A f f o r d a b l e C a r e A c t. S u s a n L. G r a s s l i, J D M a y

Size: px
Start display at page:

Download "A f f o r d a b l e C a r e A c t. S u s a n L. G r a s s l i, J D M a y 2 0 1 4"

Transcription

1 Health Care Reform T h e B i g T h r e e P r o v i s i o n s o f t h e A f f o r d a b l e C a r e A c t S u s a n L. G r a s s l i, J D M a y

2 Agenda Background The Big Three o Individual Mandate o The Exchange / Health Insurance Marketplace o Employer Shared Responsibility / Employer Mandate / Pay or Play Additional Key Provisions of the ACA 2

3 Background o Regulations o Definitions in PPACA o Grandfathered Plans

4 Background Regulations Statute: o March 23, 2010: Patient Protection and Affordable Care Act o March 30, 2010: Health Care and Education Reconciliation Act Collectively, these acts are referred to as: o Health Care Reform (HCR) o Affordable Care Act (ACA) o Patient Protection and Affordable Care Act (PPACA) Three U.S. Departments Have Authority To Collectively Issue Regulations: o U.S. Department of Health and Human Services (HHS) o U.S. Department of Labor (DOL) o U.S. Treasury Department (IRS) 4

5 Background Definitions in Affordable Care Act Example: Large Employer is defined differently throughout Health Care Reform Provision Employer-Shared Responsibility Exchanges Automatic Enrollment Form W-2 Reporting of Health Coverage Value Small Employer Tax Credit Definition of Large Employer 100 Employees or more (2015) 50 Employees or more (2016) 50 Employees or more (2014/15) 100 Employees or more(2016) 200 Employees or more Issued at least 250 Form W-2s for prior tax year Large if more than 25 employees 5

6 The Big Three o The Individual Mandate o The Exchange / Health Insurance Marketplace o Employer Shared Responsibility / Employer Mandate / Pay or Play The "Big Three"

7 The Big Three Provisions of Health Care Reform Individual Mandate o Effective January 1, 2014 The Exchange / Health Insurance Marketplace o Effective January 1, 2014 Employer Mandate/ Employer Shared Responsibility / Pay or Play o Effective date moved from January 1, 2014 to January 1, 2015 (100 +) o Effective date moved from January 1, 2014 to January 1, 2016 (50 to 99) 7

8 The Big Three Individual Mandate Effective January 1, 2014 o Introduction o Definitions o Who Must Comply o Exceptions o U.S. Supreme Court Decision o Penalties

9 The Big Three The Individual Mandate Individual Mandate: o Individuals must obtain minimum essential health coverage (MEC) for themselves and their dependents by January 1, 2014 or pay Individual Mandate Tax Tax is calculated monthly (imposed only on months without coverage) Tax is paid annually through individual federal tax return What exactly is Minimum Essential Health Coverage (MEC): o No details in definition, plan just must be designated by statute or regulation as MEC MEC is low threshold, Generally, any employer sponsored coverage, individual coverage, government coverage Exceptions: skinny, mini-med, catastrophic plans MEC is different than Minimum Value (Minimum Value is higher threshold) MEC is different from Essential health Benefits (EHBs is higher threshold) 9

10 The Big Three The Individual Mandate No Individual Mandate Tax imposed in certain cases o Exemptions to Individual Mandate Tax: A less than three (3) month gap in coverage, Households where required premium contribution is more than 8% of household income, Households below the tax filing threshold, Households that are unable to qualify for Medicaid in a state that has chosen not to expand Native American tribes, Specific Hardships o Not Applicable: Those with religious objections, those not lawfully present (aliens, and non-citizens/nationals) Those who are incarcerated 10

11 The Big Three The Individual Mandate Amount of Tax: Fixed Dollar Amount or Percentage of Income (Greater of the two) $695 o 2014: $95 PPPY, or 1% of income (MAGI) o 2015: $325 PPPY, or 2% of income (MAGI) o 2016: $695 PPPY, or 2.5% of income (MAGI) o 2017: will increase by medical inflation $95 $325 o Limits on Amount of Tax The fixed dollar tax is capped for a family at 3 times the individual tax ($695 X 3 = $2085 in 2016) 50% less for under age 18 The percentage of income tax is capped at the national average premium for Bronze coverage

12 The Big Three The Exchange / Health Insurance Marketplace An Exchange Must Be Open in Every State by January 1, 2014 o Introduction o Individual Exchange o Small Employer Exchange o Medicaid Expansion o Premium Tax Credit & Cost Sharing Reduction o Essential Health Benefits Package o Fair Health Insurance Premiums

13 The Big Three The Exchange / Health Insurance Marketplace What is the Exchange/Health Insurance Marketplace? o An internet site available in every state that offers for purchase a variety of health insurance plans (private, not government) from several different insurance carriers. Who May Purchase in the Exchange/Health Insurance Marketplace o Only individuals and small employers may purchase Individual Exchange: May purchase coverage for Individuals/Households Small Employer Exchange: (SHOP) Small employer coverage for employees State Options for Exchange/Health Insurance Marketplace Establish state exchange Establish partnership exchange Default to federally facilitate exchange Hybrid option 13

14 State Health Exchanges Each state should have had compliant Exchange by January 1, 2014 State-run Marketplace Federally-facilitated Marketplaces State-Federal Partnership Marketplaces Hybrid Marketplace: Federally-facilitated Individual Exchange and State-run SHOP

15 The Big Three The Exchange / Health Insurance Marketplace Individual Exchange: Individual/Household plans only o U S citizens and lawful residents may purchase o Some (not all) individuals may qualify for subsidies which will make health coverage less expensive for that individual These subsidies possibly trigger penalties for large employers o For 2014 plans, open enrollment was October 1, 2013 through March 31, 2014 o For 2015 plans, open enrollment is November 15, 2014 through February 15, 2015 SHOP Exchange (Small Employer Health Options Program): o Employer selects the amount they can contribute to each employee s coverage Employee shops and chooses between several plans within the budget Defined contribution and employee-paid funds may still be pre-tax dollars o Open enrollment started October 1, 2013 and is open year round for small employers Utah has had SHOP Exchange for a few years o Small Employer Tax Credit: small businesses (less than 25) may qualify for a tax credit if average wages paid is less than 50k and employer pays at least half of premiums 15

16 The Big Three The Exchange / Health Insurance Marketplace Year 2014 & Definition of Small Employer in the SHOP Exchange Less than 100 employees or less than 50 employees o However, states may define small plans as less than 50 employees. o Many states have opted to define small plans as less than 50 employees Less than 100 employees o States will no longer have the option to define as less than 50 employees o States must all define small employee as 100 States may opt to allow employer plans of any size into the Exchange Remember the definition of small employer varies between provisions in the Affordable Care Act. 16

17 The Big Three The Exchange / Health Insurance Marketplace Qualified Health Plans o By January 1, 2014 all plans sold in the Exchange must be a Qualified Health Plan o Effective date requiring Qualified Health Plan moved On November 14, 2013 and then on March 5, 2014, rules were issued which allowed employers to continue plans that are NOT Qualified Health Plans Plans renewed under the original transition relief may renew the same (non-qualified ) health plan at any time through Oct. 1, 2016 Affected individuals and small businesses may choose to re-enroll in the coverage through Oct. 1, Individuals and small businesses must receive notice of their options States have to allow for this delayed effective date 17

18 The Big Three The Exchange / Health Insurance Marketplace Qualified Health Plans o All individual and small plans in (and outside) the Exchange must be a Qualified Health Plan (QHP) o Exception: If grandfathered plan, need not offer a Qualified Health Plan o A qualified Health Plan includes the Essential Health Benefits Package What is in the Essential Health Benefits Package? o The ten essential health benefits (EHBs) o Specific limits on cost-sharing o Coverage offered meets specific minimum value levels 18

