2018 Open Enrollment Changes

Affordable Care Act

The open enrollment has gone through specific changes in design and administration. So the sponsors who are intending to be part of this should know all the changes. I have arranged a checklist for you to analyses whether you make compliance with all the requirements or not.

Design changes:

Grandfathered plan status:

If you have a grandfathered plan, then you need to make sure that the project secures its status by checking the Affordable care act (ACA) requirements. You have to provide the notice of your grandfathered status in the open enrollment. However, if you lost the state for 2018, then you have to confirm that the plan has the remaining additional benefits associated with ACA requirements.

-Out-of-pocket Maximum:

ACA’s out-of-pocket maximum smears all the non-grandfathered plans. However, all these programs have to follow cost-sharing limits on essential health benefits (EHB). There are two types of out-of-pocket maximum plan self only and family coverage. The cost limit of for person just and family coverage for 2018 is $7350 and $14700 receptively. Even in case of having a high deductible health plan, you must have the out-of-pocket maximum lower than ACA’s limits. Which in this case are $6,650 and $13,300 for self only and family coverage respectively? This restriction applies to all non-grandfathered health plan that begins on and after 1st Jan 2014.

Women Counting money - 2021 Open Enrollment Changes
Women getting her blood pressure checked - 2021 Open Enrollment Changes

Preventive health care:

The new changes in ACA demand to covers the specific preventive health care services without striking any cost-sharing orders. So confirm the requirements if you have any such plan.

Health FSA Contributions:

There are new requirements on the limit of health FSA plan contribution. Confirm the limits and discuss them with your employees.

Employers mandate under ACA and the requirements:

Applicable Large Employer Status (ALE):
The status can b grated to an employer only if it has at least 50 full-time employees for a whole calendar years business days. So to get state conform it.
1. Determine your ALE status by calculating the minimum requirement of full-time employees.
2. Identify all of the full-time employees to be included in the calculations.
3. Select a method for calculation of your full-time status from the options given by ACA.
4. You may be liable to a penalty if you do not pay a minimum required coverage to all your full-time employees.
5. Offer the employees at least 60% of the actuarial coverage as a minimum coverage payment.
6. You have to inform IRS and your employees about the payment of health coverage on Form 1095-C.

Comparative Effectiveness Research Fee (PCORI):

All the issuers of health insurance and self-funded plans sponsor have to pay an annual fee payable on every 31 of July. For 2018 the expense increased to $2.26 for each life covered.

  • ACA Disclosure Requirement
  • Summary of Benefits and Coverage
  • Grandfathered Plan Notice
  • -Notice of Patient Protections
  • Other Notices

Initial COBRA Notice

  • Notice of HIPAA Special Enrollment Rights
  • Annual CHIPRA Notice
  • WHCRA Notice
  • NMHPA Notice
  • Medicare Part D Notices
  • HIPAA Privacy Notice
Filing for affordable care act - 2021 Open Enrollment Changes

Summary Plan Description (SPD):

The SPD should be made available to new participants within 90 days, and it should reflect all the changes. The participants must provide with a narrative summary on a form 5500 also known as summary annual report or SAR.

Make sure you check all the requirements and fulfill them before opting for open enrollment.