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From the Blog
11Aug 22

IRS Announces HSA, ACA Limits for 2023

Deductible and Out-of-Pocket Limits The Internal Revenue Service has announced the deductible, out-of-pocket, and contribution limits for HSA-qualified plans for the 2023 calendar year. The minimum deductible increased from $1,400 to $1,500 for people with single coverage and from $2,800 to $3,000 for people with family coverage, compared with 2022.…

26Apr 21

BCBSTX Settlement Information

Employers who sponsored and employees/individuals who enrolled in a Blue Cross Blue Shield of Texas health plan between 2008 and 2020 may have recently received (or should soon be receiving) a communication by mail or by email about a possible settlement in a class-action lawsuit. Below is some information from…

02Apr 18

Good News and Great News about the BCBSTX provider networks

We’re excited to pass along two big announcements from Blue Cross Blue Shield of Texas (BCBSTX) concerning the provider networks on its HMO and PPO plans. You may receive communication directly from BCBSTX as well. Agreement Reached with Texas Health Resources First, an announcement that will affect all BCBSTX members:…

17Jan 18

How to Determine if an Employer is an Applicable Large Employer (ALE)

This information was copied from the website. Basic Information Two provisions of the Affordable Care Act apply only to applicable large employers (ALEs): The employer shared responsibility provisions; and The employer information reporting provisions for offers of minimum essential coverage Whether an employer is an ALE is determined each…

16Jan 18

Why Are Health Insurance Premiums for Children So High?

We've received a lot of questions and concerns from our individual and small group clients about the big jump in rates for their 2018 renewals. While there are several contributing factors (insurance trend/inflation, everyone's a year older than they were last year, etc.), the number one reason for the premium…

01Mar 17

Employer Newsletter – March, 2017

With the first few weeks of 2017 now behind us and a new administration in the White House, we thought this would be a good time for a quick update. Here are few items that you’ll want to be aware of: Health Reform and the New Administration We know a…

18Nov 16

IRS Extends Due Dates for 6055 and 6056 Reporting

Below is a notice from the National Association of Health Underwriters about today's IRS announcement that it would extend the deadline for providing forms 1095-B and 1095-C to their employees. Today, the IRS released Notice 2016-70, which extends the due dates for certain information reporting requirements for 2016 imposed by…

04Nov 16

New BCBSTX Preferred Pharmacy Network

Beginning January 1, 2017, all small group and individual metallic plans will experience a change to their Preferred Retail Pharmacy Network which allows members to pay the lowest copayment at a network of pharmacies designated as preferred. The preferred pharmacy network includes: Walgreens Walmart (including Sam’s Club Pharmacy) Albertsons (including…

27Sep 16

Important: Changes to BCBSTX Prescription Drug Formulary and Preferred Pharmacies

NOTE: The following announcement applies to Blue Cross Blue Shield of Texas ACA-compliant individual, small group, and mid-market plans but NOT to grandfathered or transitional small group plans (there are no significant changes to the formularies or preferred pharmacy networks for those plans at this time). EFFECTIVE JANUARY 1, 2017:…

29Jul 16

MSP Status for BCBSTX groups must be completed by August 26

For all BCBSTX groups, the annual deadline for information pertaining to employee count is 8/26/2016.  This information is used for the following: To determine if the group plan or Medicare is primary when a member has Medicare To determine if COBRA or State Continuation rules apply when an employee leaves…

25Jul 16

Employer Notices from

Have you received a notice from the Marketplace ( in the past few weeks? If so, you're probably wondering what it means--and what you're supposed to do about it. Here's a very quick overview. The Affordable Care Act requires the Marketplace to send a notice to employers who have one…

07Mar 16

Small employers can keep transitional plans for a few more months

On February 29, the Centers for Medicare and Medicaid Services (CMS) announced that it was extending the timeframe for “grandmothered” or transitional plans that have not yet implemented all of the requirements of the Affordable Care Act (ACA). This is big news for small companies that are trying to keep…