19 The Big Three The Exchange / Health Insurance Marketplace The Essential Health Benefits Package includes the ten elements and services of Essential Health Benefits (EHBs) 1. Ambulatory patient services 2. Hospitalization 3. Mental health and substance use disorder services, including behavioral health treatment 4. Emergency services 5. Maternity and newborn care 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Pediatric services including oral and vision care 10. Preventive and wellness services and chronic disease management 19

20 The Big Three The Exchange / Health Insurance Marketplace The Essential Health Benefits Package includes Limits on Cost-Sharing o What is Cost-sharing? Deductibles, coinsurance, copayments or similar charges a participant must pay toward medical expenses under a plan Does not include payments a participant pays for monthly premium, balance billing for out-ofnetwork services, charges for non-covered services o Cost-sharing limits in the Exchange: NO MORE Maximum deductible limits of 2k/4k A plan may not impose out-of-pocket maximums in excess of: $6,350 (individual) $12,700 (family) A plan may not impose cost sharing for Preventive Services A plan may not impose annual or lifetime limits (caps) on Essential Health Benefits (EHBs) May have limits on services or coverage in a plan that is not an EHB 20

21 The Big Three The Exchange / Health Insurance Marketplace The Essential Health Benefits Package includes coverage that meets Minimum Value o All plans must pay a minimum of 60% of the total actuarial value/cost of the benefits provided under the plan o For plans sold in the Exchange, they must also meet specific actuarial values of either 60, 70, 80 or 90 percent (plus or minus 2%) Paid by participant 40% 30% 20% 10% Paid by plan 60% 70% 80% 90% Bronze Silver Gold Platinum 21

22 The Big Three The Exchange / Health Insurance Marketplace Additional Requirements: Individual/Small Employer Plans must have Fair Premiums o Carriers may only vary premiums based on four (4) factors: 1. Age (3: 1 ratio for adults) 2. Tobacco use (1.5:1 ratio and subject to wellness program rules) 3. Geographic rating area (within a state) 4. Tier (single or family) o All other factors may not be used by carriers to increase premiums. Pre-existing conditions, health status, claims history, duration of coverage, gender, occupation, small employer size, may NOT be used when setting premiums Also known as Adjusted/Modified Community Rating Prohibits insurers from varying rates based on health status or claims history but does allow for some variance on age and lifestyle factors like tobacco us There is no medical underwriting 22

23 The Big Three The Exchange / Health Insurance Marketplace The Individual Exchange: Subsidies o Income individuals/households who don t qualify for Medicaid, still may qualify for partial help with cost of health coverage through Subsidies: Premium Tax Credit Eligibility Households with income between 100% and 400% of the FPL Cost Sharing Reduction Eligibility Households with income between 100% and 250% of the FPL o A large employer is exposed to possible penalty if an employee qualifies for and uses a subsidy in the Exchange Large employer is exposed to possible penalty if employer doesn t offer coverage to full-time employees (and dependents) that is affordable and meets minimum value 23

24 The Big Three The Exchange / Health Insurance Marketplace 2014 Federal Poverty Level, by Family Size Family Size 100% FPL 138% FPL 150% FPL 250% FPL 300% FPL 350% FPL 400% FPL 1 $11,670 $16,105 $17,505 $29,175 $35,010 $40,845 $46,680 2 $15,730 $21,707 $23,595 $39,325 $47,190 $55,055 $62,920 3 $19,790 $27,310 $29,685 $49,475 $59,370 $69,265 $79,160 4 $23,850 $32,913 $35,775 $59,625 $71,550 $83,475 $95,400 5 $27,910 $38,516 $41,865 $69,775 $83,730 $97,685 $111,640 6 $31,970 $44,119 $47,955 $79,925 $95,910 $111,895 $127,880 7 $36,030 $49,721 $54,045 $90,075 $108,090 $126,105 $144,120 8 $40,090 $55,324 $60,135 $100,225 $120,270 $140,315 $160,360 For families/households with more than 8 persons, add $4,020 for each additional person. 24

25 The Big Three The Exchange / Health Insurance Marketplace The Premium Tax Credit The Individual Exchange: Subsidies o A subsidy that helps individuals/families pay part of the monthly insurance premium for health coverage purchased in the Individual Exchange Credit amount is based on cost of second lowest cost silver plan offered o Amount individual/family pays toward the monthly premium is based on sliding scale and percentage of household income. Example: Households living between 200% - $250% of FPL will pay between 6.3% % of household income toward premium o The remaining premium amount left unpaid is covered by the federal government. May opt for refund or direct pay: Refundable through annual taxes (still paid to individuals even if they do not owe taxes) Advanceable (IRS pays each month directly to the insurance companies) 25

26 The Big Three The Exchange / Health Insurance Marketplace The Cost-sharing Reduction The Individual Exchange: Subsidies o A subsidy that helps individuals and families with household incomes pay out-ofpocket costs (cost sharing) at the point of service. Cost-sharing examples include: Deductibles, coinsurance, copayments or similar charges a participant must pay toward medical expenses under a plan o For example: Individual s plan requires a $30.00 copayment to visit doctor Only a percentage of that $30.00 will be paid by the individual, depending on specific household income The remaining amount is covered by the federal government 26

27 The Big Three Employer Shared Responsibility / Employer Mandate Effective 2015 o Introduction & Overview o Controlled & Affiliated Groups o Determining Whether Employer is Large o Determining Which Employees Must be Offered Benefits

28 Employer Shared Responsibility Large employers offer health coverage to all full-time employees, and their dependents, or exposure to possible penalty Start Here Question One Question Two Am I a large employer under this rule? Yes Which employees must be offered coverage? The "Big Three" No I will not be penalized if I don t comply with Employer Shared Responsibility. 28 All employees who work an average of 30 hours per week or 130 hours per month

29 The Big Three : Employer Shared Responsibility Determining Employer Size o General definition of large employer under Employer Shared Responsibility Employer with 50 or more employees: Large employer is defined as employer with 50 or more full-time employees or fulltime employee equivalents on business days in a given year Employer with under 50 employees is not large and does not have to comply with this ACA provision o Temporary New Definitions (Transition Rule) Large employer 100 or more full-time employees or full-time employee equivalents Small employer 99 or less full-time employees or full-time employee equivalents In 2016, small employer definition will go back to less than 50 Employers with between 50 and 99 employees will comply with Employer Mandate starting January 1, 2016 BUT EMPLOYERS OF THIS SIZE MUST FIRST PROVIDE APPROPRIATE CERTIFICATION 29

30 The Big Three : Employer Shared Responsibility Determining Employer Size Question One: Am I a large employer under this rule? o To Avoid Common mistakes/misinformation that could lead to a penalty Certain small employers may actually be considered large under this provision Important to calculate employer size correctly Understand the rules related to: Control groups and affiliated services groups Temporary/Leased employees Special categories that are not considered employees Full-time employee equivalents and Seasonal employees 30

31 The Big Three Employer Shared Responsibility Question One: Am I a large employer under this rule? o When determining employer size, employees from all entities that are part of the same controlled group or affiliated services group must be counted o Don t forget to count: All employees who are part of the same Controlled Group Three types of Controlled Groups Generally, when one business owns a significant part of another business or businesses Different types of common ownership All employees who are part of the same Affiliated Services Group Three types of Affiliated Services Groups Generally, when one company regularly performs certain types of personal services or management functions with/for related entities No need to have common ownership o Tax professionals can run an analysis to make a determination 31

