Skip to main content

Proposed Regulations

Proposed out-of-pocket maximums for 2018

The Department of Health and Human Services (HHS) recently announced the proposed out-of-pocket (OOP) maximums for 2018. The proposed amounts for 2018 are $7,350 for single coverage and $14,700 for family coverage. Please note, the QHDHP amounts are still to be determined for 2018.  We will share more information once the amounts are finalized for 2018. 


As a reminder, the limits for 2017 plan years are $7,150 for single coverage and $14,300 for family coverage.

Proposed regulations issued for premium tax credits and opt-out payment affordability implications

The IRS issued proposed regulations on July 8 regarding premium tax credits and opt-out payment affordability implications. These proposed regulations are a round-up of previous guidance that is currently being followed and would be effective for taxable years beginning on or after January 1, 2017. While there is nothing new in the proposed regulations, we’ve summarized the requirements below for you:   


  • Individuals are not eligible for premium tax credits if they are offered affordable, minimum value coverage under an employer-sponsored health plan. Coverage is deemed affordable if the employee’s required contribution for employee-only coverage does not exceed 9.5 percent (as indexed) of the employee’s household income.
  • If an employer offers funds to employees who opt-out of employer-sponsored health coverage, the amount must be added to the employee’s required contribution for determining affordability regardless of enrollment in the plan. 
  • Payments made to an employee would not be counted toward the affordability determination if each year the employee declines employer-sponsored coverage and provides evidence of other coverage (cannot be coverage in the individual market). 
  • No premium tax credit would be given to any employee who is offered an annual opportunity to enroll in employer-sponsored plan and declines coverage.
  • An employee will not lose their premium tax credit if they enroll in an excepted benefit plan offered by their employer as these plans are not considered to provide minimum essential coverage.


You can read more about opt-out payments and affordability here


If you have any questions, please contact your Client Solutions team.

Proposed regulations for 6055 reporting on catastrophic plans and Social Security Number solicitation

On August 2, 2016, the IRS released proposed regulations for 6055 reporting that is required under the individual mandate.  The proposed regulations mainly reinforce existing provisions, but there were certain new requirements added. Below is a chart that provides a high-level summary of these proposed regulations. 


ApplicabilityEffective DateAction Required
These rules would apply to all employer-sponsored health plans, regardless of group size. These proposed rules may be relied upon until final regulations are issued with the exception of reporting of coverage under catastrophic plans. As proposed, the rules for catastrophic coverage would apply for calendar year reporting beginning with 2017.   No formal action is required at this time as these regulations are only proposed.

New Requirements ProposedPrevious Requirements Reinforced
  • When reporting catastrophic coverage, issuers of catastrophic plans will report this coverage on IRS Form 1095-B. Reporting is voluntary for 2016 calendar year coverage. Those who report early will not be subject to penalties.  Exchanges aren’t required to report on catastrophic coverage.
  • The first annual SSN solicitation should be made no later than 75 days after the date on which the filing entity received the completed application for coverage on which the applicant did not include their SSN (or those of their dependents).
  • A reporting entity that makes the first annual solicitation (the second collection attempt) within 75 days of the initial solicitation will be treated as having made the second collection attempt within a reasonable time. 
  • For solicitations of SSNs of individuals already enrolled in coverage on any day before July 29, 2016, the relationship between the member and the reporting entity is considered to have been established on this date. 
  • Reporting entities have satisfied the initial solicitation attempt if they have requested the SSN as part of the application process or at any other time prior to July 29, 2016. 
  • Reporting entities that have not made the initial solicitation before July 29, 2016, should comply with the first annual solicitation requirement by making a solicitation within a reasonable timeframe after July 29, 2016. A specific timeframe has not been given.  • If a person is covered by more than one minimum essential coverage (MEC) plan provided by the same reporting entity, reporting is only required of one plan. 
  • If an employer offers both a group health plan and an HRA for which the employee is eligible and enrolled, the employer does not have to report the coverage for the HRA as long as the employee remains enrolled in the non-HRA health plan.  
  • The EIN of employer sponsoring health plan may be truncated (half of the number may be masked) on individual statements.
  • SSN solicitation of the responsible individual (the individual under whom other members are enrolled in coverage) counts as solicitation of every covered individual enrolled under that member.
  • SSNs must be solicited as members are added throughout the year (when adding a dependent after SSN solicitation attempts have been made). 
  • The deadline for the second annual solicitation (which is the third attempt to obtain a SSN) is still by December 31 of the following year. 
  • Health coverage providers may satisfy the requirement to solicit SSNs by requesting a SSN as part of an application for coverage.
  • A reporting entity is considered to have satisfied all SSN collection attempts for an individual whose coverage termed prior to September 17, 2015.


If you have any questions, please contact your Client Solutions team.


Compliance Quarterly is being provided as an informational tool. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this publication and any attachments, Meritain Health is not exercising discretionary authority over the plan and is not assuming a plan fiduciary role, nor is Meritain Health providing legal advice.


Published November 15, 2016