By Andrew Zajac
July 22 (Bloomberg)
President Barack Obama’s health care overhaul suffered a potentially crippling blow as a U.S. appeals court ruled the government can’t give financial assistance to anyone buying
coverage on the insurance marketplace run by federal authorities.
The decision, if it withstands appeals, may deprive more than half the people who signed up for the Patient Protection and Affordable Care Act the tax credits they need to buy a health plan.
The way PPACA is written makes clear that the subsidy is available only to people who
bought plans on state-run exchanges, a three-judge panel in Washington ruled today.
Only 14 states have opted to set up their own marketplaces, making delivery of tax credits via
the federal exchange crucial to meeting Obamacare’s goal of broadening health-care coverage
in the U.S.
“A very large share of people need the subsidies,” said Robert Blendon, a professor of health
policy at the Harvard School of Public Health in Boston.
If the ruling isn’t overturned, “it basically would significantly cripple the law,” Blendon said in an
interview before the ruling.
If you have medical, dental, vision, Employee Assistance Program, Flexible Spending Account (FSA), Health Reimbursement Arrangement (HRA), Life Insurance, Short or Long Term Disability plans, the Department of Labor may be knocking on your door asking for a Summary Plan Description (SPD) and Plan Document. They will want to know when you distributed the SPD to your employees and how. If you can't provide this information in a timely fashion you may be fined up to $110 per day.
A SPD is an outline of an employee benefit plan(s) provided under ERISA and listed above. It contains information such as the plan administrator, requirements for eligibility and participation in the plan(s), circumstances that result in disqualification or denial of benefits and identity of insurers administering the plan.
Oftentimes employers believe this is the responsibility of the insurance company but it is actually the employer who must make sure they are compliant. Medical, Dental, Vision Insurance companies will issue Certificates of Coverage which may have a great deal of the information that a SPD will have but will usually fall short of the needed language.
Typically with employers of less than 500 employees they will use a "Wrap-Around Plan" which creates a single document for all insured benefits.
If you do not have this in place, you need to get this done as the Department of Labor is starting to audit companies with more tenacity and looking for those dollars to fund the ACA . Costs can range from $200 to $1000 or more.
