Health Care Reform: 2015 Refresher of the Affordable Care Act (ACA)

Transcription

1 Health Care Reform: 2015 Refresher of the Affordable Care Act (ACA) Brought to you by Aon Presented by: Ryan Comstock & Shawna Brown This information is provided for informational purposes only and is not a substitute for legal advice. May 6, 2015

2 What is it? The Affordable Care Act Five Years Later Signed into law March 2010 Applies to almost all businesses in the US, including governments and churches Requires almost all individuals to obtain health insurance coverage or pay a penalty First two open enrollments in the health insurance exchanges (state or federal) is complete (estimated 11.7 million now enrolled after 2015 enrollment closed) Large employer penalties for failure to offer FT employees affordable, minimum level health insurance were delayed until 1/1/2015 for most employers with 100+ employees Updates and final regulations continue to be provided Compliance Dashboard provides you with details on the final regulations 2

3 What is it? ACA Healthcare Coverage ACA Requirement? Individual Mandate states everyone must have medical coverage How Are Individuals Covered? Marketplace / Exchange AHCCCS (Medicaid) Employer s Group Plan Who Pays? Federal Subsidy Individual Pays All Employer Contributes Employee Contributes 3

4 Session Objectives Identify key definitions impacting employer implementation of the Affordable Care Act Understand the regulatory requirements of the Affordable Care Act and how they impact health coverage for individuals and employers Introduce the new reporting requirements under the Affordable Care Act and how they impact employers (next session will be a deep dive into reporting) 4

5 Key Questions Who does the employer shared responsibility penalty apply to? When does the employer shared responsibility penalty apply? Who are full-time employees and equivalents? When does an employer have to offer coverage to fulltime employees? Does the coverage meet the mandates and affordability requirements? Will our plan be subject to the Excise Tax in 2018? 5

6 Key Health Reform Definitions ACA - refers to the 2010 Patient Protection and Affordable Care Act also known as health care reform. (For practical purposes, it also encompasses the Health Care and Education Reconciliation Act of 2010 and corresponding amendments.) Applicable Large Employer (ALE) - an employer who employed an average of at least 50 full-time employees plus full-time equivalents on business days during the preceding calendar year. All of VSEBT groups are considered ALE s for ACA purposes 6

7 Key Health Reform Definitions (cont.) Full-Time Employee Working an average of 30+ hours of service per week or 130 hours per month, annually. Hours of service includes all hours worked, vacation, sick, deployment leaves, family medical leave, etc. (Foreign hours worked not included) There are two methods for determining full-time status 1. Monthly Measurement 2. Look-back Measurement IRS final rules provide clarification for how to determine hours for workers with unique situations such as those in: educational institutions, on-call, seasonal workers, volunteers, airline workers and certain home health workers. 7

8 Key Health Reform Definitions (cont.) Full-Time Equivalent - For determining large employer status for shared responsibility requirements: Hours worked in a month by all part-time employees divided by 120. (When considered on annual basis this is 1440 hours) Health Insurance Exchange ( Exchange ) an ACA exchange is an insurance marketplace where individuals, or certain small business employees, can purchase insurance as part of a large risk pool. Each state was required to establish its own exchange or utilize the federal exchange ( Four metallic plan levels are offered plus a catastrophic option for certain individuals that qualify (the young invincible). 8

9 Key Health Reform Definitions (cont.) Exchange Subsidy Individuals who meet the income and health insurance affordability criteria will be eligible for sliding-fee premium and/or cost sharing (e.g. deductibles, co- payments) subsidies in the Exchange. (Must be ineligible for affordable, minimum essential coverage via employer.) Affordable Insurance Employee only premium cost is less than 9.56% of Household Income. Three employer safe harbor options are also provided under regulations (as of 1/1/2013). Test for hardship exemption from individual mandate: Insurance is affordable if cost is less than 8.05% of household income 9

10 Key Health Reform Definitions (cont.) Household Income (HHI) An individual s modified adjusted gross income (MAGI), as reported on their annual tax return. MAGI = AGI plus any excludible foreign earned income and taxexempt interest received during the taxable year. HHI also includes the incomes of all dependents required to file tax returns. HHI will be assessed in relation to FPL to determine eligibility for subsidies. Federal Poverty Level (FPL) Government-established income thresholds used to determine eligibility for assistance through various federal programs. 10