32 The Big Three Employer Shared Responsibility Question One: Am I a large employer under this rule? o When determining employer size, may need to count employees hired from staffing agencies Use common law employer standard to determine: Definition: A common law employer exists when the person for whom the services are performed has the right to control and direct the individual who performs the services, not only:» as to the result to be accomplished, but also» as to the details and means by which the result is accomplished» It doesn t matter if employer actually directs or controls the manner in which the services are performed; it is sufficient if the employer has the right to Recent clarification that generally: Temporary agencies will be common law employer Other staffing agencies, leasing agencies, and PEOs will not be common law employer» This means client employer will typically be common law employer 32

33 The Big Three : Employer Shared Responsibility Determining Employer Size Question One: Am I a large employer under this rule? o When determining employer size, don t just count full-time employees: Full-time employee equivalents Two or more part-time employees whose hours add up to 120 For example, 2 PT 60 hours/month = 1 FT employee To determine full-time employee equivalents, for each month, combine all part time employee hours (employees who work less than 30 hours per week) and divide by 120 Seasonal employees Employees who work full-time during a particular season but who work less than onehundred and twenty (120) days or four months or less during the entire year This definition is not used under Question 2, (how to identify full-time employees) there is a different definition of seasonal under that part of this provisions 33

34 The Big Three : Employer Shared Responsibility Determining Employer Size Question One: Am I a large employer under this rule? o To Determine Size, find Average Monthly Employee Count from the PRIOR year For example: for 2015, figure the average monthly employee count existing in 2014 and use all 12 months to calculate If an employer is small the first part of 2014 and large the second part of 2014, the employer will be considered large under this provision for 2015 if the total monthly average employee count is 100 or more For 2016, if the if the total monthly average employee count during 2015 is 50 or more, the employer is considered large o To Calculate: Find monthly employee count for full-time employees, full-time employee equivalents, and seasonal employees for entire year Add all monthly subtotals for entire year to get grand total Divide grand total by 12 to get monthly average Can use 6 consecutive months

35 The Big Three : Employer Shared Responsibility Determining Employer Size Example Question One: Am I a large employer under this rule? Jan Feb Mar Apr May June July Aug Sep Oct Nov Dec Full-Time Seasonal FTEE Total Yearly total of all employees (FT, FTEE, & Seasonal) = 645 divided by = (months in a year to obtain monthly average) NOTE: This is a small employer in 2015 and this is a large employer in 2016 unless the seasonal employee exception applies. 35

36 The Big Three : Employer Shared Responsibility Determining Employer Size Summary Question One: Am I a large employer under this rule? o Small Employer: A small employer need not comply with Employer Shared Responsibility Will not be penalized if don t offer to all full-time employees May opt to offer coverage in or out of the Exchange. If opt to offer, you still must: Comply with other PPACA provisions Determine whether you qualify for the Small Employer Tax Credit If you employ 25 or fewer employees o Large Employer: A large employer must comply with Employer Shared Responsibility or be subject to possible penalty go to Question Two 36

37 Employer Shared Responsibility Two Questions Start Here Question One Question Two Am I a large employer under this rule? Yes Which employees must I offer health coverage? No I do not have to comply with Employer Shared Responsibility All employees who work 30 hours per week on average in a month. 37

38 The Big Three : Employer Shared Responsibility Determining Which Employees Must Be Offered Coverage Question Two: Which employees must Large Employers offer coverage? o Question Two: Identifying who must be offered coverage Large employers must offer Minimum Essential Coverage to substantially all fulltime employees, and their dependents, or pay a possible penalty o Definitions Substantially All is defined as: For 2015: 70% of full-time employees For 2016: 95% of full-time employees (or all but 5 FT employees whichever is greater)» Regulations allow for margin of error» May use margin of error intentionally or unintentionally» Only protects employer from one of the two penalties (protection from $2,000 penalty but not from $3,000 penalty) 38

39 The Big Three : Employer Shared Responsibility Determining Which Employees Must Be Offered Coverage o Definitions Question Two: Which employees must Large Employers offer coverage? Minimum Essential Coverage (MEC) is almost any coverage offered, BUT to avoid all penalties, the coverage must also: be Affordable meet Minimum Value Full-time is 30 hours or more per week or 130 hours average per month Dependents are employee children up to age 26 Note: Large employers will not be penalized for failing to offer dependent coverage until 2016 and as long as they are taking steps toward it» Exception: if already offering to dependents employer must continue to do so» Taking steps: getting quotes from carriers, working on plan amendments to add dependents, notifying employees they will offer dependent coverage in

40 The Big Three : Employer Shared Responsibility Determining Which Employees Must Be Offered Coverage o o Question Two: Which employees must Large Employers offer coverage? To Identify Full-Time Employees, Count Hours Count hours worked, regardless of job description/title/classification and how paid It is possible that employees classified by employer as part time/seasonal/temporary/variable may actually be full-time under this rule When Counting Hours, include: Hours Worked: Hours when work is actually performed Service Hours: Hours for which an employee is paid or entitled to payment even when no work is performed Examples: vacation, holiday, illness, incapacity/disability, layoff, jury duty, military duty 40

41 The Big Three : Employer Shared Responsibility Determining Which Employees Must Be Offered Coverage : Question Two: Which employees must Large Employers offer coverage? o Employer Shared Responsibility Regulations list two different types of Measurement Methods to count hours to help determine Full-time Status Monthly Measurement Method Look Back Measurement Method (aka Look Back/Stability Period Safe Harbor) o Monthly Measurement Method Count each employee s hours during each month Employees could go in and out of coverage each month o Look-Back Measurement Method Track each employee s hours during a specified Look-back measurement period, and, for employees who are full-time during Look-back Period, Offer coverage during the associated Stability Period Very technical method, important to understand details if opting to use 41

42 The Big Three : Employer Shared Responsibility Determining Which Employees Must Be Offered Coverage o o Question Two: Now that I know I m a large employer, to which employees must I offer coverage? New General Rule for two Measurement Methods: Employer may NOT use the Look-back Measurement method for variable hour and seasonal employees while using the Monthly Measurement method for employees who consistently work full-time or who consistently work part-time. Must use same measurement method for all employees TWO EXCEPTIONS to the General Rule MUST use Monthly Method for newly hired full-time employees MAY use different measurement methods ONLY for the following categories of employees Salaried v. hourly employees Employees in different States (primary place of employment) Collectively bargained v. on-collectively bargained employees (union) Each group of collectively bargained employees covered by a separate collective bargaining agreement 42

43 The Big Three : Employer Shared Responsibility Coverage & Penalties Effective 2015 o Employer Shared Responsibility and the Coverage offered by Large Employers What Kind of Coverage Must be Offered to Avoid All Penalties? In order to avoid ALL possible penalties, the health coverage offered by large employers cannot be Minimum Essential Coverage: The premium must be Affordable (based on single coverage) The total coverage must meet Minimum Value Coverage Must Meet Minimum Value: Minimum value plan is like a Bronze plan in the Exchange/Health Insurance Market Plan pays at least 60% and the participant pays 40% of the total plan Plan may pay more than 60%, but not less Most plans already meet Minimum Value» HHS reported that 96% - 98% already meet Minimum Value» Mini-med plans probably do not meet this» Catastrophic plans do not meet this 43

44 The Big Three : Employer Shared Responsibility Coverage & Penalties Effective 2015 Employer Shared Responsibility and the Coverage offered by Large Employers o Affordable: Monthly Premium for single coverage cannot exceed 9.5 % of any FT employee income. May select one of three calculation methods: Premium is less than 9.5% of the employee s household income on Form W-2 as listed in Box 1 Premium is less than 9.5% of hourly rate (as of first of plan year) multiplied by 130 hours Premium is less than 9.5% of Federal Poverty Level for one person: Monthly premium example: $92.93 or less Generally the lowest threshold of the three options Easiest to administer o Should carefully select safe harbor and memorialize in plan documents. 44

