benefitfocus eMPLoYeR RoadMaP

as the industry-leader in healthcare and benefits software, our

goal at benefitfocus is to provide technology that makes life

easier for our clients. to achieve that purpose, we’re focused on

the readiness of benefitfocus HR intoucH® for relevant

provisions of the Patient Protection and affordable care act

(PPaca) – otherwise known as healthcare reform. employers

will have access to the tools they need to remain compliant,

understand requirements and take advantage of new options

as they shop, enroll, manage and exchange benefit information.

benefitfocus HR intouch is built on a comprehensive eligibility

rules engine that handles complex plan designs, business rules

and reporting. our technology is cloud-based and can meet

many current and future PPaca requirements. We’re also

making new investments to ensure that you not only abide by

the law, but also understand and benefit from subsidy programs

and other offerings. this timeline breaks down key features of

the PPaca and specifically outlines how HR intouch meets and

exceeds business needs relevant to each provision.

Dependent Coverage

extends dependent coverage

to children up to age 26 for all

individual and group policies.

increases plan age eligibility to age 26 for children and students.

Provides reinstatement options for previously canceled dependents.

notifies clients of outdated plan materials with plan age out rules.

identifies clients with invalid dependent age-out rules and updates coverage for dependents up to the age of 26.

Pre-Existing Conditions

eliminates denial of coverage

for dependents under the age

of 19 based on a pre-existing

condition. in 2014, no member

shall be denied coverage due

to a pre-existing condition.

eliminates pre-existing condition clauses for dependents.

includes life events and reinstatement options for previously canceled dependents.

allows carriers and employers to waive pre-existing exclusions for specific employees.

Tax Advantage Savings Accounts

increases the penalty for

non-qualified withdrawals

from Health savings accounts

(Hsas) to 20 percent and

excludes non-prescription,

over-the-counter drugs from

tax-free reimbursement.

Reduces tax-free individual

contribution to flexible savings

accounts (fsas) to $2,500

beginning January 1, 2013.

Helps employers and consumers understand these changes through integrated video, email notifications and plan documents loaded into HR intouch’s enrollment workflow.

configures the Platform to cap fsa contributions based on new federal levels.

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Employee Notifications for State Exchanges

by March 1, 2013, employers

must notify employees

about state health insurance

exchanges, whether the

employer’s plan meets

minimum coverage

requirements and how to

access information regarding

premium subsidies that might

be available for exchange

based coverage.

enables HR staff to send notifications through the Platform and house all relevant information in the employee portal for convenient online access.

Provides video communication to explain state exchanges to employees.

W-2 Reporting

beginning with the tax year

2012, employers must calculate

and report the aggregate

cost of applicable employer-

sponsored health insurance

coverage on employees’

form W-2s.

automatically sends the appropriate deduction amounts broken out by benefit type for each employee to your payroll system so that the cost of coverage can be accurately calculated and reported on the W-2.

Wellness Programs & Rewards

the government will provide

grants for up to five years to

small employers that establish

wellness programs. the law

will permit employers to offer

rewards – in the form of

premium discounts, waivers

of cost-sharing requirements

or benefits that would not be

provided – of up to 30 percent

of the cost of coverage for

participating in a wellness

program and meeting certain

health-related standards.

Provides an educational video on the wellness grant provision.

supports the automation of premium discounts and benefits based on wellness program participation.

Employer Mandate

employers must create an

essential health benefits

package that provides a

comprehensive set of services,

covers at least 60 percent

of the actuarial value of the

covered benefits, limits annual

cost-sharing for individuals

and families and is not more

extensive than the typical

employer plan.

supports complex business rules and a variety of plans based on benefit design needs and incorporates new essential benefit packages designed by employers.

Requires employees and consumers to acknowledge that they can only be covered in particular situations – for example, if they do not have coverage elsewhere.

Grandfathered Plans

Grandfathered plans must

comply with information

transparency requirements,

allowing consumers to compare

plan benefits, cost sharing

requirements, renewability

and continuation of coverage

provisions. an employer

sponsoring a grandfathered

plan must maintain records

documenting the coverage in

effect on March 23, 2010, and

documents to verify, explain or

clarify grandfathered status.

Provides plan and benefit summary information within HR intouch.

enables administrators to update plan summary within HR intouch to align with the standards defined by the department of Health and Human services (HHs).

Employer Penalty

beginning in 2014, the

law will impose penalties

on employers under

certain circumstances. if

large employers (over 50

employees) offer coverage,

but an employee receives

a tax credit or cost-sharing

subsidy through the state

Health insurance exchange,

then the employer pays the

lesser of either a $3,000

penalty for each full-time

employee receiving a subsidy

or $2,000 per full-time

worker after subtracting the

first 30 full-time workers.

identifies and captures the specific reasons as to why employees are declining coverage.

Employer Reporting

beginning in 2014, large employers will

be required to report:

• if they offer benefits to their full-

time employees (and dependents)

• the opportunity to enroll in

minimum essential coverage under

an employer- sponsored plan

• the length of any applicable waiting

period

• the lowest cost option in each of

the enrollment categories

• the employer’s share of the total

allowed cost option in each of the

enrollment categories under the plan

• the names, numbers, addresses

and taxpayer ids of all full-time

employees receiving coverage

offers a treasury Report that allows employers to report summary and employee- specific information for PPaca-required data, which will be in the treasury department’s required format and can be saved or printed for submission.

Individual Mandate

Requires individuals to

maintain a minimum level of

health insurance coverage

for each month beginning

in 2014. individuals will

be required to purchase

qualified health insurance

or pay a fine of $95 for

each family member or one

percent of taxable income,

whichever is greater.

integrates plan shopping tools that help individuals find appropriate plans, estimate out-of-pocket costs and provide persona-based product recommendations.

Wait Periods

the PPaca mandates that

enrollment waiting periods

may not exceed 90 days.

configures wait periods to comply with the new requirement.

Proactively identifies all existing sponsors whose medical new hire rules have a wait period greater than 90 days.

Auto Enrollment

beginning in 2015, the law

will require employers with

more than 200 employees

to automatically enroll

employees into an employer-

sponsored health insurance

plan, giving employees the

ability to opt-out after the

auto enrollment.

allows employers to configure automatic enrollment through HR intouch and allows employees to opt-out online through the user portal.

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RM100 3-13