11 Key Health Reform Provisions Minimum Essential Coverage (MEC) - For individuals includes: Public programs, such as: Medicare Part A, Medicaid, CHIP, TRICARE, certain Veterans Affairs health care programs, Peace Corp health plan. Employer-sponsored health plan that is affordable & provides minimum value Insurance purchased through an Exchange, or the individual market State health benefits risk pools and other health benefits approved by HHS Secretary Grandfathered plans For employer: a governmental or any other small or large group health plan, including a grandfathered plan 11

12 Key Health Reform Provisions Minimum Value Plan - Law requires ALE to offer at least one plan with a minimum 60% actuarial value Meets individual mandate requirement Premiums for this level plan should be lower than higher actuarial value plans Actuarial Value looks at a variety of components: deductibles, co-payments, co- insurance, as well as employer contributions to HRAs and HSAs. All VSEBT Plans meet the MVP requirements 60% Actuarial Value means: on average the plan pays for 60% of the costs for covered benefits and enrollees, on average, pay the remaining 40 percent through cost-sharing such as deductibles, copayments and coinsurance. 12

13 Key Health Reform Provisions Individual Mandate - Individual mandate to obtain health coverage: Beginning in 2014, most individuals, including children, must obtain a minimum-level of health insurance coverage known as minimum essential coverage or pay a penalty. Minimum essential coverage includes: Medicare, Medicaid, TRICARE Insurance purchased through an Exchange, or the individual market Employer-sponsored coverage that is affordable & provides minimum value Grandfathered plans (if applicable) Hardship exemption Premium cost for lowest cost plan >8.05% of Household Income 13

14 Key Health Reform Provisions Individual Mandate Penalty (if you don t have coverage) **Household income over the tax filing threshold Penalty is capped at the greater of: Either the monthly penalty amount: Flat dollar amount or % of household income Family penalty = max. 3x per person amount Dependent assessed penalty = 1/2 per person rate 14

15 Key Health Reform Provisions Employer shared responsibility penalty ALE s have to offer group health coverage to all full-time employees in 2015 that is both affordable and provides minimum value, or be subject to one of two shared responsibility penalties if any full-time employee receives Exchange subsidies: 1. Does not offer insurance (No Coverage Penalty) 2. Insurance option offered is not considered affordable under ACA (Unaffordable Penalty) 15

16 Key Health Reform Provisions No Insurance Coverage Penalty - Also applies if coverage not offered to at least 70% (2016 and beyond must be 95%) of FT employees and their dependent children under age 26. Penalty Amount = Plan Year 2015 Amount = $2000 x each full-time employee, after first 80 employees for Plan Year 2015 Plan Year 2016 and beyond Amount = $2000 x each full-time employee, after first 30 for subsequent years 16

17 Key Health Reform Provisions Unaffordable Employer Coverage Penalty - If employer fails to offer coverage that is: MEC and minimum value offered to employees and their children under age 26 (spouses can be excluded). Affordable (3 safe harbor rules apply next slide) Penalty Amount = $3000 x # of FT employees who receive exchange subsidies Inflationary adjustments to penalties begin in 2015 Penalties indexed using national premium trend increases (Not clear if it is individual or family premiums, or individual market or group market trend awaiting further guidance) Announced by HHS in October of the year preceding the effective date of the increase. Employer pays no penalty for Medicaid eligible employees 17

18 Key Health Reform Provisions Affordability Safe Harbor W- 2 Safe Harbor: Looking back at Box 1 wages in comparison to premium cost for self- only coverage FPL: For 2015, employee cost for self-only coverage can t exceed $93.77/month (Indexed) Rate of Pay: Employee s cost for self-only coverage cannot exceed 130 hours x Employee s Pay Rate x 9.56% Knowing your method of safe harbor is required for ACA reporting 18

19 Key Health Reform Provisions 2015 Transition Relief: Non-Calendar Year Plans For employer s that: Had a non-calendar year plan as of 12/27/2012 Did not modify the plan year after 12/27/2012 to begin at a later calendar date No penalty assessed for months between January 2015 and beginning of plan year, if any of these circumstances apply: Offer all eligible employees (based on 2/9/2014 plan terms) affordable, minimum value coverage by the first day of the 2015 plan year If covered at least 25% of all PT & FT-- employees within the 12 months prior to 2/9/2014 or offered coverage to at least 1/3 of employees during the open enrollment period prior to 2/9/2014. If at least 1/3 of full-time employees were covered in 12 months prior to 2/9/2014 or offered coverage to 50% or more of full-time employees during open enrollment period prior to 2/9/

