The Impact on Business

Transcription

1 The Impact on Business

2 Affordable Care Act Reform addresses access to coverage not healthcare cost or population health ACA passed in The Supreme Court upheld ACA in 2012 and President Obama was re-elected in November Major implications for: Employers Employees Providers Health plans Things to Consider: Look ahead to the next two years, when the major portions of the legislation will become effective, and start planning for compliance. Beginning January 1, 2014, employers with 50 or more full time employees who work 30 or more hours will have to provide health care benefits or pay a penalty. Hours worked by part time employees will be included in the calculation of full-time equivalent employees. Therefore, a plan to reduce hours employees work to fewer than 30 to avoid the requirement may not be an effective strategy.

3 Affordable Care Act: Small Business Tax Credit To encourage businesses to offer health benefits to their employees, the federal government is offering tax credits to small businesses. These credits are available to an estimated 4 million small businesses, including nonprofits. Taxable employers are eligible for a maximum credit of 35% of healthcare costs. Taxexempt employers are eligible for a maximum credit of 25%. To qualify, small employers must: Have fewer than the equivalent of 25 full-time workers Pay average annual wages below $50,000 Cover at least 50% of the cost of health care coverage for their workers

4 Affordable Care Act Timeline 2011 Plan Year Lifetime dollar limits on Essential Health Benefits (EHB) prohibited* Preexisting Condition Exclusions Prohibited for Children under 19* Overly restrictive annual dollar limits on EHB prohibited* Extension of Adult Child Coverage to Age 26* Prohibition on Rescissions* No Cost Sharing and Coverage for Certain In-Network Preventive Health Services** Effective Appeals Process** Consumer/patient protections** Nondiscrimination requirements on fully insured plans** (DELAYED) Certain Retiree Medical Claims Reimbursable (ERRP) Retiree Drug Plan FAS Liability Recognition Over-the-Counter Medicines Not Reimbursable Under Health FSA, HRAs, or from HSAs Without a Prescription, Except Insulin HSA Excise Tax Increase Public Long-Term Care Option (CLASS Act) No Longer Supported by HHS Medicare Part D Discounts for Certain Drugs in Donut Hole Employer Distribution of Summary of Benefits and Coverage to Participants* Comparative Effectiveness Fee Employer Quality of Care Report** Medical Loss Ratio rebates (insured plans only)* Employer Reporting of Health Coverage on Form W-2 (due January 31, 2013) Notice to Inform Employees of Coverage Options in Exchange Limit of Health Care FSA Contributions to $2,500 (Indexed) Elimination of Deduction for Expenses Allocable to Retiree Drug Subsidy (RDS) Medicare Tax on High Income Addition of women s preventive health requirements to No Cost Sharing and Coverage for Certain In-Network Preventive Health Services ** *Denotes group/insurance market reforms applicable to all group health plans. **Denotes group/insurance market reforms not applicable to grandfathered health plans. *** This requirement applies to full time employees (e.g., 30 hours per week) and will require coverage that is affordable and satisfies a certain actuarial value to avoid the penalty. Guidance forthcoming. Individual Mandate Excise Tax to Purchase Insurance on High-Cost or Pay Penalty Coverage State Insurance Exchanges Employer Responsibility to Provide Affordable Minimum Essential Health Coverage*** Preexisting Conditions Exclusions Prohibited* Annual Dollar Limits on EHB Prohibited* Automatic Enrollment Limit of 90-Day Waiting Period for Coverage* Employer Reporting of Health Insurance Information to Government and Participants Increased Cap on Rewards for Participation in Wellness Program** Cost-sharing limits for all group health plans, not just HDHPs/HSA (deductibles and OOP maximum)** Transitional Reinsurance contributions

5 Affordable Care Act: Impact on Employees While employees may cover dependent children up to age 26 under health insurance, HSA dollars (per IRS regulations) may only be used for children up to age 24 (if a full time student). HSA penalty increase (10% to 20%) Over-the-Counter Medicines not Reimbursable under Spending Accounts FSA contributions limited to $2,500 Medicare tax on high income (additional 0.9% for $200,000 or more) Those with investment income also could be subject to a new 3.8% Medicare tax on at least a portion of their capital gains and dividends Individual mandate to purchase insurance (or pay a penalty) in 2014 Healthcare Reform is being funded by taxes and penalties on both the employer and the employee and also by reductions in payments to doctors and hospitals. Note: It is not under health care reform, but tax-free educational assistance ($5,250) expires 01/01/2013.

6 Requirements Already in Place Lifetime dollar limits on Essential Health Benefits (EHB) prohibited Preexisting Condition Exclusions Prohibited for Children under 19 Overly restrictive annual dollar limits on EHB prohibited Extension of Adult Child Coverage to Age 26 Prohibition on Rescissions No Cost Sharing and Coverage for Certain In-Network Preventive Health Services Effective Appeals Process Over-the-Counter Medicines Not Reimbursable Under Health FSA, HRAs, or from HSAs Without a Prescription HSA Excise Tax Increase

7 2012 Calendar Year Health Cost Reporting on IRS Form W-2 Employer and employee costs for employer-sponsored health coverage must be reported on W-2 Does not apply to Health FSA salary reduction contributions, long-term care, standalone dental, standalone vision, indemnity or specified illness coverage Does not apply if employer reported fewer than 250 W-2s the preceding year Effective for 2012 W-2s due by 1/31/13 Identify coverage subject to reporting Determine cost data to be collected Coordinate with payroll vendor

