Employee Benefits Update Including PPACA

Transcription

1 Employee Benefits Update Including PPACA Christine Burke Worthen, Esq. Assistant General Counsel Eastern Maine Healthcare Systems Brewer, Maine

2 Recap: PPACA Provisions Already in Effect (2011 Plan Year) a. Coverage of adult children to age 26 (grandfathered starting 2014 even if other coverage available) b. OTC drugs require prescription for HRA/FSA/HSA reimbursement c. First dollar preventive care coverage (note ongoing changes: women s preventive care 2013) (not for grandfathered plans) d. Out-of-network emergency care coverage (not for grandfathered plans)

3 Recap: PPACA Provisions Already in Effect (2011 Plan Year) (cont d) e. Elimination of lifetime dollar limit f. Elimination of pre-existing condition limits for children under 19 g. Expansion of appeals rules (not for grandfathered plans) h. Limits on rescissions (i.e., retroactive cancellations) failure to pay premiums, fraud i. Restricted annual limits for essential health benefits

4 Grandfathered Health Plans a. What it means to be grandfathered b. What will cause loss of grandfathered status Cannot Significantly Cut or Reduce Benefits Cannot Raise Coinsurance Charges Cannot Significantly Raise Copayment Charges Cannot Significantly Raise Deductibles Cannot Significantly Lower Employer Contributions Cannot Add or Tighten an Annual Limit on What the Insurer Pays Cannot Change Insurance Companies

5 PPACA Provisions in Effect for 2013 W-2 Reporting Requirement Applies to employers that issued > 250 W- 2 s in 2011 (NOT on controlled group basis) Report on W-2 issued in January 2013, Box 12, Code DD Does NOT make benefit taxable informational only Applies to grandfathered plans Do not need to issue W-2 simply to report coverage (so can leave out COBRA participants and retirees)

6 PPACA Provisions in Effect for 2013 W-2 Reporting Requirement W-2 must show total cost of coverage includes employer AND employee contributions (whether pre or post tax) Include imputed income (e.g., for domestic partners) Fully insured - use premium; self-insured - value of COBRA premium (without 2% fee) Track what happens i.e., employee leaves, changes coverage, premiums increase, etc.

7 PPACA Provisions in Effect for 2013 W-2 Reporting Requirement Report value of employer-sponsored group health coverage Group health coverage includes: Medical coverage Dental and vision IF part of medical Employee Assistance Plan ( EAP ) if charge COBRA premium Wellness program if charge COBRA premium Employer flex credits/dollars

8 PPACA Provisions in Effect for 2013 W-2 Reporting Requirement Group health coverage does NOT include: Stand-alone dental and vision HRA/HSA/FSA STD/LTD/LTC Life insurance EAP and wellness if do not charge COBRA premium Workers compensation Accident insurance

9 PPACA Provisions in Effect for 2013 Health FSA Contributions Beginning in 2013, maximum Health FSA contributions via salary reduction are capped at $2,500 Applies on a plan year basis Carryovers under grace period will not count against $2,500 maximum Other accounts, such as dependent care FSA s, are not affected

10 PPACA Provisions in Effect for 2013 Health FSA Contributions May see relaxation of use it or lose it rule Amend plan by 2014 Limit does not apply to noncashable employer flex credits

11 PPACA Provisions in Effect for 2013 Summary of Benefits and Coverage Must provide to participants on first day of open enrollment period beginning on or after 9/23/2012 Does not take the place of an SPD DOL has template posted on website Provides summary of coverage, glossary, examples (pregnancy and chronic condition) Can provide electronically Fully insured insurer will provide

12 PPACA Provisions in Effect for 2013 FICA Medicare Tax Increase Additional FICA withholding applies to employee s share of wages greater than $200,000 Employer withholds an additional 0.9% (no employer match) If MFJ with combined wages greater than $250,000, couple owes the 0.9% tax (MFS wages greater than $125,000)

13 PPACA Provisions in Effect After 2013 Cadillac Tax Excise tax on high cost plans beginning in 2018 Tax equal to 40% of excess benefit Goal is to get insurers to offer plans that cost less than amount that triggers the tax Insurer pays tax if group health plan Employer pays tax if HSA/Archer MSA Plan administrator pays for all other plans

14 PPACA Provisions in Effect After 2013 Pay or Play Health coverage excise tax for employers with 50 or more full time employees - Effective 1/1/ Full time employee works 30 or more hours per week - Penalty exposure if employer does not offer certain health insurance to all full-time employees OR offers certain types of inappropriate insurance

15 PPACA Provisions in Effect After 2013 Pay or Play Full time employees IRS guidance issued re how to determine if full time Average 30 hours per week Variable hours IRS guidance for newly hired and ongoing employees Lookback/stability period safe harbors for ongoing

16 PPACA Provisions in Effect After 2013 Pay or Play Penalty Scenario #1: Penalty if fail to offer each full-time employee minimum essential coverage ( MEC ) (employersponsored group health plans in small/large market should be ok) that: Provides minimum value (i.e., plan s share of total allowed cost of benefits is at least 60%) AND Is affordable (employee premium for individual coverage must not exceed 9.5% of wages)

17 PPACA Provisions in Effect After 2013 Pay or Play Penalty Scenario #1: Penalty if offer MEC that is unaffordable or fails to provide minimum value: $250/month ($3,000/year) for each full time employee who receives premium credit or cost sharing reduction through exchange, capped at penalty that would be imposed if didn t offer coverage

18 PPACA Provisions in Effect After 2013 Pay or Play Penalty Scenario #2: Penalty for failure to offer minimum essential coverage If an employee receives premium credit or cost sharing reduction through exchange then monthly penalty equal to: number of full time employees in excess of 30 multiplied by $ ($2,000/year)

19 PPACA Provisions in Effect After 2013 Pay or Play Keep in mind: Only employees with household income up to 400% of FPL are eligible for premium credit/cost sharing reduction If employee enrolls in Mainecare, penalties do not apply

20 Tax Provisions (cont d) Small employer health insurance credit - Tax credit is provided for a qualified small employer for nonelective contributions to purchase health insurance for its employees - Eligible employer must have no more than 25 fulltime equivalents - Employer must cover 50% of the single rate of coverage - Average wages must be no more than $50,000 - In counting FTE s, exclude self-employed (partners, sole proprietors, 5% owners and 2% S-corporation shareholders - Credit is up to 35% of cost of premiums beginning in 2010 (increases to up to 50% in 2014)