Upload
greg-chartier-phd
View
225
Download
0
Tags:
Embed Size (px)
DESCRIPTION
Get ready for the Affordable Care Act. The light you see is the oncoming train! Lot's of things happening, not too many answers and it will take a few years to flesh it all out.
Citation preview
PPACA, Preparing for 2014
HR Essentials
Employer Shared Responsibility
Effective 1/1/14Employer must count all full time
employees and part time employees on a full time equivalent basis, in determining if they have 50 or more employees.
Employer Shared Responsibility
Full time=30 or more hours per week, per month or 130 hours of service per calendar month (must count each hour for which an employee is paid or entitled to payment for work, vacation, etc.)
Seasonal workers are not counted.Penalties assessed for “no coverage” or
coverage that is “not affordable” or does not provide “minimum value.”
Employer Shared Responsibility
Determining large employer status:For each calendar month of the preceding
calendar year, employers must:◦Count the # of FT employees who work an
average of 30 hours per week per month.◦Calculate the # of FT equivalents by adding the
# of hours worked by non-FT employees and divide by 120.
◦Add the number of FT and FT equivalents for each of the 12 months of the preceding year.
◦Add the monthly totals and divide by 12. If the average is over 50, you are a large employer.
Employer Shared Responsibility
Transition relief for smaller employers:◦Employers can determine whether they are
large or not based on the period of 6 consecutive months during 2013 instead of 12 months.
◦This is only allowable for 2014 calculations.◦The 6 month period must be no less than 6
months and end no sooner than 90 days before the start of the plan year beginning 1/1/14.
Employer Shared Responsibility
The Penalties:◦Sledge Hammer Penalties.
If a large employer does not offer coverage to 95% of the FT employees and their dependents and at least 1 FT employee receives a premium tax credit or cost sharing reduction.
The penalty is $2000 x the # of FT, minus the first 30 employees.
This is not deductible as a business expense.
Employer Shared Responsibility
The Penalties:◦Tack Hammer Penalties:
If a large employer offers coverage to their FT employees and their dependents but the coverage is not “affordable” or it does not provide “minimum value.”
The penalty is the lesser of $3000 x the # of FT employees receiving a premium tax credit or $2000 x the total number of FT employees.
Employer Shared Responsibility
“Not Affordable”◦Employees share of the self-only premium for
the employer’s lowest cost plan that provides minimum value cannot exceed 9.5% of the household income or the employee may be eligible for a premium tax credit to purchase coverage through the exchange.
◦Safe Harbors: W-2 harbor. 9.5% of Box 1 of W-2 Rate of pay harbor. 9.5% of employee’s hourly
rate of pay x 130 hours. Federal Poverty Level harbor. 9.5% of the FPL for 1
person.
Employer Shared Responsibility
“Minimum Value”◦A plan fails to provide minimum value if the
plan’s share of the total allowed costs of benefits is less than 60% of such costs (% of medical expenses-deductibles, coinsurance, copays, etc.) MV Calculator. Allows employers to input cost
sharing features. www.cms.gov/resources/files/mv-calculator-final-2-20-2013.xlsm
Safe Harbor Checklist. Provides a checklist to review. Actuarial Certification. To get a decisive conclusion
that the plan meets MV standards.
Employer Shared Responsibility
Transition relief for tax penalty:◦The regulations provide transition relief for
large employers that maintain a non-calendar year plan as of 12/27/12.
◦The employer is not subject to the penalty provided they are offered affordable, MV coverage on the first day of the 2014 plan year if the plan: Was offered to at least 1/3 of all employees (FT
and PT) at the most recent open enrollment prior to 12/27/12.
Covered ¼ of all employees as of 12/27/12.
The Individual Mandate
As of 1/1/14, the individual mandate requires most individuals to have minimum essential coverage or pay a penalty which is called the “shared responsibility payment.”
What qualifies as minimum essential coverage?
Minimum Essential Coverage
An employer group health planAn individual health insurance planA government plan like Medicare,
Children’s Health Insurance Program (CHIP) or TRICARE.
