Category: Affordable Care Act
ACA Update: Enhanced No-Cost Cancer Screenings for Women Coming in 2026
Big changes are coming to women’s preventive care coverage! Starting with plan years on or after December 31, 2025, group health plans and health insurance issuers must expand their no-cost coverage for women’s preventive care. This expansion includes additional breast cancer imaging or testing needed to complete an initial mammogram, as well as patient navigation…
Compliance Recap | Feb. 2025
RESULTS OF AGENCY ENFORCEMENT OF MHPAEA INVESTIGATIONS The U.S. Departments of Labor (DOL) and Health and Human Services (HHS) recently released their latest enforcement findings on the Mental Health Parity and Addiction Equity Act (MHPAEA), covering investigations completed during the 2023-2024 fiscal year. Their report sheds light on key areas of noncompliance and emphasizes the government’s ongoing…
New Legislation Updates ACA Reporting Rules
At the close of 2024, Congress passed two new pieces of legislation: the Paperwork Burden Reduction Act and the Employer Reporting Improvement Act. These laws simplify the Affordable Care Act (ACA) reporting requirements for employers and introduce new limits on the IRS’s authority to enforce “pay-or-play” penalties, among other changes. Under the ACA, applicable large…
ACA Reporting Deadlines for 2025: What You Need to Know
For employers subject to the Affordable Care Act (ACA), staying compliant with reporting requirements is non-negotiable. With 2025 due dates just around the corner, now is the time to prepare for distributing Forms 1095-C to employees and filing with the IRS. These forms provide essential information about health coverage offered to employees and are critical…
The Pay or Play Percentage Increase for 2025
The Affordable Care Act (ACA) requires large employers to offer affordable health insurance coverage to their full-time employees or face a penalty known as the “Pay or Play” tax. This tax is based on the employer’s average monthly wage (AMW) and the number of full-time employees. The affordability rate for employer-sponsored health coverage will increase from 8.39% to…
Medical Loss Ratio (MLR) Rebates: A Timely Reminder
The Affordable Care Act (ACA) introduced the Medical Loss Ratio (MLR) to ensure that health insurance companies spend a significant portion of premiums on medical care and quality improvement activities rather than administrative costs and profits. When insurers fail to meet the MLR threshold, they are required to issue rebates to plan sponsors. Understanding MLR…