Health Care Primer: What Do You Really Need to Know? Christianna L. Finnern

Transcription

1 Health Care Primer: What Do You Really Need to Know? Christianna L. Finnern

2 Obligations Under the Health Care Law Employers should be aware of their short and long term obligations under the Patient Protection and Affordable Care Act (PPACA). PPACA will require all Americans and non citizen lawful residents to obtain health insurance.

3 Obligations Commencing in 2012 Employers must provide health plan participants with a summary of benefit coverage. Employers must include in employee s W 2 forms information regarding the value of employer provided health coverage. Employers with self funded health plans are required to pay an annual fee of $2 multiplied by the average number of covered participants under the plan ($1 for the first year of implementation).

4 Obligations Commencing in 2013 Employers must explain to employees the availability of health exchanges, which will take effect in An Exchange would be available to employers with up to 100 employees when it opens for enrollment January 2, 2014.

5 Other Compliance Issues in 2013 Contributions to flexible spending accounts (FSAs) are subject to a $2,500 annual limit. An employer can no longer deduct prescription drug expenses paid for Medicare retirees to the extent the employer receives the subsidy provided under Part D of Medicare. Health plans will need to comply with administrative simplification requirements (operating rules for electronic healthcare transactions).

6 Compliance Issues in 2014 Plans cannot impose preexisting conditions exclusions. Plans cannot have waiting periods longer than 90 days. Cost sharing provisions of a medical plan (except for grandfathered plans) may not exceed specified dollar limits.

7 Compliance Issues in 2014 Plans (except for grandfathered plans) are generally required to permit participation in clinical trials, cannot deny coverage for routine costs of care provided under clinical trials, and may not discriminate based on participation in a clinical trial. If an employer chooses not to offer coverage or offers unaffordable coverage, the employer is subject to penalties. Employers providing minimum essential coverage under their plans need to report certain information annually to the U.S. Treasury and to covered individuals.

8 Compliance Issues in 2014 Employers are required to annually certify whether they offer their full time employees the opportunity to enroll in a plan providing minimum essential coverage and, if so: the length of the waiting period required by the plan, how many months during the year the coverage was offered, and certain other information about the plan as well as information about their full time employees.

9 What is a Health Insurance Exchange? A Health Insurance Exchange is a marketplace for individuals and businesses to compare, choose, and purchase affordable health insurance. An Exchange is an online marketplace where Minnesotans can purchase private health insurance or enroll in public programs like Medical Assistance and the Children's Health Insurance Program (CHIP). An Exchange can help small business provide affordable coverage to employees.

10 Health Insurance Exchanges in Minnesota The exchange moved from the Department of Commerce to the Minnesota Department of Management and Budget. Minnesota is working toward a Nov. 16 deadline for submitting a blueprint proposal for the state based exchange.

11 Health Insurance Exchanges in Minnesota Who is eligible to use an Exchange? An Exchange may be used by individual consumers and small businesses with up to 100 employees when it opens for enrollment on January 1, Minnesota may limit eligibility to small businesses with up to 50 employees before 2016, but the determination has not yet been made. Large employers may participate in 2017.

12 Small Business Tax Credit Small businesses may be eligible for the small business health care tax credit if they: Cover at least 50 percent of the coverage costs for workers, Pay average annual wages below $50,000, and Have fewer than 25 full time employees. 2013: maximum tax credit is 35 percent of premiums paid by small businesses and 25 percent by nonprofits. 2014: value of the credit increases to 50 percent for small businesses and 35 percent for nonprofits.

13 Penalties under PPACA PPACA does not explicitly mandate that employers offer health insurance to employees. However, certain employers that have at least 50 full time employees will face penalties, beginning in 2014, if one or more full time employees obtains a premium credit through an exchange. Individuals may be eligible for premium credits if the employer does not offer coverage, offers unaffordable coverage, or does not provide minimum value.

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15 Thank you.