45 The Big Three : Employer Shared Responsibility Coverage & Penalties Effective 2015 Affordability Chart 2014 Hourly Rate Hours / Week Annual Comp 9.5% of Annual Comp Max. Monthly EE Only Premium $ $11,310 $1, $ $ $15,080 $1, $ $8 30 $12,480 $1, $ $8 40 $16,640 $1, $ $10 30 $15,600 $1, $ % FLP for 1 N/A $11,490 $1, $92.93 Unaffordable = an employee s cost for self-only coverage is more than 9.5% of income 45

46 The Big Three : Employer Shared Responsibility Coverage & Penalties Effective 2015 Effective Dates for Coverage offered by Large Employers o Calendar Year Plans Large employers with 100 or more employees comply starting January 1, Employers with 50 or more employees comply starting January 1, 2016 o Non-Calendar Year Plans Large employers with 100 or more employees comply starting January 1, Employers with 50 or more employees comply starting January 1, 2016 o Exception Some, but not all, employers with non-calendar year plans may start complying on the first day of their 2015 plan year instead of January 1, 2015 if: Employer is large (100 or more) for 2015 Employer meets specific requirements (next page) 46

47 The Big Three : Employer Shared Responsibility Coverage & Penalties Effective 2015 o To qualify for the exception, an Employer must be able to answer in the affirmative to all bullets: The employer maintained a non-calendar year plan as of December 27, 2012 and has not modified the plan year since then, and The employer (needs to qualify for at least one): Offered coverage at last open enrollment to at least 1/3 of ALL employees, or Actually covered at least ¼ of ALL employees (measured on any one selected day between February 10, 2013 and February 9, 2014) Offered coverage at last open enrollment to at least ½ of full-time employees, or Actually covered at least 1/3 of FULL-TIME (measured on any one selected day between February 10, 2013 and February 9, 2014) As of the first day of the 2015 plan year, the employer offers coverage to at least 70% of its full-time employees. 47

48 The Big Three : Employer Shared Responsibility Coverage & Penalties Effective 2015 Three Possible Penalties starting 2015 o Non-Offering Penalty Large Employer fails to offer Minimum Essential Coverage to all (defined as 70% in 2015 and 95% in 2016) full-time employees $2, annually multiplied by the number of all full-time employees (minus 80 in 2015 and minus 30 in 2016) o Affordability Penalty Large Employer offers all full-time employees health coverage but the monthly premium is not affordable to an employee $3, annually multiplied by the number of employees who go to the Individual Exchange and qualify for and use the premium tax credit (also calculated monthly) o Minimum Value Penalty Large Employer offers all full-time employees health coverage but the coverage does not meet minimum value $3, annually multiplied by the number of employees who go to the Individual Exchange and qualify for and use the premium tax credit (also calculated monthly) 48

49 The Big Three : Employer Shared Responsibility Coverage & Penalties Effective 2015 o If any full-time employee buys health insurance through the Individual Exchange, qualifies for and uses a subsidy (premium tax credit or cost-sharing reduction), o Then large employers are exposed to a penalty if one of the following applies: Employer Fails to offer health coverage to all FT employees Employer charges unaffordable monthly premiums Employer offers inadequate coverage (doesn t meet minimum value) $2,000 penalty multiplied by all FT employees (minus X) $3,000 penalty X all FT employees who get subsidy $3,000 penalty X all FT employees who get subsidy 49

HEALTH CARE REFORM CHECKLIST

HEALTH CARE REFORM CHECKLIST HEALTH CARE REFORM CHECKLIST As a small employer, you need to be aware of the new regulations tied to the Affordable Care Act. Refer to this checklist to ensure you understand each one and that you re

More information

Health Care Reform: Ready or Not, Here it Comes! Presented by:

Health Care Reform: Ready or Not, Here it Comes! Presented by: Broader Perspective. Business Solutions. Health Care Reform: Ready or Not, Here it Comes! Presented by: Ryan Fridborg, MAOD, SPHR Executive Vice President, Employee Benefits rfridborg@boltonco.com Marilyn

More information

Section 2: INDIVIDUALS WHO CURRENTLY HAVE

Section 2: INDIVIDUALS WHO CURRENTLY HAVE Section 2: INDIVIDUALS WHO CURRENTLY HAVE COVERAGE OR AN OFFER OF COVERAGE FROM THEIR EMPLOYER Section 2 covers enrollment issues for individuals who have coverage or an offer of coverage whether through

More information

Federal Health Reform FAQs

Federal Health Reform FAQs Federal Health Reform FAQs Individuals 1. What is an exchange? An exchange, as created under the Affordable Care Act (ACA), is a place where consumers can purchase subsidized health insurance coverage.

More information

Health Care Reform Update

Health Care Reform Update Small Businesses No Financial Requirements for Small Businesses: The ACA imposes no financial requirements for small businesses to contribute to their employees health insurance. However, beginning in

More information

Health Care Law Implementation: What Nonprofits Need to Know WELCOME!

Health Care Law Implementation: What Nonprofits Need to Know WELCOME! Health Care Law Implementation: What Nonprofits Need to Know WELCOME! Health Care Law Implementation: What Nonprofits Need to Know (PPACA) Health Care Law Implementation: What Nonprofits Need to Know Heather

More information

The Patient Protection and Affordable Care Act What Employers need to know

The Patient Protection and Affordable Care Act What Employers need to know The Patient Protection and Affordable Care Act What Employers need to know Presented by: Misty Baker mbake@iiat.org 800-880-7428 This update is based on the known provisions of the PPACA. This is not to

More information

The Effect of the Affordable Care Act on Your Small Business. Presented to : Greater Kansas City Chamber Business Class

The Effect of the Affordable Care Act on Your Small Business. Presented to : Greater Kansas City Chamber Business Class The Effect of the Affordable Care Act on Your Small Business Presented to : Greater Kansas City Chamber Business Class November 6, 2013 KHN Kaiser Health News Current Headlines October 31- November 4,

More information

AFFORDABLE CARE ACT LARGE EMPLOYER HEALTH REFORM CHECKLIST. Edition: November 2014

AFFORDABLE CARE ACT LARGE EMPLOYER HEALTH REFORM CHECKLIST. Edition: November 2014 AFFORDABLE CARE ACT Employers that offer health care coverage to employees are responsible for complying with many of the provisions of the Affordable Care Act (ACA). Most health reform changes apply regardless

More information

HEALTH REFORM AND MULTIEMPLOYER PLAN COVERAGE 2014 AND BEYOND

HEALTH REFORM AND MULTIEMPLOYER PLAN COVERAGE 2014 AND BEYOND WWW.BKLAWYERS.COM HEALTH REFORM AND MULTIEMPLOYER PLAN COVERAGE 2014 AND BEYOND ABA SECTION OF LABOR AND EMPLOYMENT LAW EMPLOYEE BENEFITS COMMITTEE MID- WINTER MEETING 201 BLITMAN & KING LLP Franklin Center,

More information

OVERVIEW OF PRIVATE INSURANCE MARKET REFORMS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND RESOURCES FOR FREQUENTLY ASKED QUESTIONS

OVERVIEW OF PRIVATE INSURANCE MARKET REFORMS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND RESOURCES FOR FREQUENTLY ASKED QUESTIONS OVERVIEW OF PRIVATE INSURANCE MARKET REFORMS IN THE PATIENT PROTECTION AND AFFORDABLE CARE ACT AND RESOURCES FOR FREQUENTLY ASKED QUESTIONS Brief Prepared by MATTHEW COKE Senior Research Attorney LEGISLATIVE

