Health care reform at-a-glance. August 2014

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1 Health care reform at-a-glance August 2014

2 Employer mandate Shared responsibility payment for failing to offer coverage to at least 95%* of all fulltime employees (FTE) and children if any FTE gets subsidy in marketplace $2,000 (indexed) times the number of FTEs (excludes first 30* FTEs). FTE defined as working 30 or more hours per week. Not required to offer coverage to part-time employees, retirees, or spouses but must offer to broader category of children. No minimum employer subsidy required. Penalties first imposed in 2016 for failure to satisfy mandate in 2015 Low penalty may encourage some employers to drop coverage. Analysis and determination of FTE required. Complicated measurement rules administrative burden of determining FTE status. Adjust eligibility terms of plan. * 95% threshold lowered to 70% and first 80 FTEs excluded for 2015 only. Shared responsibility payment for full-time employees who opt out of employer plan and get subsidy in marketplace $3,000 (indexed) for each FTE who enrolls in marketplace and receives low income subsidy if: (1) employee s contribution for single coverage under employer plan exceeds 9.5% of W-2 income, rate of pay, or the federal poverty level (FPL) for individuals, or (2) employer plan fails to provide minimum value, i.e., the actuarial value of plan is below 60%. See Public marketplaces below for more information on low income subsidy eligibility. Employer not required to offer coverage that satisfies the affordability or minimum value requirements, but risks payment if coverage not offered. Analysis of coverage and plan costs required. Reporting of employer-sponsored coverage Must report to both IRS and employees information regarding coverage provided to full-time employees and dependents reporting voluntary. Reporting first required in 2016 for coverage provided in 2015 Administrative burden; extensive data collection and reporting requirements. Individual mandate Penalty for failure to have minimum essential coverage Greater of 1.0% of MAGI or $95/person in 2014, 2.0% or $325/person in 2015, 2.5% or $695/person in 2016; indexed for individuals who fail to maintain minimum essential coverage. Family dollar amount capped at 300% of individual penalty. Penalties first imposed in 2015 for failure to satisfy mandate in 2014 Plan cost may increase if more employees enroll to avoid penalty. 2

3 Reporting of minimum essential coverage Insurers and sponsors of self-funded plans must report to both IRS and individual that employee, retiree, and dependents had minimum essential coverage in preceding year reporting voluntary. Reporting first required in 2016 for coverage provided in 2015 Administrative burden, including efforts to collect dependent tax ID numbers. Health plan provisions applying to both grandfathered and non-grandfathered employer plans Annual and lifetime dollar limits No lifetime or annual dollar limits on essential health benefits (EHB). Not applicable to most FSAs, HSAs, and integrated HRAs. Self-funded and large group plans must use authorized definition of essential health benefit ( benchmark plan ) beginning in on/ after January 1, 2014 (annual limits phased in for ) Analysis of benchmark plans required. To maintain dollar limits on benefits, self-funded plan must select appropriate benchmark plan. Extension of child coverage to age 26 Up to age 26 for medical coverage regardless of marital or student status, residence, or support. Excludes stand-alone dental and vision coverage. Cannot charge more than for other similarly situated individuals. Beginning January 1, 2014, grandfathered plans cannot exclude children eligible for other employer coverage. on/after September 23, 2010 Plan costs may increase if more dependents are covered. Income tax exclusion for child coverage to age 26 Exclusion through end of calendar year in which child reaches age 26. Includes dental, vision, health FSA, and HRA (different rule for HSA). March 30, 2010 Simplifies payroll administration. Plan may terminate coverage when the child turns 26, prior to the end of the tax year. Pre-existing condition exclusion No pre-existing condition exclusions for enrollees. on/after January 1, 2014 Limited impact on most employer plans. Will reduce job lock. Waiting periods Waiting periods over 90 days prohibited. on/after January 1, 2014 Most cost implications for organizations with high turnover. 3

4 Treatment of OTC drugs as medical expense Health FSAs, HRAs, and HSAs prohibited from reimbursing cost of OTC drugs (other than insulin) unless prescribed by a physician. January 1, 2011 OTC medical items (other than medicines and drugs) still eligible for reimbursement. Administrative costs may increase. Health FSA cap Salary reductions capped at $2,500; indexed. In 2014 indexed cap remains $2,500. on/after January 1, 2013 Cafeteria plan document must be amended by December 31, 2014, but plan compliance required starting January 1, Carryover amount of up to $500 permitted if health FSA does not have a grace period. HIPAA wellness incentives No discrimination regarding eligibility or coverage on the basis of a health status-related factor. Incentives increased to 30% (and additional 20% (up to 50%) for tobacco use) of cost of coverage. on/after January 1, 2014 Non-tobacco use incentives may affect affordability and minimum value determinations for purpose of employer penalty. New regulations affect design of current wellness programs. Employers must review programs to ensure compliance. Increased costs. Automatic enrollment Auto-enrollment required for employee with option to opt out of coverage. Not enforced until regulations are issued. After regulations are issued May result in increased costs due to higher enrollment and more complex administration. Marketplace notice Notice to current employees concerning availability of health insurance marketplace provided by October 1, 2013, and to all new employees hired on and after that date. Model notices include one for employers that offer coverage to some or all employees and one for employers that do not offer coverage. October 1, 2013 Must be provided to all employees regardless of benefit eligibility. Statutory requirement, but no penalty if notice is not provided. 4