Student health coverageMedicare Advantage PlanState high risk pool coverage
Individual Mandate
Penalties will be assessed when individuals file their 2014 taxes in 2015.
2014: greater of $95 per adult and $47.50 per child under 18 (maximum of $285 per family) or 1% of the income over the tax filing threshold.
2015: greater of $325 per adult and $162.50 per child under 18 (max of $975 per family) or 2% of the income.
2016: greater of $695 per adult and $347.50 per child (max of $2085 per family) or 2.5% of the income.
2017 and later: increase based on COL.
Individual Mandate
Individuals who do not meet the following criteria will not pay a penalty if they do not have minimum essential coverage:◦ Individuals who cannot afford coverage: more than 8% of
annual household income.◦ Taxpayers with income below the tax filing threshold.◦ Individuals who qualify for hardship exemption:
State did not choose to expand Medicare (14 have opted out) Personal or financial hardship
◦ Individuals who have a gap of less than 3 consecutive months in a calendar year.
◦ Non US citizens, individuals in prison, Members of Native American Tribes.
Exchanges
Exchange Basics
The law requires the creation of the American Health Benefit Exchange for individuals and the Small Business Health Options Programs (SHOP) Exchange for small employers up to 50 lives.◦ In 2016, SHOP Exchanges must increase small
group to 100 employees◦States can choose to expand their SHOP
Exchanges to serve groups larger than 100 in 2017Insurance coverage can be purchased
beginning in October 2013 and will be effective January 1, 2014.
Exchange Basics
An Exchange is an organized “marketplace” designed to help people shop for and enroll in health insurance coverage.
Individuals, families and small businesses will be able to use the Exchange to help compare commercial insurance options, calculate costs and select coverage online, in person, on the phone or by mail.
The Exchange will help people to check their eligibility for health care programs like Medicaid and sign up for these programs if they are eligible.
The Exchange will also be able to tell what type of financial assistance is available to applicants to help them afford health insurance.
Exchange Basics
State based health insurance exchanges are not optional. HHS is calling them “Marketplaces” instead of Exchanges because there is no Spanish word for Exchanges that translates accurately.◦If a state doesn’t create one, the federal
government till step in and operate the exchange for the state.
◦19 states, including NYS have been approved to operate their own Exchange.
Exchange Subsidy Basics
Subsidized coverage will be available for individuals purchasing coverage through the exchange.
Low income people who are part of an employer group that buys coverage through a SHOP exchange are not eligible for the personal premium tax credit.
Only subsidies that will be distributed through the SHOP exchanges are the small business tax credits.
People with “credible” and “affordable” group coverage cannot leave the group plan and buy subsidized coverage through the individual exchange even if they are low income.
Employer Responsibilities
Employers must provide a notice to current employees and new hire about exchanges and subsidies.◦March 1 deadline has been delayed◦DOL is expected to provide model generic language◦New notification date will probably be late summer
or early fallEmployers will have to help verify coverage.
◦HHS will use data from insurance exchange markets to determine whether people have coverage when the individual mandate takes effect.
SHOP Exchanges
SHOP exchanges will be a new purchasing environment for small employers
Advantages:◦Choice and value: health plans at a variety of
price points.◦Tax benefits: up to 50% of premium
contributions for qualifying employers◦Defined Contribution: employer can set fixed
amount to contribute to employee coverage◦Ease of administration: one monthly premium
invoice
NYS Health Benefit Exchange
April 12, 2012, Governor issues Executive Order to set up the exchange
October 1, 2012, NYS formally submits its plan to HHS
December 14, 2012, HHS provides conditional certification to NYS
NYS has been awarded more than $400 million in grants to fund the start up
NYS Health Benefit Exchange
1/31/13, RFPs to health insurers and dental plans to participate in the Exchange
2/15/13 Letter of Interest due4/30/13 due date for network, rates, etc.,
submission from insurers7/15/13 anticipated selection of insurersBrokers and “Navigators” will assist in
placing coverage.
Question/Comments?