November 12, 2014 – Notice from the Department of Health and Human Services (HHS) and the Department of the Treasury (including the Internal Revenue Service) regarding Group Health Plans that Fail to Cover In-Patient Hospitalization Services

The IRS has announced that it will amend proposed Affordable Care Act (ACA) regulations to clarify that plans that do not provide substantial coverage for in-patient hospitalization services or for physician services (or for both) (referred to as Non-Hospital/Non-Physician Services Plans) will not satisfy the minimum value (MV) requirement regardless of whether they appear to do so through the online MV Calculator (Excel® file), along with the Department of Health & Human Services’ MV Calculator Methodology (PDF).

An employee who is offered coverage under an eligible employer-sponsored plan that provides affordable and MV coverage may not receive premium tax credit assistance for coverage on the public exchange. An applicable large employer may be subject to a section 4980H assessable excise tax payment of $250 per month for each full-time employee who receives premium tax credit relief on the public exchange where employer-sponsored coverage is offered but does not satisfy the MV requirement.

Click to read the full notice (PDF)