordable Care Act (PPACA) insurance companies are required to use 80-85 cents from each premium dollar collected to pay for medical care.  Reducing or eliminating avoidable readmissions that cost billions of dollars per year nationwide would reduce insurance premiums by a larger amount.

Click Here to read the full article.

Topics: Obamacare, PPACA, Healthcare waste

Small Employer Federal Income Tax Credit Explained

Posted by Tom Stonebraker on Jan 31, 2011 1:18:00 PM

Small employers who provide health insurance coverage to their employees may not realize they can claim a federal income tax credit on their 2010 filing, due to the Patient Protection and Affordable Care Act (PPACA). Unfortunately, a very low percentage of qualified business owners are taking advantage of this credit according to recent government reports. Even if companies have completed their 2010 filing, they can still submit an amended filing to request this tax credit.

Eligibility Rules
Small group employers must meet the following guidelines to be eligible for this federal income tax credit1. The requirements are a combination of three factors related to the business - size of their company, percentage of health care coverage they provide, and total wages paid.

Firm size. First, there are restrictions on the number of employees that an employer may have. A qualifying employer must have less than the equivalent of 25 full-time workers when totaling all individuals’ hours of employment. When all part-time and full-time hours of employment are combined and divided by a full time 40 hour week, and if the number of employees needed to cover the total hours is less than 25 employees, the employer will qualify for the credit.
Provide health care coverage. Secondly, the employer must confirm that they cover at least 50 percent of the cost of health care coverage for their employees. To determine this, the firm size equivalent number determined above must be used. Next, the employer must know the cost they pay to cover a single full time employee’s insurance premium. The employer must then make the following calculation:
Equivalent firm size multiplied by (X) the cost paid for an individual premium and divided by (/) two.
The above calculation is the percentage of health care coverage that the employer must cover in order to qualify for the credit. Therefore, they do not have to pay full coverage for each employee. They could reach the required premium with some full coverage and some partial coverage of employees.
Total Wages Paid. Finally, there are wage restrictions on the qualifications. Employers with 10 or fewer Full Time Equivalent (FTE) employees, paying annual average wages of $25,000 or less will receive the maximum credit of 35 percent.
Employers with greater than 10 and fewer than 25 Full Time Equivalent (FTE) employees, paying annual average wages of less than $50,000 will also receive the minimum credit of 35 percent of premiums paid.
All tax-exempt organizations that meet either of the above criteria can only claim the minimum credit of 25 percent of premiums paid.
As the IRS states: “The credit is completely phased out for employers that have 25 or more FTEs or that pay average wages of $50,000 or more per year. Because the eligibility rules are based in part on the number of FTEs, not the number of employees, employers that use part-time workers may qualify even if they employ more than 25 individuals.2”

Amount of credit and years available.
As stated by the IRS: “Small businesses can claim the credit for 2010 though 2013 and for any two years after that. For tax years 2010 to 2013, the maximum credit is 35 percent of premiums paid by eligible small businesses and 25 percent of premiums paid by eligible tax-exempt organizations. Beginning in 2014, the maximum tax credit will increase to 50 percent of premiums paid by eligible small business employers and 35 percent of premiums paid by eligible tax-exempt organizations.2”

More information. Please visit the FAQ section on the IRS website as there are several examples listed and helpful questions and answers pertaining to different circumstances.

Claiming the Credit

Small employers, whether businesses or tax-exempt organizations, will use the new Form 8941, Credit for Small Employer Health Insurance Premiums, to calculate the small business health care tax credit.
For-profit small businesses will include the amount of the credit as part of the general business credit on their income tax returns.
Tax-exempt organizations will include the amount of the credit on Line 44f of revised Form 990-T, Exempt Organization Business Income Tax Return. Form 990-T has been revised for the 2011 filing season to enable eligible tax-exempt organizations, even those that owe no tax on unrelated business income, to claim the small business health care tax credit.
For your interest: In an Analysis of the Small Business Health Insurance Tax Credit and Effects on Coverage conducted by the Committee on Small Business Democrats U.S. House of Representatives, a document was created showing the Impact of Health Care Tax Credit, by State. Please take a look at this document, as it pertains to the small group market in each individual state.

For further details , please visit the IRS website. Here the IRS provides form 8941 filing instructions, an informational video as well as a useful FAQ. Also, for further assistance with specific questions which cannot be answered in the information or links provided above, please click here for a state-by-state IRS Taxpayer Assistance guide.

IRS Small Business Health Care Tax Credit for Small Employers http://www.irs.gov/newsroom/article/0,,id=223666,00.html
IRS Helps Small Employers Claim New Health Care Tax Credit; Forms and Additional Guidance Now Available on Small Business Health Care Tax Credit http://www.irs.gov/newsroom/article/0,,id=231928,00.html

Topics: Obamacare, PPACA, Small employer Federal income tax credit explained

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