Monday, July 1, 2013

Meet IRS Form 1095-A

July 1, 2013

Officials at the Internal Revenue Service have been plowing ahead with efforts to set up the machinery needed to make the Patient Protection and Affordable Care Act (PPACA) health insurance exchange system work.
PPACA calls for the exchanges, or Web-based health insurance supermarkets, to offer premium tax credits for moderate-income consumers who cannot get affordable, high-quality coverage from their employers.
In "Information Reporting for Affordable Insurance Exchanges" (Reg-140789-12) (RIN 1545-BL42), a set of draft regulations, the IRS has proposed the regulations exchanges would use to report on consumer tax credit eligibility to the IRS and tell the consumers what information was flowing to the IRS.

An exchange would send information about the individuals enrolled in the "qualified health plans" (QHPs) sold through the exchange every month, "on or before the fifteenth day of the month following the month of coverage," according to the preamble to the proposed regulations.
"Each taxpayer or responsible adult who enrolled, or whose family member enrolled" in an exchange QHP would get a summary of the information going to the IRS on a new form, the Form 1095-A.
An exchange would have the send the statement to the taxpayer or responsible adult "on or before January 31 of the year following the calendar year of coverage."

The draft regulations are set to appear in the Federal Register Tuesday. Comments on the draft regulations will be due 60 days after the official publication date.

In related news, the IRS also has published two batches of advice explaining how IRS officials are interpreting the premium tax credit rules.

In IRS Notice 2013-41, officials talk about how potential access to coverage through special health insurance programs, such as a state Children's Health Insurance Program (CHIP) plan or the TRICARE health plan for military dependents, might affect eligibility for exchange premium tax credits.

Officials have decided, for example, that individuals who lose eligibility to Medicaid or CHIP coverage because they fail to pay their share of the premiums for those programs will not be eligible for exchange premium tax credits.

Individuals who are eligible for state high risk pools, state high-risk pools, student health plans, TRICARE programs, and "Medicare Part A coverage requiring payment of premiums" will be ineligible for premium tax credits only if they are actually enrolled in those types of coverage programs, not if they are simply theoretically eligible to enroll in the programs.

Public comments on the notice are due Aug. 26.

In another notice, IRS Notice 2013-42, officials talk about how to interpret the PPACA rules for individuals who are eligible for employer-sponsored health plans with plan years that start on a date other than Jan. 1.

http://www.lifehealthpro.com/2013/07/01/meet-irs-form-1095-a?eNL=51d1d7e8150ba0e20e000225&utm_source=HCRW&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=105824905

Court rules Hobby Lobby can challenge PPACA

June 27, 2013

DENVER (AP) — In a health care decision giving hope to opponents of the federal birth-control coverage mandate, a federal appeals court ruled Thursday that Hobby Lobby stores won't have to start paying millions of dollars in fines next week for not complying with the requirement.

The 10th Circuit Court of Appeals in Denver decided the Oklahoma City-based arts and crafts chain can proceed with its case and won't be subject to fines in the meantime.

The reprieve gives Hobby Lobby Stores Inc. more time to argue in a lower court that for-profit businesses — not just currently exempted religious groups — should be allowed to seek an exception if the law violates their religious beliefs. The company had sued to overturn the mandate on grounds that it violates the faith of founder and CEO David Green and his family.
The appeals court remanded the case for more argument, but the judges indicated Hobby Lobby had a reasonable chance of success.
"Sincerely religious persons could find a connection between the exercise of religion and the pursuit of profit," the judges wrote. "Would an incorporated kosher butcher really have no claim to challenge a regulation mandating non-kosher butchering practices?"
More than 30 businesses in several states have challenged the contraception mandate. Hobby Lobby and a sister store — Christian booksellers Mardel Inc. — won expedited federal review because the chain would have faced fines Monday for not covering the required forms of contraception.
The U.S. Department of Justice has argued that allowing for-profit corporations to exempt themselves from requirements that violate their religious beliefs would be in effect allowing the business to impose its religious beliefs on employees.
Lawyers for the Green family called the ruling a "resounding victory for religious freedom."
The Greens "run their business according to their Christian beliefs," said Emily Hardman, spokeswoman for the Washington-based Becket Fund for Religious Liberty, which represents Hobby Lobby.
Americans United for Separation of Church and State said the judges were wrong to say Hobby Lobby had a case.
"This court has taken a huge step toward handing bosses and company owners a blank check to meddle in the private medical decisions of their workers," executive director Barry Lynn said in a statement. "This isn't religious freedom; it's the worst kind of religious oppression."
The 10th Circuit opted to hear the case before eight active judges, not the typical three-judge panel, indicating the case's importance.
Hobby Lobby's lawsuit will now head back to U.S. District Court for the Western District of Oklahoma, which earlier ruled against Hobby Lobby's religious exemption request.
Hobby Lobby calls itself a "biblically founded business" and is closed on Sundays. Founded in 1972, the company now operates more than 500 stores in 41 states and employs more than 13,000 full-time employees who are eligible for health insurance.
http://www.benefitspro.com/2013/06/27/court-rules-hobby-lobby-can-challenge-ppaca?eNL=51cc8aee160ba08a62000319&utm_source=BenefitsProNewsAlert&utm_medium=eNL&utm_campaign=BenefitsPro_eNLs&_LID=95777790

Employer Sponsored Health Insurance on the Way Out?

