Small Business Options Post-PPACA Reform (How PPACA is affecting businesses and changing our options) Kevin Conley Partner, Bremer Conley

Transcription

1 Small Business Options Post-PPACA Reform (How PPACA is affecting businesses and changing our options) Kevin Conley Partner, Bremer Conley 1

2 PPACA - ACA - Healthcare Reform - Obamacare President Obama signed the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010 Included many insurance market reforms Many new compliance and notice requirements for employers New individual mandate to purchase and maintain minimum coverage Problem: Focuses on insurance market reforms and subsidies does not address the true cost drivers in health care 2

3 What Does It Mean For Small Businesses? Increased costs (newly mandated benefits, new taxes, new needs for outsourced services, new penalties for non-compliance) Increased compliance requirements (DOL & IRS now coordinating efforts) Decreased access to free professional help Positive: Increased opportunities (new products and platforms created, the end of the one-size-fits-all benefits program) 3

4 Compliance Requirements Minimum plan design requirements (metal levels, minimum values, essential health benefits) Summary of Benefits Coverage (SBC) distribution W-2 Reporting (over 250 only, for now) MLR Rebate distribution Health Exchange Notices COBRA Notices HIPAA Special Enrollment Rights Newborn & Mothers Protection Notice Women s Health & Cancer Notice Medicare Part D Creditable Coverage Notice CHIP Premium Assistance Notice Notice of Grandfathered Status HRA HPIDs (delayed) FTE Calculations (IRS forms 6055 & 6056) 4

5 Your Internal Team Executive leadership vision and capacity for risk Finance plan funding, tax implications and payroll logistics HR benefits and communication (morale, training, retention) Marketing internal and external communications (branding, recruiting) 5

6 Your External Team Insurance Broker or Consultant with knowledge of PPACA, employee benefit plans and invested in benefit programs for your size company Accountant with knowledge of PPACA and its tax implications Attorney with knowledge of PPACA, ERISA, COBRA, FMLA or someone in the firm that specializes in these areas of practice PR/Marketing Firm 6

7 Performing A Goals & Needs Analysis Questions your team should be asking: Why is it important for us to have a plan? What are the specific goals of our current plan? Does it achieve them? How much time are we willing to spend on drafting, renewing, implementing, and communicating our plan? What would happen if we didn t have a plan? (i.e. morale, retention, recruitment, absenteeism, presenteeism, workers comp claims) Can we afford our current plan? How much longer will we be able to afford our plans? What changes will we need to make to continue to offer plans? 7

8 Performing A Goals & Needs Analysis Questions your team should be asking (cont d): What products are we currently offering? Do they fit within the overall goals/needs of the plan? Is our current plan fully compliant with all applicable laws? Are the employees administering the plan fully educated in their responsibilities? Are we prepared to be audited by the DOL? Will we pass an audit? What do the employees want in a plan? Can we provide what they want? What do we need to offer to be competitive for recruitment? How are we positioning our plan as part of the recruitment process? Do we compete against large or small companies? 8

9 What Are My Options? 1. Continue with current group plan strategy 2 50: Renew as is in 2015 Subject to Community Rated metallic plans Choose a plan or two and move on 51 99: Move to an October 1 st, 2015 renewal to push back Community Rates until at least October of 2016 Self-Funded: Use self-funding to retain composite rates and benefit flexibility 2. Drop our plan altogether What affect would this have on the quality of our employees? 2 50: Not required to offer coverage, not subject to a fine or penalty 51 99: Annual penalty of $2,000 per employee 3. Move to a Defined Contribution plan 4. Move to a Max Funded / Level Funded plan 5. Enroll in the SHOP Exchange 9

10 Do You Have 50 Employees? Companies with shared ownership count as one for the FTE count Full-Time = 30 hours per week or more Full-Time Equivalent = add up all hours worked (for those under 30 hours) and divide by 30 Final count and determination of eligibility is done in the following year and retroactive New: Tools coming out now like Paylocity s embedded FTE calculator help you avoid surprises Begin tracking employees data in January, 2015 for reporting in 2016 (name, social, dates worked, hours worked, dates on plan) 10