8 2012 Calendar Year Medical Loss Ratio (MLR) Rebates Insurers offering coverage with respect to employer group health plans that fail to spend a sufficient amount of the premiums they collect for medical care and health quality improvement must pay a rebate to their policyholders Comparative Effectiveness Fee Carriers and group health plans will be assessed a $2 fee ($1 the initial year) times the average number of covered lives under plan Summary of Benefits and Coverage Effective 1/1/11, but rebates not paid until 8/1/12 09/30/12 09/30/19 09/23/12 Develop strategy for handling rebates that are a plan asset Develop cost estimate of anticipated fee for initial year and subsequent years for fiscal planning purposes Distribute to employees

9 2013 Calendar Year Women s Preventive Health Services Health plan must offer certain preventive services for women with no cost-sharing for in-network providers, including: Well woman annual visit Screening for gestational diabetes Contraceptives Not applicable to grandfathered plans Effective plan years on or after 8/1/12 (1/1/2013) Develop cost estimate of enhanced preventive services for fiscal planning purposes Ensure enhanced preventive services are communicated to employees prior to effective date Update SPD

10 2013 Calendar Year Additional Medicare Payroll Tax on Employees with High Earned Income An additional 0.9% Medicare Hospital Insurance (HI) payroll tax is imposed on employees wages in excess of $200,000 ($250,000 if married filing jointly, $125,00 if married filing separately) Employers are only required to deduct and withhold the additional Medicare tax if the employee receives wages from the employer in excess of $200,000 If an employer fails to deduct and withhold the tax when required to do so, the employer will be subject to penalties or additional taxes for such failure Effective for tax years beginning after 12/31/12 Stay tuned for guidance Coordinate with payroll provider

11 2013 Calendar Year Health FSA Annual Salary Reduction Contribution Limited to $2,500 $2,500 annual limit will be subject to cost-of-living adjustments beginning in 2014 Effective 1/1/13 Amend Health FSA documents before 1/1/13 Consult with health FSA administrator on transition to reduced limit if plan year is not a calendar year Update SPD

12 2014 Calendar Year Auto-Enrollment for New Hires Employers with more than 200 full-time employees must: Automatically enroll newly hired fulltime employees Automatically re-enroll employees currently enrolled in plan Default health coverage option must be designated Opt-out mechanism must be offered Employers are not required to comply with this requirement until final regulations are issued Effective 3/23/10 but delayed until regulations issued (likely by 2014) Await final regulations from DOL Conduct preliminary impact assessment

13 2014 Calendar Year 90 Day Limit on Waiting Period This requirement does not require an employer to offer coverage to any particular employee or class of employees, including part-time employees This requirement prohibits requiring an otherwise eligible employee to wait more than 90 days before coverage is effective While guidance still needs to be issued, it is likely that an employer could still require an individual to complete a certain number of hours to be eligible for coverage the 90-day period would begin after those hours of service (to be specified in upcoming guidance) Applies to all group health plans, regardless of grandfathered status Effective as of 01/01/2014 Await guidance upcoming guidance is expected to address situations where employees are eligible for coverage after they complete a specified number of hours of service within a specified period (DOL Technical Release ) Update SPD accordingly

14 2014 Calendar Year Cost Sharing Limitations Overall cost sharing for all new group health plans cannot exceed $6,250 for self-only coverage and $12,500 family coverage Regulations should clarify if high deductible plans with offsetting accounts funded by the employer are permissible Not applicable to grandfathered plans Effective as of 01/01/2014 Await guidance Government has not yet confirmed whether cost sharing such as co-pays must apply towards the out-ofpocket expense maximum limit; regulations needed, but a consideration

15 2014 Calendar Year Transitional Reinsurance Program ACA established a number of programs to minimize the effects of adverse selection that may occur in the initial years of operation of the Exchanges Effective Stay tuned for guidance All health insurance issuers and TPAs on behalf of self-insured group health plans will submit contributions to support reinsurance payments to issuers that cover high-cost individuals in nongrandfathered individual market plans It appears that the fee will be imposed on all group health plans, including stand-alone retiree medical plans, for each enrollee in the plan Does not apply to limited excepted dental/vision plans While methodology pertaining to the amount of the fee has not yet been issued, the fee could be between $60 and $80 per capita on an annual basis in 2014

16 2014 Calendar Year Employer Shared Responsibility Payment Tax or penalty may be imposed on large employer that, for any month, either: $2K per FTE for failing to offer minimum essential [health] coverage (MEC) to FTEs (and their dependents); or $3K per FTE for offering MEC, but coverage is unaffordable relative to employee s household income or does not provide minimum actuarial value Tax is due if FTE is certified as having purchased health insurance through Exchange for which a premium tax credit or cost-sharing reduction is allowed or paid to employee Amount of the shared responsibility payment for each month depends on whether or not MEC is offered Still waiting for regulations and guidance Effective for months beginning after 12/31/13 Stay tuned for guidance Begin to review who may be considered FTEs Begin to review whether self-only coverage is affordable for FTEs

17 2018 Calendar Year Excise Tax on Cadillac Plans 40% excise tax on insurers and TPAs who offer coverage costing more than $10,200 individual, $27,500 family (indexed) Threshold of $11,850 individual, $30,950 for retirees and selected high-risk occupations, or adjust for age and sex Effective January 1, 2018 Determine which existing plans based upon current trend will trigger the excise tax Further guidance is forthcoming

18 Next Steps Start planning and implementing compliance strategies: Adjust plans and all documents to comply with the requirements. Educate employees. The legislation will most likely not be repealed and the expected finetuning and further guidance is not likely to change these major obligations.