Posted: June 27, 2013 at 11:15 am
A significant portion of employers that currently offer health insurance to their employees are likely to drop that benefit in the next five years. According to a survey by J.D. Power, a division of McGraw-Hill Financial Inc. (NYSE: MHFI), some 15% of employers either definitely or probably will not offer health coverage to employees.
 
The conclusion the Power draws is that “health plans risk losing group business unless they improve employer satisfaction.” As one might expect, cost is an important factor, but so are program offerings like preventive health programs and wellness initiatives.
In the fully insured segment, the highest rated insurer is Health Care Services Corp. (HCSC), with a score of 741 out of a possible 1,000 points. Cigna Corp. (NYSE: CI) and Kaiser are tied for second with a score of 737, and Aetna Inc. (NYSE: AET) is third at 724.

In the self-insured segment, Cigna is rated highest at 707, with Aetna second at 694, followed by WellPoint Inc. (NYSE: WLP) and UnitedHealth Group Inc. (NYSE: UNH) at 692 and 669, respectively.

On the issue of cost, J.D. Power notes:
Cost satisfaction among employers that indicate they intend to continue sponsoring coverage in the future is 106 points higher than among those that intend to drop coverage (696 vs. 590, respectively). Satisfaction with cost is improving as more consumer driven high-deductible plans are offered to employees, which 82 percent of employers indicate are controlling costs.
Competition from public and private exchanges is set to begin later this year in most states, and that may be another reason that so many employers are seriously considering dropping their existing coverage. Government-sponsored health insurance is expected to cost less and some employers are likely thinking that it is not worth the trouble to offer insurance.
Paul Ausick

Top Obamacare official sees problems, would be 'surprised' if it starts well

By PAUL BEDARD | JUNE 25, 2013 AT 10:05 AM
A top administration aide in charge of implementing Obamacare said on Tuesday that he would be "surprised" if it starts perfectly, the latest gloomy assessment of the massive revolution in how Americans get health insurance.
Gary Cohen, deputy administrator and director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services, told a friendly audience at the Brookings Institution that the early kinks in Obamacare should eventually even out, but that the beginning will be messy.
Citing critical press reports questioning whether the administration will be ready on January 1, the official kickoff of Obamacare, Cohen said, "Will it be as wonderful on the first day as it is on the 30th day, or the 60th day, or the 90th day, or year five? Maybe not."
He added, "I certainly wouldn't claim that we're not going to have any problems at and everything's going to work perfectly. I would like for that to happen. But it would be a surprise, I think, if that were to happen."
Instead, he said, that the public has "to recognize that this is a big thing, it is complex, it does involve a lot of people and a lot of moving parts in terms of technology and other things, but it is happening and we are on schedule, we are hitting our milestones."
Mandy Cohen, the senior technical advisor for Obamacare, also said that the administration will mount a paid media campaign to promote the health reform when enrollment begins in October. She added that the focus will be on the mothers of younger Americans who aren't eager to pay for health care.
Paul Bedard, The Washington Examiner's "Washington Secrets" columnist, can be contacted at pbedard@washingtonexaminer.com.
http://washingtonexaminer.com/top-obamacare-official-sees-problems-would-be-surprised-if-it-starts-well/article/2532353?goback=%2Egde_2889111_member_252995743

FASB proposes new accounting for insurance contracts

Some welcome opening what analysts have termed "the insurance black box of financials"
June 28, 2013

The Financial Accounting Standards Board (FASB) Thursday issued for public comment a controversial proposal that would change financial reporting of insurance contracts, fundamentally reconstructing the measurement of insurance liabilities and income as they are reflected in income and earnings statements.

The proposed update would apply to all contracts that meet the definition of an insurance contract, not just those written by insurance companies. It would also apply to ceding insurers in reinsurance contracts.
Basically, it would require accounting to be based on current assumptions of cash flows to fulfill the coverage on a quarterly basis, adjusted for the time value of money--even if the claims are not being paid out for years. 
Currently, as analysts note, U.S. Generally Accepted Accounting Principles (GAAP), which requires insurance premiums for long-duration contracts to be recognized when due, not quarterly. The proposal would not go into effect until 2018. 
The move is an effort to update GAAP and make the accounting standards more comprehensive as well as forward-looking, or principles-based, and also work toward a converged international standard, although the new proposal falls a bit short on that. The industry is hopeful, however, for more deliberations--starting in January--to iron out differences between the U.S. and European models. 
The FASB proposal was developed as part of its broader joint project with the International Accounting Standards Board (IASB), which released its own proposal June 20. Both proposals contain similar fundamentals--most notably the use of current estimates--but differences exist, FASB noted in a statement.
The proposed changes to insurance contract accounting will introduce volatility into financial statements, according to rating agencies and analysts. However, some in the industry do not mind, as long as there is one global standard.

