PPACA PATIENT PROTECTION AND AFFORDABILITY CARE ACT

Disclaimer

Please note that this presentation and any discussion generated from this presentation is for informational purposes only.

This should not be construed as legal or tax advice. Please seek a qualified lawyer or tax advisor should you need specific advice.

FLORIDA TECH IS SELF- INSURED

THE EMPLOYER IN A SELF-INSURED PLAN REIMBURSES THE ADMINISTRATOR THE AMOUNT IT HAS PAID IN CLAIMS ON BEHALF OF ITS EMPLOYEES AND ENROLLED

FAMILY MEMBERS.  THEREFORE, THE EMPLOYER, NOT THE INSURANCE COMPANY, IS DIRECTLY PAYING MEDICAL CLAIMS AND BEARS THE RISK FOR THOSE COSTS. *

*HTTP://BLOG.HORIZONBLUE.COM/ARTICLEDETAILS/SELF-INSURANCE-WHAT-IT-REALLY-MEANS

A Quick Note on Fully Insured Vs. Self Insured Plans

ObamaCare Vs. Affordable Care Act

What Does The General Public Know?

Employee Vs. Employer

Employee Mandate January 1, 2014Must HAVE coverage

Employer Mandate January 1, 2015Must OFFER coverage

Employee Side- Individual Mandate Individuals must have coverage or pay a penalty

○ Penalty is assessed when you file your personal income tax return and is based on your household income

○ 2014 ranges from $95 per person to $285 per family○ 2015 ranges from $325 per person to $975 per family○ 2016 ranges from $695 per person to $2,085 per family

How to get coverage Coverage will come from a government run

marketplace or their employer’s plan

Employee Side- Marketplaces

www.healthcare.gov

Employee Side- Marketplace Rates

Employee Side- Subsidies

If you have qualified Employer Coverage, Medicaid or Medicare you won’t qualify

$$ Amount Determined at the State level and if Medicaid programs were expanded in that state

FL Medicaid WAS NOT expanded

Also Based on Income Level, # of Children, Smokers vs. Non-smokers, etc.

IRS Reporting Requirements○ Penalty for false information

Employee Side- Coverage Expansion

Young Adults remain on plan until age 26Insurance cannot drop you when you are sickPrevention against gender discriminationLife-time Limits and Annual Maximums can’t be setPre-existing Condition Exclusions not allowedEssential Health Benefits definedFree preventative services

Employer Side- Three Tiers Employer Mandate

Healthcare must be Offered to all Full Time Employees○ Defined as anyone regularly working more than 30 hours per week○ Delayed Until January 1, 2015

Coverage must be Affordable○ W-2 reporting

Coverage must be Essential○ ambulatory patient services; emergency services; hospitalization;

maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.*

○ https://www.healthcare.gov/glossary/essential-health-benefits/

How Do We Pay For This?

Taxes, taxes and more taxesWatch out for Fully-Insured Vs. Self-Insured

○ Taxes differ under each type of planIndividual mandate shared responsibility tax

○ Penalty tax if you don’t have coverageEmployer taxes

○ PCORI Fee (2014-2018)*- $2/covered life- annual

○ Re-Insurance Fee (2014-2016) $5.25/covered life- monthly

○ Cadillac Tax (2018) Excise Tax of 40% on High Value Plans

* Fees are funded by ICUBA

Florida Tech Changes Identify Who Is Eligible

Healthcare must be offered to ALL FTE’sFTE = anyone that regularly works more than 30 hours

per weekStarts April 1, 2015

Ensure Plans are CompliantICUBA plans are certified as Essential and GOLD LEVEL

Educate The EmployeesControlling Claims Costs, Wellness Programs, What Do

We Get For Free○ Monthly Seminars Coming in 2014 and beyond

Florida Tech Changes

Open Enrollment is EARLYJanuary 21st and January 22nd

○ Hartley Room from 9:00am - 7:00pm

On-line Enrollment January 21st- February 5th ○ Computers will be available from 8am-5pm every

day in the Human Resources Office○ Make sure to update your ICUBA online account

Questions