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Tools & Resources

We're committed to providing the information you need to navigate national health care reform, fulfill new responsibilities, and make informed decisions. Choose from the categories below for a collection of helpful tools and resources.

Tax Credits Help Make Coverage More Affordable
Do you purchase health insurance directly? If your job doesn't offer an employer-sponsored plan and you are under age 65, you may qualify for a tax credit to make your premiums more affordable.

Under health care reform, these premium tax credits start in January 2014, and enrollment begins this October. The tax credits will be based on income. To find out if you qualify, use the health care reform subsidy calculator
Dependent Coverage to Age 26
Important Employer Information for Dependent Coverage to Age 26
This fact sheet outlines employer responsibilities and includes information on the mandated 30-day enrollment period, model language for notifying employees, and our dental coverage extension.

Important Notice: Extension of Dependent Coverage to Age 26
This customizable document is designed to help employers notify employees that their dependents under age 26 may now be eligible to enroll in their group health plan or health insurance coverage.

Dependent Care Coverage Extension to Age 26 FAQs
Answers to frequently asked questions about extended dependent coverage to age 26.

For more information on this topic, please see the Dependent Coverage—Extension to Age 26 provision.
Employer W-2 Reporting Responsibility
W-2 Reporting Requirement
This news item provides information on the IRS draft Form W-2 for 2011 and changes to the new requirement for employers to report health coverage costs.
Grandfathering
The Grandfathering Rule
This fact sheet defines the grandfathering rules, our approach to grandfathering, changes that may result in a loss of grandfathered status, and some advantages and disadvantages of grandfathering.

Should Your Client Grandfather a Group Health Plan?
This decision-making tool can help determine whether or not a client's group health plan could benefit from grandfathering.
Personal Spending Accounts
Changes to Personal Spending Accounts
This news item provides important information about the changes to Personal Spending Accounts beginning in 2011.

Reimbursement Rules for Over-the-Counter Medicines
Answers to frequently asked questions about reimbursement rules for over-the-counter medicines.

For more information on this topic, please see the Changes to Personal Spending Accounts provision.
Preventive Care Coverage
Expanded Coverage for Preventive Care Under National Health Care Reform
This fact sheet explains how coverage will expand for preventive care, such as screenings, immunizations, and other types of services. It also lists the preventive care services with no member cost share for adults and children, as well as any restrictions that may apply.
Small Employer Tax Credit
Small Business Tax Credit Guide
Use this guide to get more information about the small business tax credit program.

IRS Form 8941
This form with instructions can be used by small businesses to calculate the new small business health care tax credit.

Small Employer Tax Credits FAQs
Answers to frequently asked questions about the small business health care tax credit for small employers.

For more information on this topic, please see the Small Employer Tax Credits provision.
Summary of Benefits and Coverage (SBC)
- Summary of Benefits and Coverage (SBC)
  This fact sheet explains the distribution terms of the Summary of Benefits and Coverage (SBC).
- Guide to Your Summary of Benefits and Coverage (SBC)
  This guide helps you understand the new SBC format and explains the information it contains.
- Glossary of Health Coverage and Medical Terms
  This glossary provides common health care terms to better understand and evaluate plan choices. To receive a printed copy, call 1-800-262-BLUE (2583).
Self-funding accounts may use ReportBlueSM to help calculate PCORI
The Affordable Care Act created the Patient-Centered Outcomes Research Institute (PCORI) to help care givers and patients make better care decisions. PCOR is funded in part by a fee assessed on self-insured plans. There are three ways to calculate this fee:
- Actual count method: Total number of lives covered for each day of the plan year, divided by the total number of days in the plan year.
- Snapshot method: Total number of lives covered on one or more dates in each quarter, divided by the total number of dates on which the count was made.
- Form 5500 method: The number of total participants reported on Form 5500.
While we cannot calculate, report, or pay the PCORI fee for self-funded accounts, ReportBlue can be used to obtain a snapshot of the number of covered lives to help you calculate your fee. To learn more about ReportBlue's reporting and analysis options and register, contact your account executive.

Self-funded accounts can use ReportBlue to calculate PCORI
New Taxes and Fees Under the Affordable Care Act
Beginning in 2013, insurers, fully insured companies, and self-funded companies will be required to pay three new taxes and fess:
1. The Patient-centered Outcomes Research Institute (PCORI) fee. The Affordable Care Act created PCORI to help caregivers and patients make better care decisions. Fees from employers and insurance companies that provide medical plans will fund PCORI.Fees will be calculated based on the number of lives covered per year. For our insured accounts, Blue Cross Blue Shield of Massachusetts will file and pay the fees. For our self-funded accounts, plan sponsors must calculate, report, and pay the PCORI fee. The first payment of the annual fee will be due on or before July 31, 2013.
2. The Transitional Reinsurance fee. This program will help stabilize premiums in the individual health insurance market and will be supported by fees from fully insured and self-funded plans on an annual basis. For our insured accounts, Blue Cross Blue Shield of Massachusetts will calculate, report, and pay the reinsurance fee. For self-insured group health plans, the plan must pay the fee. Recent regulations allow for a third party administrator (TPA) or administrative services only (ASO) contractor to submit fees on behalf of a plan. The federal regulations did not establish a process for submission these fees. We expect to be able to submit the fee on behalf of our self-funded accounts, but we can’t say for certain until we receive the appropriate federal guidance.
3. The Health Insurance Industry fee. The Insurer Fee is an annual fee on health insurers beginning in 2014 to help fund the federal and state Exchanges. Health insurers will split the fee, based on their percentage of market share. For plans that are subject to the health insurance industry fee, the fee will be included as part of the health plan premium, spread out over the months the plan is in effect.
See the Affordable Care Act Taxes and Fees Fact Sheet for more information.

This information is provided for informational purposes only and does not constitute legal advice. Please consult your legal counsel regarding your specific situation.

Please note that this content is only intended to describe national health care reform requirements under the Patient Protection and Affordable Care Act (PPACA). It does not address Massachusetts law requirements or the potential impact of Massachusetts law on federal PPACA requirements.

For purposes of PPACA implementation, Blue Cross Blue Shield of Massachusetts assumes the plan year is the policy year, unless an account notifies us otherwise.