More information

Health insurance Marketplace. What to expect in 2014

Health insurance Marketplace. What to expect in 2014 Health insurance Marketplace What to expect in 2014 Overview The Affordable Care Act (ACA) includes several provisions geared to extend greater access to health insurance benefits to more people. Beginning

More information

Parker, Smith & Feek - ACA Update: 2014 November 2013

Parker, Smith & Feek - ACA Update: 2014 November 2013 Affordable Care Act (ACA) Background Core of law is an attempt to reduce # of uninsured Multiple approaches to expanding insurance coverage Requires most in US to have health insurance Creates state-based

More information

Healthcare Reform Preparedness for Small Businesses

Healthcare Reform Preparedness for Small Businesses Healthcare Reform Preparedness for Small Businesses Blue KC on Wheels Community awareness initiative Health screenings Wellness information Seminars on healthcare reform, health insurance and wellness

More information

Employer s Guide To Health Care Reform

Employer s Guide To Health Care Reform Employer s Guide To Health Care Reform A nonprofit independent licensee of the Blue Cross Blue Shield Association National strength. Local focus. Individual care. SM As part of our commitment to being

More information

HHealth HEALTH INSURANCE EXCHANGE FAQs

HHealth HEALTH INSURANCE EXCHANGE FAQs HHealth HEALTH INSURANCE EXCHANGE FAQs Page 1 TABLE OF CONTENTS Introduction... 3 Background... 3 Health Insurance Exchange FAQs... 4 What is the Patient Protection and Affordable Care Act (PPACA)?...

More information

Introduction to the New Health Care Laws Michelle Walker, Rocky Mountain Health Plans January 14, 2015

Introduction to the New Health Care Laws Michelle Walker, Rocky Mountain Health Plans January 14, 2015 Introduction to the New Health Care Laws Michelle Walker, Rocky Mountain Health Plans January 14, 2015 Agenda Basics of Health Care Reform Changes in Individual Healthcare Coverage Mandates Affordability

More information

THE AFFORDABLE CARE ACT IN VIRGINIA --THE BASICS-- MARY FRANCES CHARLTON Attorney and ACA Coordinator LEGAL AID JUSTICE CENTER

THE AFFORDABLE CARE ACT IN VIRGINIA --THE BASICS-- MARY FRANCES CHARLTON Attorney and ACA Coordinator LEGAL AID JUSTICE CENTER THE AFFORDABLE CARE ACT IN VIRGINIA --THE BASICS-- MARY FRANCES CHARLTON Attorney and ACA Coordinator LEGAL AID JUSTICE CENTER Overview Affordable Care Act, aka Obamacare Goals Affordable Insurance Coverage

More information

Introduction. Affordable Care Act Overview of Changes

Introduction. Affordable Care Act Overview of Changes Introduction Affordable Care Act Overview of Changes Presented by: Tim Dillingham, CLU Benefit Resource Group, Inc. 201 E Broad Street, Suite 1 Linden, MI 48451 810-735-6500 810-735-6610 (fax) tim@benefitresourcegroup.net

More information

Health Policy Essentials: Private Health Insurance. Bernadette Fernandez, Annie Mach, & Namrata Uberoi February 13, 2015

Health Policy Essentials: Private Health Insurance. Bernadette Fernandez, Annie Mach, & Namrata Uberoi February 13, 2015 Health Policy Essentials: Private Health Insurance Bernadette Fernandez, Annie Mach, & Namrata Uberoi February 13, 2015 Briefing Agenda What is the purpose of private health insurance (PHI)? How is PHI

More information

Exchanges and the ACA What You Need to Know for 2014

Exchanges and the ACA What You Need to Know for 2014 Exchanges and the ACA What You Need to Know for 2014 How the Affordable Care Act affects the Individual Health Insurance Market This presentation is for informational purposes only and does not constitute

More information

Nevada Employer s Guide to the Affordable Care Act. Nevada Division of Insurance

Nevada Employer s Guide to the Affordable Care Act. Nevada Division of Insurance Nevada Employer s Guide to the Affordable Care Act Nevada Division of Insurance Nevada Employer s Guide to the Affordable Care Act State of Nevada Department of Business and Industry Division of Insurance

More information

Health Insurance Marketplace. vhealth insurance exchanges. What to expect in 2014. What to expect in 2014

Health Insurance Marketplace. vhealth insurance exchanges. What to expect in 2014. What to expect in 2014 vhealth insurance exchanges Health Insurance Marketplace What to expect in 2014 What to expect in 2014 The basics of exchanges As part of the Affordable Care Act (ACA or health care reform law), starting

More information

Health Care Reform Provision Plans/Insurers Impacted Effective Date What Employers Should be Doing Now

Health Care Reform Provision Plans/Insurers Impacted Effective Date What Employers Should be Doing Now Health Care Reform 2013 & 2014 Planning Employers should review the fast-approaching 2013 and 2014 health care reform requirements. State Exchanges will be opening enrollment as soon as October 1, 2013

More information

How The Affordable Care Act will Affect You and Your Business. Logo

How The Affordable Care Act will Affect You and Your Business. Logo How The Affordable Care Act will Affect You and Your Business. AFFORDABLE CARE ACT (ACA) DISCLOSURE The information provided is to be used as a guide. Since the ACA is still a work in progress, changes

More information

AFFORDABLE CARE ACT LARGE EMPLOYER HEALTH REFORM CHECKLIST. Edition: October 2015

AFFORDABLE CARE ACT LARGE EMPLOYER HEALTH REFORM CHECKLIST. Edition: October 2015 AFFORDABLE CARE ACT Employers that offer health care coverage to employees are responsible for complying with many of the provisions of the Affordable Care Act (ACA). Most health reform changes apply regardless

More information

HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS. New York Edition

HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS. New York Edition HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS New York Edition NAVIGATING NEXT STEPS IN HEALTH CARE REFORM PAGE 2 www.discovermvp.com There s a constant stream of changes and updates related

More information

Scott Lyon, Senior Vice President Small Business Association of Michigan

Scott Lyon, Senior Vice President Small Business Association of Michigan Scott Lyon, Senior Vice President Small Business Association of Michigan Patient Protection and Affordable Care Act H.R. 3590 Health Care & Education Affordability Reconciliation Act H.R. 4872 20,000 30,000

More information

HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS. Vermont Edition

HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS. Vermont Edition HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS Vermont Edition NAVIGATING NEXT STEPS IN HEALTH CARE REFORM There s a constant stream of changes and updates related to health care reform,

More information

State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE

State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE Scott Walker, Governor Theodore K. Nickel, Commissioner Wisconsin.gov 125 South Webster Street P.O. Box 7873 Madison, Wisconsin 53707-7873 Phone:

More information

HEALTH INSURANCE MARKETPLACES FACT SHEET

HEALTH INSURANCE MARKETPLACES FACT SHEET HEALTH INSURANCE MARKETPLACES FACT SHEET INFORMED ON REFORM Overview A Health Insurance Marketplace, also known as a Health Insurance Exchange, is available in every state as a public option for individuals

More information

It goes by many names: Patient Protection and Affordable Care Act (PPACA) or ACA or Obama Care or simply Healthcare Reform.