20 Methods for Determining Full-Time Status of Employees Monthly Measurement Total each employees hours worked each month and compare to 130 hours. If at or over = full-time If below = not full time Optional weekly rule Pros: Calculates actual # of full- time employees in real-time Cons: Administration of monthly benefit enrollment; employees on/off plan monthly Look-Back Measurement Employer use prior hours of service over employerselected period as a determinant future full-time status. Pros: Predictability; Longer measurement period can reduce number to which benefits must be offered Cons: May not accurately reflect number of full-time employees 20

21 2015 Transition Relief 2015: Shortened Measurement and Stability Periods Transition Measurement Period Between 6 12 consecutive months Starts no later than July 1, 2014 Ends no earlier than 90 days before the start of 2015 plan year Example: Calendar plan year (January 1) Measurement period: April 15 October 14, 2014 Administrative period: October 15 December 31, 2014 Example: Non-calendar plan year (July 1) Measurement: June 15, 2014 April 14, 2014 Administrative Period: April 15 June 30,

22 2018 Cadillac Tax The Cadillac Tax is an excise tax (permanent annual tax) scheduled to take effect in 2018 to reduce health care usage and costs by encouraging employers to offer plans that are cost-effective and engage employees in sharing in the cost of care. It is a tax on employers that provide high-cost health benefits to their employees. The tax is a 40% nondeductible excise tax on aggregate value of employer-sponsored health coverage in excess of thresholds. Purpose: Slow the rate of growth of health care spend and generate $80B over the next 10 years to help finance the expansion of health coverage Please Note: Final regulations have not been issued information presented is subject to change. 22

23 2018 Cadillac Tax Coverages subject to taxation include: Medical (Fully Insured & Self-Funded Plans) HSA employer and employee pre-tax contributions Health FSA HRA Self-insured dental and vision plans Coverages excluded include: Stand-alone dental (fully insured) Stand-alone vision (fully insured) Accident coverage Disability benefits Long-term care insurance 23

24 2018 Cadillac Tax For Planning Purposes: Thresholds for actives and post-medicare retirees are: $10,200 for single coverage in 2018 $27,500 for family coverage in 2018 (other than self-only coverage) For pre-65 retirees and individuals in high-risk professions, the threshold amounts are $11,850 for individual coverage and $30,950 for family coverage. Thresholds will be updated for 2018 when final regulations are issued and indexed for inflation in future years 24

25 ACA Fees The Fee When? Who? How Much? Patient-Centered Outcomes Research Fee 2013 All Plans - Self Insured plans file Form 720 (VSEBT) 1st Year: $1 / Life 2nd Year: $2 / Life After: Indexed Transitional Reinsurance Fee 2014 TPA's and Insurers (VSEBT) (EE & Dependents) 2014: $ : $ : $26 Cadillac Tax (Excise) 2018 High Cost Plans 40% Tax on excess value over threshold 25

26 What s next? ACA Reporting 1094 & 1095 Purpose of Employer Reporting Determine which full-time employees, if any, were offered coverage Reconciled with individual reporting to confirm eligibility for Exchange subsidies. Confirm that coverage offered was at least 60% actuarial value Confirm that coverage was affordable for employee If these tests aren t met, determine employer penalty. More to come Stay tuned!! 26

27 What do I need to do? Establish a system for identifying full time employees (those working 30 or more hours per week) Adopt an hours counting methodology for variable, part-time, temporary and seasonal employees Adopt a monthly measurement or look-back measurement method Document plan eligibility rules (30 hours per week / waiting periods etc.) Test plans for affordability (9.56% of W-2 wages) or against Safe Harbors Ensure plan meets the 60% minimum value Examine the design of any standalone Health Reimbursement Account or Health FSA plans to ensure compliance with ACA Evaluate your current medical plan costs for 2015/2016 Plan Year. How will the impact of YOY medical trend impact your plans? Do you have a strategy to mitigate the tax impact by getting below the thresholds? 27

28 Thank you! If you have any questions after our session is over, please contact your VSEBT Account Manager: Darlene Kracht: Julie Padelford: Melissa Bennett: Sheri Gilbert: 28