11 What Are My Options? Continue with Current Group Plan Strategy How much longer can we afford to do what we re doing? Do we have an HRA? (may lose it once you go to community rates) How can we make it better for us and for our employees? How to save money without just transferring cost to employees? Current Strategy Medical, Dental, Vision & Life plans (one size fits all) New Strategy Medical options with Worksite products to fill the gaps? 11

12 What Are My Options? Drop our plans completely What impact would it have on our employees? Can we carve out management or executives? (still allowed for now) Would our employees be eligible for subsidies on the Marketplace? Fines for businesses with at least 50 FTEs that do not offer a minimum level of coverage ($2,000 per employee, per year) - Is this cheaper than offering a plan, considering your contributions? 12

13 What Are My Options? Defined Contribution Plans Traditionally only for employers with over 1,000 employees ($$$) In 2007, the Secretary of the Treasury made individual medical plans eligible for Section 125 reimbursement Gives employees multiple options for their coverage so they can choose what they want and what they think fits their family the best Concerns: New hires have a limited (60-day) Special Enrollment Period to enroll Very disruptive at renewals (every employee needs face-to-face meetings) Every employee has something different Still considered a group plan, subject to COBRA Do they know how to analyze their liability for each plan? Do they truly understand how their insurance works? 13

14 How Defined Contribution Works Employer gives a set ( defined ) amount of money to every eligible employee Employees get their own coverage and use the money contributed from their employer to pay for it They can use some or all of the money, but they only get the money once they ve purchased coverage Employees get the benefits they think fit them the best, not just what the employer decides they can afford for the group Potential savings on FICA and other taxes Still disagreement on whether or not you can run individual premiums through your Section 125 plan (FICA tax implications) 14

15 Other Options? PEO Single source for common HR & payroll tasks Offers integration between HR, Benefits and Payroll Tax implications Loss of employer control (employees are no longer yours) Potentially volatile insurance premiums (based on book & claims) No itemization to see what you are paying for High administrative fees (2011 average was $118 PEPM) Very difficult to unwind from a PEO once you re in READ THE FINE PRINT BEFORE SIGNING ANYTHING Better options are available 15

16 Other Options? Small business Health Options Program (SHOP) Required for getting the Small Business Tax Credit 25 employees or less, average $50,000 or less Sliding scale, (Largest: 10 employees or less, average $25,000 or less) Accessed through for 2015 effective dates Allows an employer with 50 or fewer FTEs to offer multiple medical and dental plans to their employees Can continue to work with a SHOP-certified Broker or Consultant Multiple enrollment and employer contribution options Administrator, business and employees set up accounts online to enroll Tax credit can only be taken for two consecutive years Other requirements for eligibility (e.g., 50 or fewer, 70% participation) 16

17 Other Options? Level Funded / Max Funded A new type of self-funding for smaller employers The employer is responsible for paying the group s claims, not the insurance company Medically underwritten (medical applications) Estimate your annual claims, then pro-rates them monthly to calculate your cost Uses composite rates instead of the new community rates with 1-year age bands Include pro-rated monthly aggregate stop-loss coverage At the end of the year, if you perform well, you get money back If you did worse, your stop-loss protects you from additional costs No set rules (does it include state mandated benefits like autism coverage?) PCORI taxes and reinsurance taxes are now the employer s responsibility Good for young, healthy groups Not a Silver Bullet or the right answer for many Can save money, but no big savings up front (long-term) 17

18 Communication Who? Employees & their dependents Potential employees (recruiting) What? Your plan(s) details & required notices (exchange notice, SBC, MLR distributions, etc.) General healthcare reform information in general & resources available to them (your insurance broker or consultant, exchange sites, etc.) Why? Improve employee retention & presenteeism (reduce stress, uncertainty) Improve morale (employees that understand their benefits are more satisfied with them) Improve employee recruitment by creating a culture of transparency and engagement 18

19 The greatest danger in times of turbulence is not the turbulence it is to act with yesterday s logic. Peter Drucker Sometimes all you have to do to change the view is change your perspective How can you look at your benefits differently than you did last year? 19

20 Opportunity Times of transition create opportunities for those that are willing to embrace the change. Instead of looking at healthcare reform as a hurdle to overcome, choose to see it as an opportunity to leverage change to create a competitive advantage for your company. Don t panic. We are all in the same boat and there are options for you. 20

21 THANK YOU Questions? 21