It goes by many names: Patient Protection and Affordable Care Act (PPACA) or ACA or Obama Care or simply Healthcare Reform. WHAT IS HEALTHCARE REFORM? Healthcare Reform (HCR) is a law passed by Congress that provides many different requirements. A very important aspect of the law is that it is designed to provide individuals

More information

The New Health Insurance Marketplace. Choices and Opportunities for Small Groups

The New Health Insurance Marketplace. Choices and Opportunities for Small Groups The New Health Insurance Marketplace Choices and Opportunities for Small Groups What is the Affordable Care Act? The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010

More information

How the Affordable Care Act Affects Medical Support Orders in Oklahoma Frequently Asked Questions Spring, 2014 1

How the Affordable Care Act Affects Medical Support Orders in Oklahoma Frequently Asked Questions Spring, 2014 1 How the Affordable Care Act Affects Medical Support Orders in Oklahoma Frequently Asked Questions Spring, 2014 1 General 1. Did Oklahoma expand Medicaid? No, Oklahoma did not expand Medicaid. 2. Who is

More information

HEALTH INSURANCE EXCHANGE FAQS

HEALTH INSURANCE EXCHANGE FAQS HEALTH INSURANCE EXCHANGE FAQS 0 TABLE OF CONTENTS INTRODUCTION... 1 BACKGROUND... 1 HEALTH INSURANCE EXCHANGE FAQS... 1 1 INTRODUCTION IN EARLY 2010, CONGRESS PASSED THE PATIENT PROTECTION AND AFFORDABLE

More information

Nebraska Health Insurance Exchange Update

Nebraska Health Insurance Exchange Update Nebraska Health Insurance Exchange Update Overview of the Affordable Care Act and the Federally Facilitated marketplace. September 2014 AFFORDABLE CARE ACT» The Affordable Care Act: Establishes a Health

More information

to Health Care Reform

to Health Care Reform The Employer s Guide to Health Care Reform What you need to know now to: Consider your choices Decide what s best for you Follow the rules 2013-2014 Health care reform is the law of the land. Some don

More information

The New Healthcare Law and Its Impact on Small Business

The New Healthcare Law and Its Impact on Small Business U. S. Small Business Administration Washington Metropolitan Area District Office The New Healthcare Law and Its Impact on Small Business Julie C. Verratti Advisor U.S. Small Business Administration Julie.Verratti@sba.gov

More information

TO UNDERSTANDING THE AFFORDABLE CARE ACT

TO UNDERSTANDING THE AFFORDABLE CARE ACT 3 STEPS TO UNDERSTANDING THE AFFORDABLE CARE ACT What s Inside Step 1: What Understand what you re buying 4 Step 2: How How can you buy health insurance? 20 STEPS TO UNDERSTANDING THE AFFORDABLE CARE ACT

More information

AFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST

AFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST AFFORDABLE CARE ACT SMALL EMPLOYER Employers that offer health care coverage to employees are responsible for complying with many of the provisions of the Affordable Care Act (ACA). Most health reform

More information

Issue Brief: The Health Benefit Exchange and the Small Employer Market

Issue Brief: The Health Benefit Exchange and the Small Employer Market Issue Brief: The Health Benefit Exchange and the Small Employer Market Overview The federal health care reform law directs states to set up health insurance marketplaces, called Health Benefit Exchanges,

More information

HEALTH BENEFIT EXCHANGE SURVIVAL GUIDE FOR SMALL BUSINESS. New York Edition

HEALTH BENEFIT EXCHANGE SURVIVAL GUIDE FOR SMALL BUSINESS. New York Edition HEALTH BENEFIT EXCHANGE SURVIVAL GUIDE FOR SMALL BUSINESS New York Edition NAVIGATING NEXT STEPS IN HEALTH CARE REFORM PAGE 2 www.discovermvp.com There s a constant stream of changes and updates related

More information

5Want to know more about the health

5Want to know more about the health www. WHAT S INSIDE STEPS TO UNDERSTANDING OBAMACARE Introduction 4 Step 1 Does your current health insurance plan need to change? 6 Step 2 How will you pay for health insurance in 2014? 10 Step 3 What

More information

Effective dates for provisions of the PPACA are spread out from 2010 through 2018. This document focuses on 2013 and 2014.

Effective dates for provisions of the PPACA are spread out from 2010 through 2018. This document focuses on 2013 and 2014. As part of our ongoing initiative to provide added value to our customers, this health care reform summary is being provided on an information only basis. This is NOT a legal document and is not intended

More information

PENALTIES Employer Shared Responsibility under the Affordable Care Act (ACA)

PENALTIES Employer Shared Responsibility under the Affordable Care Act (ACA) PENALTIES Employer Shared Responsibility under the Affordable Care Act (ACA) What employers need to know to make informed decisions about ACA compliance. Employer Shared Responsibility Under the employer

More information

www.thinkhr.com AFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST

www.thinkhr.com AFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST www.thinkhr.com AFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST Employers that provide health coverage to employees are responsible for complying with many of the provisions of the Affordable

More information

Prescribed Side Effects of the Patient Protection and Affordable Care Act (PPACA): Healthcare Reform Update

Prescribed Side Effects of the Patient Protection and Affordable Care Act (PPACA): Healthcare Reform Update August 14, 2013 Presented by: Jay Hutto, CPA Prescribed Side Effects of the Patient Protection and Affordable Care Act (PPACA): Healthcare Reform Update Click HERE to listen to webinar. August 14, 2013

More information

State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE

State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE Scott Walker, Governor Theodore K. Nickel, Commissioner Wisconsin.gov 125 South Webster Street P.O. Box 7873 Madison, Wisconsin 53707-7873 Phone:

More information

Patient Protection and Affordable Care Act (ACA) ACA Guide for Group Employers Employer Information

Patient Protection and Affordable Care Act (ACA) ACA Guide for Group Employers Employer Information Patient Protection and Affordable Care Act (ACA) ACA Guide for Group Employers Employer Information DISCLAIMER 2 This information is being provided in an effort to alert you to changes required by the

More information

www.thinkhr.com 877-225-1101 Employer Health Reform Checklist

www.thinkhr.com 877-225-1101 Employer Health Reform Checklist www.thinkhr.com 877-225-1101 Employer Health ThinkHR grants the reader non-exclusive, non-transferable, and limited permission to use this document. The reader may not sell or otherwise use this document

More information

AFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST HR COMPLIANCE CENTER

AFFORDABLE CARE ACT SMALL EMPLOYER HEALTH REFORM CHECKLIST HR COMPLIANCE CENTER AFFORDABLE CARE ACT Employers that provide health coverage to employees are responsible for complying with many of the provisions of the Affordable Care Act (ACA). Provisions take effect on staggered dates

More information

Simple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future.

Simple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future. Simple answers to health reform s complex issues facing every employer, and what you can do now to protect your business and your future. If you have any questions, please contact: Health Reform: A Guide

More information

The Healthcare Law April 19, 2010

The Healthcare Law April 19, 2010 The Healthcare Law April 19, 2010 This healthcare bill, recently made law, is a comprehensive overhaul that increases coverage to 94% of Americans and makes sweeping changes to our current healthcare system.