5 Summary of benefits and coverage (SBC) 4-page, double-sided summary of benefits with a prescribed format, content, language, and timing must be provided to new enrollees and at open enrollment. Open enrollment periods beginning on/after September 23, 2012 Good faith compliance required; Departments approach is to assist plan sponsors with compliance rather than impose penalties. Greater coordination among vendors required. Reporting plan value on Form W-2 Total value of medical coverage on an employee-specific basis reported on Form W-2 issued in January for preceding calendar year. Some exemptions, such as coverage provided under certain church or multiemployer plans. Reporting first required in 2013 for coverage provided in 2012 Informational only; value of coverage not subject to tax. Medical loss ratio (MLR) reporting and rebates Insurers to submit MLR reports to HHS and issue rebates to enrollees in insured plans in large group market (more than 50 employees) where loss ratio (ratio of claims to premium) is less than 85%. Note that this provision applies on a calendar year, not plan year basis. Rebates payable by August 1. Starting with 2014 reporting year, reporting due date is July 31, and rebates are payable by September 30. January 1, 2011 Applies only to insured plans. Plans must apply portion of rebate attributable to employee contributions appropriately. Determination of rebates under ERISA may be required 5

6 Health plan provisions applying only to non-grandfathered employer plans Preventive care Insured plan nondiscrimination Preventive care services must be covered at 100% when provided innetwork. Insured plans prohibited from discriminating in favor of highly compensated. Enforcement delayed until guidance released. on/after September 23, 2010 Increased coverage may cause plan costs to change. Plan sponsor may delegate IRO contracting to claims administrator. OB/GYN, pediatrician, ER services Preauthorization or referral requirements prohibited. Appeals process Mandatory internal and external claims and appeals process. Self-funded plans must contract with at least three independent review organizations (IROs). Women s preventive services Additional preventive services for women covered at 100%. on/after August 1, 2012 Increased costs due to removal of costsharing and requirement to cover items not generally covered before. 6

7 Clinical trials Must cover routine patient costs in connection with participation in approved trials. on/after January 1, 2014 Some increased claims costs. Out-of-pocket (OOP) limits In-network OOP maximum for EHB same as for HSA-compatible HDHP in For 2014, $6,350/$12,700; proposed for 2015, $6,600/$13,200 (indexed annually). OOP maximum must take into account deductibles, coinsurance, and copayments. Requires coordination with carve-out vendors. Emphasis on EHB and benchmark plan. Plan s maximum OOP limit can be divided among different coverage categories of benefits so long as the combined amounts don t exceed the annual OOP limit. (Special transition rule for 2014 for carve-out vendors such as prescription drug.) Provider nondiscrimination No discrimination against provider acting within the scope of license. May vary rates based on quality or performance measures; good faith compliance until regulations issued. Plan quality of care reporting Group health plans and health insurance issuers required to submit an annual report to HHS addressing plan or coverage benefits and provider reimbursement structures regarding the cost and quality of care. After guidance issued Guidance yet to be issued. Retiree health Reinsurance program for early retirees (age 55-64) and dependents A temporary program employers accepted into the program receive reinsurance reimbursement for medical claims for retirees. $5B to subsidize 80% of costs between $15K and $90K (indexed). Terminates December 31, 2013 or when funds exhausted, if earlier. June 1, 2010 Funds exhausted in 2012; plan sponsors must use ERRP funds promptly, but no later than December 31, Phase-out of donut hole Brand drug coverage in Medicare Part D donut hole $250 rebate in 2010 for beneficiaries who reach donut hole. Phases out donut hole by 2020 in combination with brand drug discount. Drug manufacturers required to discount brand drugs in donut hole by 50% EGWP+Wrap employer-sponsored plan can provide equivalent benefits at significant savings. 7

