USA: Alliant Compliance Fast Facts & FAQ – July 15 2016

The following information was provided by Alliant, Asinta’s partner in the United States.

New Exchange Appeal Materials

Federally-facilitated exchanges and certain state-operated exchanges have issued an optional form for employer appeals. Employers can still appeal an exchange notice by letter but the form simplifies the appeal process. Click here if you have clients who have received notices saying they may be subject to an Employer Shared Responsibility Payment (e.g. Pay or Play penalty) who would like to appeal. This form can be used if your clients have received notices from any federally-facilitated exchange, or the following state exchanges:

  • California
  • Colorado
  • District of Columbia
  • Kentucky
  • Maryland
  • Massachusetts
  • New York
  • Vermont

The form has instructions on timing, how to submit, and what to expect after the form’s been filed. If your clients need additional support, feel free to share our sample completed appeal form (attached to this FFF) along with our FAQ “What to Do If You Get a Letter from an Exchange”.

FAQ Guidance on the new SBC Template

The FAQ guidance addresses the applicability date of the latest SBC template (“2017 SBC”) that was released on April 6, 2016. Groups health plans with an annual open enrollment period (under the ACA all groups should have an annual OE), are required to use the 2017 SBC beginning on the first day of any open enrollment period that begins on or after April 1, 2017.  Calendar year plans, therefore, are not required to use the 2017 SBC at their next open enrollment. In addition to the effective date of the 2017 SBC, the FAQ addresses what value health plans and issuers should enter on the new coverage example for “Treatment of a Simple Fracture”? The FAQs provide that until further notice, plans and issuers should enter default values of “$0” on each field for this example.

The new SBC materials are available here:  https://www.dol.gov/ebsa/healthreform/regulations/summaryofbenefits.html

Question of the Week

Q:  Under Pay or Play, what happens when an employee is out on disability leave?  Do those hours count toward their full-time status?

A:  It depends. Disability leave can mean many things and the meaning can differ from employer to employer. For purposes of the Pay or Play and full-time employee determinations, the hours of an employee who is out on short term disability leave and or long term disability leave under an employer-sponsored policy will count toward their full-time status determination. This is true for both the monthly method and the look-back method. These hours will continue to count as hours worked for the duration of STD/LTD leave as long as the individual is employed. See our Calculating Hours of Service piece for additional information.

Thanks again to Alliant for providing us with this content.