More information

Legislative Brief: COMPREHENSIVE HEALTH COVERAGE ESSENTIAL HEALTH BENEFITS PACKAGE

Legislative Brief: COMPREHENSIVE HEALTH COVERAGE ESSENTIAL HEALTH BENEFITS PACKAGE Laurus Strategies Legislative Brief: COMPREHENSIVE HEALTH COVERAGE ESSENTIAL HEALTH BENEFITS PACKAGE The Affordable Care Act (ACA) requires non grandfathered health insurance plans in the individual and

More information

State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE

State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE Scott Walker, Governor Theodore K. Nickel, Commissioner Wisconsin.gov 125 South Webster Street P.O. Box 7873 Madison, Wisconsin 53707-7873 Phone:

More information

SURVIVAL GUIDE FOR SMALL BUSINESS

SURVIVAL GUIDE FOR SMALL BUSINESS HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS New York edition NAVIGATING NEXT STEPS IN HEALTH CARE REFORM PAGE 2 www.discovermvp.com There s a constant stream of changes and updates related

More information

Health Care Reform (HCR)

Health Care Reform (HCR) Health Care Reform Effects on the Wood County Employee Health Benefits Plan For Plan Year 2013 Employee Health Benefits Committee October 18, 2012 1 Health Care Reform (HCR) Affordable Care Act (ACA) The

More information

Presented by South Dakota Community Action Partnership

Presented by South Dakota Community Action Partnership Presented by South Dakota Community Action Partnership The project described was supported by Funding Opportunity Number CA-NAV-13-001 from the U.S Department of Health and Human Services, Centers for

More information

Patient Protection and Affordable Care Act Compliance Checklist for Employers

Patient Protection and Affordable Care Act Compliance Checklist for Employers October, 2014 Patient Protection and Affordable Care Act Compliance Checklist for Employers Under the Employer Mandate in the Affordable Care Act, effective January 1, 2015, employers with 50 or more full-time

More information

4/8/2013. Health Care Reform and the. NYS Exchange. Dr. Arthur Vercillo, MD Regional President April 8, 2013. Health Care Reform and the NYS Exchange

4/8/2013. Health Care Reform and the. NYS Exchange. Dr. Arthur Vercillo, MD Regional President April 8, 2013. Health Care Reform and the NYS Exchange Health Care Reform and the NYS Exchange Presentation to the Health Planning Council Advisory Board April 8, 2013, Ithaca NY By Dr. Arthur Vercillo, MD Additional resources on next to last slide. Health

More information

#21 - Should You Provide Health Insurance in 2014?

#21 - Should You Provide Health Insurance in 2014? #21 - Should You Provide Health Insurance in 2014? Yes, for all size groups, but only if you can afford it and it serves other purposes (such as controlling competition for employees or you don t want

More information

State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE

State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE State of Wisconsin / OFFICE OF THE COMMISSIONER OF INSURANCE Scott Walker, Governor Theodore K. Nickel, Commissioner Wisconsin.gov 125 South Webster Street P.O. Box 7873 Madison, Wisconsin 53707-7873 Phone:

More information

Health Care Reform PPACA. General Assembly Greensboro, NC 2013

Health Care Reform PPACA. General Assembly Greensboro, NC 2013 Health Care Reform PPACA General Assembly Greensboro, NC 2013 Near-term Provisions 1 These fees apply to both insured and self-insured plans. Additional Coming Changes PPACA Patient Protection and Affordable

More information

David Lyons Founding Director and Chief Executive Officer

David Lyons Founding Director and Chief Executive Officer The New Health Insurance Marketplace Changes Impacting Small Employers and the SHOP Opportunity David Lyons Founding Director and Chief Executive Officer CoOportunity Health 10/1/2013 1 Why the Change?

More information

The Health Benefit Exchange and the Commercial Insurance Market

The Health Benefit Exchange and the Commercial Insurance Market The Health Benefit Exchange and the Commercial Insurance Market Overview The federal health care reform law directs states to set up health insurance marketplaces, called Health Benefit Exchanges, that

More information

Health care reform for large businesses

Health care reform for large businesses FOR PRODUCERS AND EMPLOYERS Health care reform for large businesses A guide to what you need to know now DECEMBER 2013 CONTENTS 2 Introduction Since 2010 when the Affordable Care Act (ACA) was signed into

More information

Patient Protection and Affordable Care Act (ACA) ACA Guide for Group Employers Agent and Broker Information

Patient Protection and Affordable Care Act (ACA) ACA Guide for Group Employers Agent and Broker Information Patient Protection and Affordable Care Act (ACA) ACA Guide for Group Employers Agent and Broker Information DISCLAIMER 2 This information is being provided in an effort to alert you to changes required

More information

Nebraska Health Insurance Exchange Update

Nebraska Health Insurance Exchange Update Nebraska Health Insurance Exchange Update Overview of the Affordable Care Act and the Federally Facilitated marketplace. September 2015 AFFORDABLE CARE ACT OVERVIEW» The Affordable Care Act was enacted

More information

The Affordable Care Act:

The Affordable Care Act: The Affordable Care Act: An Update on the Employer Mandate William A. Dombi, Esq. MARCH ON WASHINGTON Conference & Exposition March 24, 2014 Health Care Reform Framework Health insurance reforms Expanded

More information

Health Care Reform: Health Plans Overview. Presented by: Brian Lenzo, Preferred Benefits Services

Health Care Reform: Health Plans Overview. Presented by: Brian Lenzo, Preferred Benefits Services Health Care Reform: Health Plans Overview Presented by: Brian Lenzo, Preferred Benefits Services Agenda What is the legal status of the law? Which plans must comply? Grandfathered plans Reforms currently

More information

Helbling Benefits Consulting Your Health Care Reform Partner

Helbling Benefits Consulting Your Health Care Reform Partner Helbling Benefits Consulting Your Health Care Reform Partner Will you be hit with penalties due to health care reform? Once the employer mandate becomes effective, some employers may have to pay a penalty

More information

SURVIVAL GUIDE FOR SMALL BUSINESS

SURVIVAL GUIDE FOR SMALL BUSINESS HEALTH INSURANCE MARKETPLACE SURVIVAL GUIDE FOR SMALL BUSINESS Vermont edition NAVIGATING NEXT STEPS IN HEALTH CARE REFORM There s a constant stream of changes and updates related to health care reform,

More information

Kansas Insurance Department

Kansas Insurance Department Kansas Insurance Department The Affordable Care Act What Happens Now? Kansas Society of CPAs June 5, 2013 Linda J. Sheppard, Special Counsel & Director of Health Care Policy and Analysis 2010 Affordable

More information

GBS Benefits, Inc. Health Care Reform. The Individual Mandate, Exchanges, and Medicaid Expansion

GBS Benefits, Inc. Health Care Reform. The Individual Mandate, Exchanges, and Medicaid Expansion GBS Benefits, Inc. Health Care Reform August 2013 The Individual Mandate, Exchanges, and Medicaid Expansion As of January 1, 2014, the Affordable Care Act (ACA) requires most U.S. citizens and lawful residents

More information

CLICK HERE TO ADD TITLE

CLICK HERE TO ADD TITLE CLICK HERE TO ADD TITLE HEALTH CARE REFORM & ITS EFFECTS ON YOUR BUSINESS Presented by Jenny Arthur, SPHR AGENDA Background/History The Past: Previously Implemented HCR Provisions The Present: Current/Pending

More information

The Affordable Care Act: Health Coverage Options & Considerations in 2014

The Affordable Care Act: Health Coverage Options & Considerations in 2014 The Affordable Care Act: Health Coverage Options & Considerations in 2014 J A C K S O N V I L L E A R E A C H A M B E R O F C O M M E R C E A U G U S T 2 7, 2 0 1 3 L A U R A M I N Z E R E X E C U T I

More information

American Health Benefit Exchanges Fact Sheet A Provision of the Patient Protection and Affordable Care Act (PPACA)

American Health Benefit Exchanges Fact Sheet A Provision of the Patient Protection and Affordable Care Act (PPACA) American Health Benefit Exchanges Fact Sheet A Provision of the Patient Protection and Affordable Care Act (PPACA) This Fact Sheet reflects the Final Ruling published by the Department of Health and Human

More information

Health Reform Changes: What s New for 2014? New Hampshire Insurance Department September 11, 2013