8 Loss of deduction for expenses related to RDS payments Deduction of expenses for which RDS payment received eliminated in EGWP plans more attractive. Insurance market reform for individuals and small groups Minimum benefit package Guaranteed issue and renewability OOP limits Fair health insurance premiums Bronze, Silver, Gold and Platinum with actuarial values of 60% to 90%. Catastrophic plan for individuals under age 30, individuals exempt from individual mandate because affordable coverage is not available, or individuals who satisfy hardship exemptions. Plans must cover EHB. Health insurance issuers offering coverage in individual or group markets must accept every employer and individual in the state that applies for such coverage and must renew coverage at the option of the plan sponsor. In-network OOP maximum for EHB same as for HSA-compatible HDHP in For 2014, $6,350/$12,700; proposed for 2015, $6,600/$13,200 (indexed annually). Plan s maximum OOP limit can be divided among different coverage categories of benefits so long as the combined amounts don t exceed the annual OOP limit. (Special transition rule for 2014 for carve-out vendors such as prescription drug.) Health insurance issuers may vary the premium rate charged to nongrandfathered individual or small group from the rate established for that particular plan based only on the following factors: family size (individual or family), geography (rating area), age (within a ratio of 3:1 for adults), and tobacco use (within a ratio of 1.5:1) Marketplace plans could become available to large employers in More robust individual market for former employees and retirees. Applies to individual and small group plans offered both in and out of marketplace. OOP maximum must take into account deductibles, coinsurance, and copayments. If cost of coverage in individual and small group market stabilizes, the need for COBRA and employer-sponsored early retiree coverage declines. 8

9 Medical loss ratios - minimum standards for insured plans Insurers to submit MLR reports to HHS and issue rebates to enrollees in insured plans in the individual and small group market where loss ratio (ratio of claims to premium) is less than 80%. Note that this provision applies on a calendar year, not plan year basis. January 1, 2011 More robust individual market is especially valuable to former employees, particularly early retirees. Rebates payable by August 1. Starting with 2014 reporting year, rebates are payable by September 30. Small employer subsidies Tax credits of up to 50% available to certain small employers (up to 25 employees) that offer health insurance coverage to their employees through the SHOP marketplace. Credit may be claimed only for two consecutive years Only available if employer s FTEs average annual wages are no more than $50,800 (for 2014) and employer pays at least 50% of self-only cost. Public marketplaces Marketplaces State- or federally-run marketplaces available for individuals and small employers (defined as at least 2 employees and up to 100 employees, but most states have defined as under 51 employees). In 2016 must be available to small employers (up to 100 employees). In 2017 states can make available to large employers (over 100 employees) Availability of subsidies and community rating may reduce need for pre-65 retiree programs. Low-income subsidies for coverage in the marketplace Subsidies available to individuals between 133% and 400% of FPL. Employees eligible for employer coverage may receive subsidies only if employer coverage fails to provide minimum value or if employee contributions exceed 9.5% of household modified adjusted gross income. Retirees eligible for subsidies as long as not enrolled in employer coverage regardless of minimum value or affordability. Consider availability of subsidies in designing strategy for 2014 and beyond. 9

10 Taxes and fees HSA nonqualified withdrawals Penalty tax increased from 10% to 20%. January 1, 2011 Communicate to employees. Pharmacy manufacturer tax Annual fee on manufacturers of branded prescription drugs based on market share Cost likely will be shifted to employers. Comparative effectiveness research (PCORI) fee Fee on insured and self-funded plans to fund clinical effectiveness research. For plan years after October 1, 2013, fee equals $2/covered life/year; indexed thereafter. Payment due by July 31, of each year. Plan years ending after September 30, 2012 and before October 1, 2019 Affects cost of providing group health plan coverage. Determine which prescribed method results in lowest number of covered lives. Itemized medical deduction Medicare hospital insurance tax Itemized medical deduction threshold increased from 7.5% to 10% Individual income tax provisions that could increase pressure for employers Tax rate increased from 1.45% to 2.35% for income in excess of $200K (single or head of household) /$250K (joint filers). 3.8% unearned income tax on net investment income in excess of $200K (single or head of household)/$250k (joint filers). to offer tax-advantaged benefits. Additional Medicare tax increases administrative burden for employers. Employer required to collect tax only for employees earning $200K or more from employer. Medical device excise tax 2.3% excise tax on the manufacturer or importer for the sale of certain medical devices. Cost will likely be shifted to employers. 10

11 Health insurance providers fee Annual fee on entities that provide health insurance (self-insured employers specifically excluded) In addition to medical, fee also applies to insured dental, vision, EGWP, and MAPD plans. Estimated 2014 increase in premiums of 1.7% to 3.0%. Transitional reinsurance fee Fee paid by insurers and self-funded plans (major medical coverage) from 2014 to 2016 to help fund reinsurance program. For 2014, contribution rate $63 per covered life per year ($5.25 per month); for 2015, contribution rate $44 per covered life. Affects cost of providing health plan coverage. "Cadillac plan" excise tax 40% tax on value of coverage above $10,200/individual and $27,500/family (Indexed at CPI-U+1% for 2019, CPI-U only after 2019). $11,850/$30,950 for pre-medicare retirees. Adjusted for high risk industries, age, and gender. Excludes dental and vision. For multiemployer plans, all coverage is considered family coverage Affects cost of providing health plan coverage. May result in the limitation of health FSAs and executive programs and reduction in total health benefit package Xerox Corporation and Buck Consultants, LLC. All rights reserved. Xerox and Xerox and Design are trademarks of Xerox Corporation in the United States and/or other countries. Buck Consultants is a registered trademark of Buck Consultants, LLC in the United States and/or other countries. BR

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