29Dec 15

IRS delays reporting deadlines for applicable large employers

Earlier today, the Internal Revenue Service (IRS) announced that it would give self-insured and applicable large employers additional time to comply with the 6055 and 6056 reporting requirements for 2015. In Notice 2016-4, the IRS said that "additional time to adapt and implement systems to gather, analyze, and report" the required…

24Dec 15

Cadillac tax postponed by two years

A few days ago, President Obama signed legislation delaying the Affordable Care Act’s “Cadillac tax” for two years. The tax on high cost health plans is now scheduled to go into effect in 2020. The provision delaying the excise tax was included in a year-end spending package passed by Congress…

04Dec 15

Why employees of small companies should sign up for Medicare Part B

When an individual turns 65 or is on Social Security Disability for 2 years, he or she is eligible for Medicare Part A (hospital insurance) and Part B (medical insurance). For most people, there’s no charge for Part A since they’ve paid for it during their working years through payroll…

10Nov 15

What is a Medical Emergency?

The Affordable Care Act requires insurance companies to pay for emergency services as an in-network benefit even if you receive care from a non-network provider, but what's the definition of a medical emergency? Well, it may differ slightly from one insurance company to another, but here's the definition found in…

12Oct 15

Employer Reporting under the ACA

Beginning in 2015, employers are required to provide information to their employees and to the IRS about their employer-sponsored health coverage, but there’s a lot of confusion about which employers are subject to the requirement and what tax forms they’re required to file. Here’s a quick overview. Two Requirements There…

05Oct 15

Congress passes bill to retain current definition of small group

Employers with 51 to 100 employees have been understandably worried for the past few months. That’s because, starting with their renewal date in 2016, the Affordable Care Act would re-define them as small employers, making them subject to the modified adjusted community rating rules and the requirement to cover all…

28Sep 15

New IRS Resource helps Employers Understand the Health Care Law

The new ACA Information Center for Applicable Large Employers page on features information and resources for employers of all sizes on how the health care law may affect them if they fit the definition of an applicable large employer. The web page includes the following sections: What’s Trending for…

21Sep 15

Fact Sheet on the Cadillac Tax

The Affordable Care act creates Section 4980(I) of the tax code, often referred to as the Cadillac Tax. Scheduled to go into effect in 2018, the Cadillac Tax is a 40% excise tax on high valued health plans, those with premiums above a certain pre-determine threshold. It would affect all…

14Sep 15

Calculating the Employer Mandate Penalty for 2015

We’ll keep this short and simple, but calculating the employer mandate penalty can get very complicated very quickly. In general, the Affordable Care Act requires employers with 50 or more employees, including full-time equivalents, to offer affordable coverage providing minimum value to those employees working 30 hours per week or…

10Sep 15

JME Webinar: The New Employer Reporting Requirements

Thank you to everyone who attended the New Employer Reporting Requirements webinar September 9th--we hope you found the information beneficial. As promised, you can download a copy of the presentation and access the tax forms and instructions below. The New Employer Reporting Requirements slides (PDF) IRS Form 1094C (2014) IRS…

07Sep 15

Common Ownership Rules

The employer mandate requires companies with 50 or more full-time employees, including full-time equivalents (FTEs), to offer affordable, minimum value coverage to their employees or pay an excise tax. However, it’s possible that a company with fewer than 50 employees could also be subject to the employer mandate if it’s…

31Aug 15

Is Your Company Subject to the Employer Mandate?

With the recent news that the definition of small group will not be expanded to include groups with 51 to 100 employees next year, meaning that mid-sized employers will not be subject to the modified adjusted community rating rules, we thought it might be time for a quick refresher about…

24Aug 15

Children of covered employees still eligible for CHIP

Most employers, especially larger employers, try to provide health insurance to their employees. It’s a great employee benefit that helps attract quality workers and serves as an excellent retention tool. Unfortunately, even though they’d like to, most companies cannot afford to provide health insurance for their employees’ family members. Sure,…

17Aug 15

Is COBRA going away?

COBRA was signed into law back in 1986 and requires companies with 20 or more employees to offer an opportunity for employees and their family members to continue their group health coverage when they lose that coverage for a variety of reasons. One of the purposes of COBRA was to…

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