Health Reform Changes: What s New for 2014? New Hampshire Insurance Department September 11, 2013 Health Reform Changes: What s New for 2014? New Hampshire Insurance Department September 11, 2013 1 New Hampshire Insurance Department Presentation Overview What s New in 2014 Key Questions for Individuals

More information

Navigating the New Health Insurance Environment

Navigating the New Health Insurance Environment Navigating the New Health Insurance Environment The Affordable Care Act and Professional Employer Organizations (PEOs) This white paper is an overview of eight building blocks of an effective small-business

More information

THE HEALTH INSURANCE MARKETPLACE

THE HEALTH INSURANCE MARKETPLACE THE HEALTH INSURANCE MARKETPLACE Presented by Raffa Financial Services Source: Centers for Medicare & Medicaid Services Design 2013 Zywave, Inc. All rights reserved. OBJECTIVES This session will help you:

More information

Health Reform. Employer Penalty Delay: What are the Consequences? Impact of the Delay on Employers

Health Reform. Employer Penalty Delay: What are the Consequences? Impact of the Delay on Employers Health Reform Employer Penalty Delay: What are the Consequences? Martin Haitz (484) 270-2575 martin.haitz@marcumfs.com Issued date: 07/29/13 The employer penalty provisions and two reporting requirements

More information

The Affordable Care Act: What Public Employers Need to be Doing Now

The Affordable Care Act: What Public Employers Need to be Doing Now The Affordable Care Act: What Public Employers Need to be Doing Now April 30, 2014 J. Richard Johnson IPMA-HR Webinar Copyright 2014 by The Segal Group, Inc. All rights reserved. 1 ACA Update Discussion

More information

THE KANSAS AFFORDABLE CARE ACT IMPLEMENTATION. Linda J. Sheppard November 6, 2014

THE KANSAS AFFORDABLE CARE ACT IMPLEMENTATION. Linda J. Sheppard November 6, 2014 THE KANSAS AFFORDABLE CARE ACT IMPLEMENTATION Linda J. Sheppard November 6, 2014 The Kansas Market Approximately 348,000 Kansans are uninsured - 12.3% of the state s population 44,130 are children, but

More information

Summary of Provisions Affecting Employer-Sponsored Insurance

Summary of Provisions Affecting Employer-Sponsored Insurance JULY 2014 AFFORDABLE CARE ACT Summary of Provisions Affecting Employer-Sponsored Insurance Much of the public discussion about the Affordable Care Act (ACA) has focused on the expansion of coverage to

More information

Navigating the New Health Insurance Environment THE AFFORDABLE CARE ACT AND PROFESSIONAL EMPLOYER ORGANIZATIONS (PEOS)

Navigating the New Health Insurance Environment THE AFFORDABLE CARE ACT AND PROFESSIONAL EMPLOYER ORGANIZATIONS (PEOS) Navigating the New Health Insurance Environment THE AFFORDABLE CARE ACT AND PROFESSIONAL EMPLOYER ORGANIZATIONS (PEOS) EXECUTIVE SUMMARY The recent health care overhaul affects how businesses administer

More information

Health Care Reform Where Are We Now? Preparing for 2015

Health Care Reform Where Are We Now? Preparing for 2015 Tuesday, July 1, 2014 2 3 p.m. Central time Health Care Reform Where Are We Now? Preparing for 2015 David Hunt, CHBC Senior Managing Consultant BKD, LLP dhunt@bkd.com Philip Floyd, CFP, CFS Senior Managing

More information

Q. My company already offers employee health coverage, how does the law impact me?

Q. My company already offers employee health coverage, how does the law impact me? Frequently Asked Questions Q. Will my business be required to provide employee health insurance under the health care law? A. The law does not mandate employers provide employees health care coverage.

More information

The Affordable Care Act: What Does It Mean for Self-Employed Individuals in Agriculture and Small Business?

The Affordable Care Act: What Does It Mean for Self-Employed Individuals in Agriculture and Small Business? FIRM Team Fact Sheet 13-03 Available at http://firm.msue.msu.edu David B. Schweikhardt Adam J. Kantrovich Brenda R. Long Michigan State University Extension October 2013 The Patient Protection and Affordable

More information

The Vermont Health Benefit Exchange: An Update for Small Business Owners

The Vermont Health Benefit Exchange: An Update for Small Business Owners The Vermont Health Benefit Exchange: An Update for Small Business Owners Today s Presentation Health Reform Goals Overview of Health Care Reform What is the Exchange? What Does the Exchange Look Like?

More information

The Affordable Care Act. President Obama signed the Affordable Care Act (ACA) into law on March 23, 2010.

The Affordable Care Act. President Obama signed the Affordable Care Act (ACA) into law on March 23, 2010. The Affordable Care Act President Obama signed the Affordable Care Act (ACA) into law on March 23, 2010. The ACA was enacted to: v Increase quality and affordability of health insurance v Lower the uninsured

More information

Health Insurance Exchange

Health Insurance Exchange Health Insurance Exchange Lynn A. Blewett, Ph.D. Professor, Division of Health Policy and Management, University of Minnesota School of Public Health Director, State Health Access Data Assistance Center

More information

PPACA/Healthcare Reform CHANGES

PPACA/Healthcare Reform CHANGES PPACA/Healthcare Reform CHANGES beginning in 2014 for small employers A guide to understanding the administrative provisions, benefit changes, new taxes and credits, market reforms and purchasing options

More information

The Affordable Care Act: What Does it Mean for Individuals and Families?

The Affordable Care Act: What Does it Mean for Individuals and Families? The Affordable Care Act: What Does it Mean for Individuals and Families? FIRM Team Fact Sheet 13-04 Available at http://www.firm.msue.msu.edu David B. Schweikhardt Adam J. Kantrovich Brenda R. Long Michigan

More information

Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion

Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Affordable Care Act (ACA) Health Insurance Exchanges and Medicaid Expansion Table of Contents Expanded Coverage... 2 Health Insurance Exchanges... 3 Medicaid Expansion... 8 Novartis Pharmaceuticals Corporation

More information

GLOSSARY OF KEY HEALTH INSURANCE CONCEPTS

GLOSSARY OF KEY HEALTH INSURANCE CONCEPTS The Affordable Care Act: A Working Guide for MCH Professionals Module 2 GLOSSARY OF KEY HEALTH INSURANCE CONCEPTS Overview A fundamental first step in accessing health care in the United States is having

More information

Welcome to the KASA webinar series!

Welcome to the KASA webinar series! Welcome to the KASA webinar series! Today s topic: What Youth Leaders and Millennials Need to Know about Health Insurance and the Affordable Care Act Presenter: Erin Hemlin, Young Invincibles Hosted by:

More information

HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal)

HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal) Group Health Insurance Q & A HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal) 1. Will small employers continue to have 12 month rates as they exist today? a. Yes. Employer groups

More information

Sandy Wood, CEBS (Certified Employee Benefit Specialist) Healthcare Consultant sandy@thebenefitsacademy.com 206-669-3345

Sandy Wood, CEBS (Certified Employee Benefit Specialist) Healthcare Consultant sandy@thebenefitsacademy.com 206-669-3345 1 Sandy Wood, CEBS (Certified Employee Benefit Specialist) Healthcare Consultant sandy@thebenefitsacademy.com 206-669-3345 2 Terms you need to know Required Notices 2014 Plan Requirements The Grandfathered

More information

MODULE 16: MEDICARE AND THE HEALTH INSURANCE MARKETPLACES

MODULE 16: MEDICARE AND THE HEALTH INSURANCE MARKETPLACES MODULE 16: MEDICARE AND THE HEALTH INSURANCE MARKETPLACES Objective This module will educate HIICAP counselors about how Medicare is affected (and not affected) by the health insurance Marketplaces. What

More information