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Monthly Archives: April, 2018

  • Small Businesses May Be Able to Keep Existing Health Coverage Through 2019

    Policies Renewed Under Extended Transitional Policy Must End by December 31, 2019

    A previously extended transitional policy which allows health insurance issuers, at their option, to continue group coverage that would otherwise be terminated or cancelled has been further extended to policy years beginning on or before October 1, 2019, provided that all policies end by December 31, 2019. Health insurance issuers that renew coverage under the extended policy are required to provide standard notices to affected small businesses for each policy year.

    Policies subject to the transitional relief will not be considered to be out of compliance with key Affordable Care Act provisions, including:

    • The requirement to cover a core package of items and services known as essential health benefits;
    • The requirement that any variations in premiums be limited with regard to a particular plan or coverage to age, tobacco use, family size, and geography;
    • The requirements regarding guaranteed availability and renewability of coverage; and
    • The requirements relating to coverage for individuals participating in approved clinical trials.

    Click here to review the extended transitional policy.

    Visit our ACA by Year & Company Size section for an overview of other requirements related to Health Care Reform.

    To access your HR library, please visit

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  • 2019 Cost-Sharing Limits for Most Group Health Plans Released

    Health Care Reform Updates

    by Team Nash


    HHS Issues Key Rule for 2019

    A new rule from the U.S. Department of Health and Human Services (HHS) addresses, among other things, the requirement under the Affordable Care Act that non-grandfathered group health plans limit annual out-of-pocket cost-sharing for coverage of essential health benefits under the plan. Under the rule, these out-of-pocket expenses may not exceed $7,900 for self-only coverage or $15,800 for family coverage in 2019.

    Please visit our Health Care Reform section for other employer requirements.

    To access your HR library, please visit

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  • Individual Mandate Exemptions Available for 2017 Tax Returns

    Affordability, Tax Filing Threshold, and Other Exemptions Available

    Under the Affordable Care Act’s (ACA) ”individual mandate” (also called individual shared responsibility) provision, every individual must have minimum essential health coverage for each month, qualify for an exemption, or make a payment when filing his or her federal income tax return for tax year 2017.

    Among other exemptions, individuals may claim the following exemptions from the individual mandate by filing Form 8965, Health Coverage Exemptions, along with his or her 2017 tax return:

    • Affordability Exemption: The lowest-priced coverage available to the individual, through either a Health Insurance Marketplace or employer-based group health plan, would have cost the individual more than 8.16% of his or her household income for plan years beginning in 2017, as computed on the tax return.
    • Tax Filing Threshold Exemption: The individual’s gross income or household income was less than the applicable minimum threshold for filing a tax return (see ”2017 Federal Tax Filing Requirement Thresholds”).
    • Short Coverage Gap Exemption: The individual went without coverage for less than three consecutive months during the year.
    • Medicaid Expansion Exemption: The individual’s household income is below 138% of the federal poverty line for his or her family size, and at any time during the year, the individual resided in a state that did not participate in the Medicaid expansion under the ACA. States that did not expand Medicaid for all of 2017 include: Alabama, Florida, Georgia, Idaho, Kansas, Maine, Mississippi, Missouri, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin, and Wyoming.

    Click here to learn more about individual mandate exemptions.

    Be sure to visit our Individual Mandate (Individual Shared Responsibility)section for additional details.

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  • Living Planet Aquarium

    This is a great cause that Team Nash has been behind since the beginning. Please donate what you can.

    You can easily donate here:


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  • Reminder: Counting Employees Vital to ACA Compliance

    Company Size Impacts Application of “Pay or Play”

    Employers are reminded that it is important to know how many full-time employees they have in order to ensure compliance with the employer shared responsibility provisions (“pay or play”) of the Affordable Care Act, which apply only to applicable large employers (ALEs).

    Determining ALE Status
    Whether an employer is considered an ALE for a particular calendar year depends on the size of its workforce during the preceding calendar year. For example, employers will use information about the size of their workforce during 2017 to determine if their company is an ALE for 2018. Employers with an average of at least 50 full-time employees in the preceding calendar year-including full-time equivalent employees (FTEs)-are generally deemed ALEs for the current calendar year.

    Identifying Full-Time Employees
    In general, for purposes of pay or play:

    • A full-time employee is, for a calendar month, an employee who is employed on average at least 30 hours of service per week(130 hours of service in a calendar month is treated as the monthly equivalent of at least 30 hours of service per week).
    • A full-time equivalent employee is a combination of employees, each of whom individually is not a full-time employee, but who, in combination, are equivalent to a full-time employee.

    For additional rules on determining who is a full-time employee, including what counts as an hour of service, click here.

    To learn more about pay or play, check out our Health Care Reformsection.

    To access your HR library, please visit

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  • Reminder: Group Health Plans Required to Offer Special Enrollment

    Certain Events Trigger 30 or 60-Day Special Enrollment Periods

    Under HIPAA, certain events that happen to employees or their dependents trigger a right to “special enroll” in a group health plan. Special enrollment allows individuals who previously declined health coverage to enroll in coverage outside of a plan’s open enrollment period.

    An employee and his or her dependents must be provided at least 30 days to request special enrollment in a group health plan because of:

    • Loss of eligibility for other coverage, such as coverage from a spouse’s employer;
    • Termination of employer contributions toward other health coverage; or
    • Certain life events, including marriage, birth, adoption, or placement for adoption.

    An employee and his or her dependents must be provided at least 60 days to request special enrollment in a group health plan because of:

    • Loss of coverage under a state Children’s Health Insurance Program (CHIP) or Medicaid; or
    • Determination of eligibility for premium assistance under CHIP or Medicaid.

    Group health plans must make all employees eligible to enroll in the employer’s group health plan aware of their special enrollment rights at or before the time an employee is initially offered the opportunity to enroll in the plan by distributing a Notice of Special Enrollment Rights. A downloadable model notice from the U.S. Department of Labor (DOL) is available here (scroll to page 2 of the PDF-marked as page 138). Please note that the DOL’s model notice does not discuss the 60-day special enrollment period requirement mentioned above.

    Check out our HIPAA for All Employers section for additional group health plan requirements under HIPAA.

    To access your HR library, please visit

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    Please Note: The information and materials herein are provided for general information purposes only and are not intended to constitute legal or other advice or opinions on any specific matters and are not intended to replace the advice of a qualified attorney, plan provider or other professional advisor. This information has been taken from sources which we believe to be reliable, but there is no guarantee as to its accuracy. In accordance with IRS Circular 230, this communication is not intended or written to be used, and cannot be used as or considered a ‘covered opinion’ or other written tax advice and should not be relied upon for any purpose other than its intended purpose.

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