The accounting convergence work got underway more than a decade ago, at least, but in the past few years it has taken on a greater urgency as the international community, led by Europe, pressures for commonality and convergence on a great number of financial work streams in the wake of the global economic crisis. 

“The proposed standard is intended to bring greater consistency and relevance to the accounting for contracts that transfer significant risk between parties,” stated FASB Chairman Leslie F. Seidman in a statement. “Current U.S. standards on insurance have evolved over the years as new products have been introduced, leading to some inconsistencies in GAAP. The proposed standard would require a current measure of insurance contracts, including the use of updated assumptions and discounting."
The proposed update would require contracts that transfer significant insurance risk to be accounted for in a similar manner, regardless of the type of institution issuing the contract. Thus, it would apply to banks, guarantors, service providers and other types of insurers, in addition to traditional insurers.
An insurer would recognize revenue in net income in proportion to the value of coverage or services provided. Claims and contract-related expenses would be recognized when incurred. This is a bit like marking to market, although there is no "market," for long-tail insurance claims, as one analyst noted.
Any amounts received that are expected to be returned to the policyholder or the policyholder’s beneficiary, regardless of whether an insured event occurs, would be excluded from revenue and expenses. 
The contracts most used by life, annuity and long-term health insurers would use one approach, the so-called “building block” approach, and the contracts most used by property casualty insurers and short-term health writers would use another approach, the "premium allocation" approach. 

The building block approach would be measured each reporting period based on the current present value of the fulfillment cash flows. This would be based on the expected value that incorporates all relevant information and considers all features of the contract, including guarantees and options. The measurement would also include a margin that initially reflects the expected profitability of the contract. 

The premium allocation approach would include a liability for remaining coverage that represents the gross cash inflows not yet earned and is released in subsequent periods on the basis of the expected timing of incurred claims and benefits. A separate liability would be recorded when the claim is incurred and be measured based on the expected present value of future cash flows.

"In general, it will introduce volatility across all lines of business, and not just because of quarterly updates or the quarterly reset," said J. Paul Newsome, managing director and the senior insurance analyst in the Research Department of Sandler O’Neill + Partners in Chicago. "There is more volatility in the building block accounting method because you are introducing more assumptions into the insurance," Newsome said.

Mike Monahan director of accounting policy at the American Council of Life Insurers (ACLI), said the member companies are “100 percent behind” global accounting convergence and are optimistic that further deliberations will be joint (FASB and IASB) and they would be able to iron out remaining differences.

“We do not want a separate set of books for our multi-nationals. We hope they pick one method and go with it,” Monahan said.  

For example, there is the use of a single margin for unearned profit on insurance contracts by FASB and a double margin--a risk margin and a service margin of embedded profit--favored by Europeans and the IASB. 

“...These are not big differences. The pain is keeping track of two separate systems,” Monahan said.

As for volatility, Monahan said, “We don’t believe in masking volatility--we believe you should be showing that. Under the current system, the numbers are hidden. Now they will be there for all to see, so there is no black box mentality (as some analysts suggest of insurers’ financials). 

The draft accounting methodology “would open the box and show the moving parts,” Monahan said.

“There is more transparency, which we think is important."

“If the IASB and FASB are successful, a version of  the building block method will be used by most countries on a global basis and there will be more consistency of accounting possibly globally from a theoretical perspective, but I am not so certain you will have better comparability because so much subjectivity in how the accounting is prepared,” Newsome said.  

The purpose behind this standard is more political than anything else, he noted.

“The proposal could significantly change key performance indicators such as net loss and expense ratios for entities with significant reinsurance programs,” stated Ernst & Young accounting in a report on the proposed rules.

A lot of this is driven out of Europe and not the United States. The Europeans do not have a standard, therefore they are creating one. The U.S. and much of North American and the offshore communities, which have half the world’s insurance,  already have a standard (GAAP) but it is incompatible with IASB standards. “It is a little like the tail wagging the dog,” Newsome said.

Under both FASB and IASB proposed approaches, an insurer would recognize revenue in net income in proportion to the value of coverage or services provided. Claims and contract related expenses would be recognized when incurred. Any amounts received that are expected to be returned to the policyholder or the policyholder’s beneficiary regardless of whether an insured event occurs would be excluded from revenue and expenses. 

Comments for both the FASB proposed update and the IASB exposure draft are due at the end of October. The FASB website offers a general overview of the proposal and one that focuses on the types of companies and contracts that would be affected by it.

http://www.lifehealthpro.com/2013/06/28/fasb-proposes-new-accounting-for-insurance-contrac?eNL=51cde19f150ba0b055000162&utm_source=LifeHealthProDaily&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=97614151

Today's Datapoint

14 … health insurance exchanges will soon carry products from Humana Inc., according to the insurer’s CEO Bruce Broussard, in a Reuters interview.

Quote of the Day

“The fact that [the testing of the Federal Services Data Hub, which will link state exchanges to several federal agencies] went as smoothly as it did [for the Maryland Insurance Exchange] is very encouraging. Maryland is way ahead on this, but most state systems are barely being held together with spit and rubber bands.”

— John Gorman, founder and executive chairman of Gorman Health Group, told the audience at his firm’s recent annual forum outside Washington, D.C.