Slide share health care reform health webinar
Transcript of Slide share health care reform health webinar
Welcome to:The Affordable Care Act
Please Dial in using: 800-925-
9789Access Code: 2831265
Jim Hill and Ken Jim Hill and Ken McGeeMcGee
Affordable Care Affordable Care Act : Act : Are you prepared?Are you prepared?
• Will I have to buy it
• Can I still get it though my Employer
• I own a small business. Will I have to buy health insurance for my workers?
The Affordable Care Act is back on a fast track.
Health Reform Implementation Timeline
What is the ACA:Promoting Health Coverage
Medicaid Coverage
(up to 133% FPL)
Employer-Sponsored Coverage
Exchanges(subsidies 133-
400% FPL)
IndividualMandate
Health Insurance
Market Reforms
Universal Coverage
2012-2013 Compliance Deadlines
W-2 Reporting
• Employers must report aggregate cost of group health plan coverage on each employee’s Form W-2
• Does not change the tax rules for health coverage – coverage is still not taxable
Effective Date
• Then:−Originally effective for the 2011 tax year (W-2 Forms
provided in Jan. 2012)− IRS later made 2011 reporting optional for all employers
• Now:−Mandatory for 2012 tax year (W-2 Forms provided in Jan.
2013) −For small employers (those that file fewer than 250 W-2
Forms), reporting requirement is delayed until further guidance issued
−Covered employers need to be compiling data
Summary of Benefits and Coverage
• Simple and concise explanation of benefits−Applies to GF and non-GF plans
• Model template and guidance available− Instructions−Sample language−Uniform glossary of terms
• Final guidance specifies compliance deadlines−Original deadline was March 23, 2012
SBC Compliance Deadlines
• Issuers to health plans: Sept. 23, 2012
• Health plans:−Open enrollment: 1st day of the 1st open enrollment
period that begins on or after Sept. 23, 2012 or−Other enrollment: 1st day of the 1st plan year that
begins on or after Sept. 23, 2012
• Special rules specify when SBC must be provided
Providing the SBC to Enrollees
• Plans must provide SBC to enrollees:
−For each benefit package offered or which they are eligible
−Annually at renewal (or 30 days before new plan year if automatic renewal)
−With enrollment application materials (if no written enrollment materials, when the participant is first eligible to enroll)
−Before the first day of coverage (if there have been changes to the SBC)
−To special enrollees within SPD timeframe
−Upon request
SBC Standards
• Appearance−Cannot be longer than 4 double-sided pages−12-point or larger font−May be color or black and white−Paper or electronic form−Template available
• Language:−Easily understood language−“Culturally and linguistically appropriate manner” –
interpretive services and written translations upon request−Translations will be available
60-Day Notice Rule
• Material modifications not in connection with renewal must be described in a summary of material modifications (SMM) or an updated SBC
• Material modification:−Enhancement of covered benefits or services−Material reduction in covered benefits or services−More stringent requirements for receipt of benefits
• Must be provided at least 60 days BEFORE modification becomes effective
Health FSA Limits
• Current limits−No limit on salary reductions−Many employers impose limit
• Beginning in 2013, limit is $2500/year−Limit is indexed for CPI for later years
• Applies to plan years beginning on or after 1/1/13−This is a change from initial effective date
• Does not apply to dependent care FSAs
New Notice Requirement
• Employers must notify new employees regarding health care coverage−At time of hiring
• Notice must include information about 2014 changes:−Existence of health benefit exchange−Potential eligibility for subsidy under exchange if
employer’s share of benefit cost is less than 60 percent−Risk of losing employer contribution if employee buys
coverage through an exchange
2014 Compliance Deadlines
Individual Mandate
• Individuals will be required to have health coverage that meets minimum standards in 2014
• Individual mandate spreads costs among whole population
• Mandate enforced through the tax system
• Penalty for not having insurance: greater of $695 (up to $2085 for family) or 2.5% of family income
• Exemptions for certain groups and if people cannot find affordable health insurance
The big picture for individualsAmericans not covered under a government plan will have three options for health insurance in 2014:
1. Get coverage through their employer if available
2. Buy an individual market plan through either:
• The individual market exchange – Purchaser may be eligible for subsidy
• The off-exchange market
3. Go uninsured (will pay penalty unless they qualify for anindividual exemption)
Penalties for individualsOutside
exchange – Fully insured Large Group
and self-insured
Outside exchange – Fully
insured Small Group and Individual
2014:Greater of $95 or 1% of taxable income
2015:Greater of $325 or 2% of taxable income
2016:Greater of $695 or 2.5% of taxable income
2017 and beyond:Annual adjustments
Health plan requirements: Product tiers
All will include Essential Health
Benefits
Platinum 90%
actuarial value
Gold 80%
actuarial value
Bronze60%
actuarial value
Silver70%
actuarial value
Actuarial Value** =
Total Expected Payments by Health Plans for EHBs
Total Costs of EHBs for the Standard Population
•Plus catastrophic plan offering for individuals younger than 30/ financial hardship
Health plan requirements continued
* The health care reform law does not require carriers to offer plans with at least a 60% actuarial value, nor does it require employers to provide health coverage. However, it imposes penalties on 50+ employers that do not provide minimum coverage.
Outside exchange –
Fully insured Large Group
and self-insured
Inside exchange
Outside exchange – Fully
insured Small Group and Individual
Include essential health benefits
Provide 60% actuarial value minimum
Adhere to deductible and out-of-pocket maximum limits
Comply with “metal levels” – benefit tiers with specified actuarial values (60% 70% 80% 90%)
Be certified by the exchange through which the plan is offered (certification requirements to be determined)
*
Health Insurance Exchanges
• States will receive funding to establish health insurance exchanges
• Individuals and small employers can purchase coverage through an exchange (Qualified Health Plans)− In 2017, states can allow employers of any size to
purchase coverage through exchange
• Individuals can be eligible for tax credits−Limits on income and government program eligibility−Employer plan is unaffordable or not of minimum value
Health Insurance Exchanges
• What will they look like
• How many options will we have
• Actual Value out of Pocket levels− Platinum− Gold− Silver− Bronze
Employer Responsibility
• Large employers subject to “Pay or Play” rule
• Applies to employers with 50 or more full-time equivalent employees in prior calendar year
• Penalties apply if:
−Employer does not provide coverage to all FT employees and any FT employee gets subsidized coverage through exchange OR
−Employer does provide coverage and any FT employee still gets subsidized coverage through exchange
Employer Penalty Amounts
• Employers that do not offer coverage to all full-time employees:
−$2,000 per full-time employee
−Excludes first 30 employees
• Employers that offer coverage:
−$3,000 for each employee that receives subsidized coverage through an exchange
−Capped at $2,000 per full-time employee (excluding first 30 employees)
More 2014 Changes
• No pre-existing condition exclusions or limitations
−Applies to everyone and all plans
• Wellness program changes
• Limits on out-of-pocket expenses and cost-sharing
• No waiting periods over 90 days
Contact information
Linkedin-www.linkedin.com/in/thejimhill/Facebook- http://www.facebook.com/jimhillcma
Linkedin-www.linkedin.com/in/kmcgeeFacebook: http://www.facebook.com/KennethMcGeeII
Thank you!