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

Transcription

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

2 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 may occur and we will be providing updates via seminars and correspondence. Always check with your health insurance consultant and Accountant to ensure compliance with this law. Federal Health Care Reform Update Revised Jan. 10,

3 AFFORDABLE CARE ACT (ACA) MAJOR CHANGES TO HEALTH INSURANCE PLANS: (PRIOR TO 2013) 1. Dependent children coverage to age 26 (higher in some states) 2. No lifetime dollar limits on health benefits 3. No pre-existing condition exclusion on children % coverage for preventive services in network 5. Medicare Part D donut hole closing 6. Prescription required for OTC medications paid out of HSA s 7. Small Business Tax Credits Federal Health Care Reform Update Revised Jan. 10,

4 AFFORDABLE CARE ACT (ACA) Small Business Tax Credits Companies with less than 25 employees Contribute at least 50% of premium per employee Average annual wages of less than $50,000 for 2010 to Companies with 10 or fewer employees Contribute at least 50% of premium per employee Average annual wages less than $25,000 For 2014, employers who contribute 50% or more of premium per employee (inside exchanges only post 2014) 50% tax credit for small for-profits, 25% for non-profits Federal Health Care Reform Update Revised Jan. 10,

5 AFFORDABLE CARE ACT (ACA) Medical Loss Ratio (MLR) Summary of Benefits and Coverage (SBC) A uniform and easy to understand summary of benefits 30 day notice for plan changes on renewal 60 day notice for any material modifications and / or plan changes that occur off cycle renewal Employer sponsored coverage dollar value to be reported on W-2 s Effective Employer groups that issued more than 250 W-2 s Includes both the employee and employer portions of premium Federal Health Care Reform Update Revised Jan. 10,

6 AFFORDABLE CARE ACT (ACA) Required Notifications 2013 Availability of Health Insurance Exchanges Premium subsidies and their availability Original date was 03/01/2013, delayed Flexible Spending Accounts Limitations of $2500 per year Taxes and Fees Effective either 2013 Medical Renewal or January 2014 How fees are handled depends on carrier and renewal date Federal Health Care Reform Update Revised Jan. 10,

7 Taxes and Fees Overview Fee Description Date Duration PCORI Research Fee Helps fund the Patient Centered Outcomes Research Institute that evaluates health outcomes, clinical effectiveness, and benefits of medical treatments. 10/1/2012 Begins 2012 Phases out 2019 Basis Of Assessment $1 pmpy in year 1 $2 pmpy in year 2 Insurer Fee Annual fee on health insurance sector to fund Health Exchange subsidies. 1/1/2014 Groups and Individuals 2.3% of Premium Transitional Reinsurance Fee Used to stabilize Individual Market Funds reinsurance for high claimants in and out of exchange 1/1/ $6 pmpm Excise Tax on High Cost Coverage Insurers and Employers who offer rich benefit coverage 1/1/2018 Permanent 40% of value of employer coverage exceeding $10200 Federal Health Care Reform Update Revised Jan. 10,

8 AFFORDABLE CARE ACT (ACA) Grandfathered and Non-Grandfathered Plans Grandfathered - Employers who have not made any changes to their health plan or employee contribution amounts May still offer a class carve-out or management plan May not be subject to community ratings in 2014 Non-Grandfathered Employers who have made changes to existing health plans or increased employee contribution amounts Not allowed to offer class carve out or management plan Will become community rated Federal Health Care Reform Update Revised Jan. 10,

9 AFFORDABLE CARE ACT (ACA) GOING FORWARD : 2014 Employers with more than 50 FTE (Full Time Equivalent) Employees Must offer qualified coverage to employees and dependent children Penalties and Fines will be assessed for those that do not offer coverage that meets specific standards Employers with more than 200 full time employees must auto enroll employees onto the health plan (delayed) Small group redefined from 2-50 to (delayed until 2016) No more than a 90 day waiting period for new employees No annual dollar limit on Essential Health Benefits All health plans will be guaranteed issue with no pre-existing Individual mandate and fines go into effect Federal Health Care Reform Update Revised Jan. 10,

10 PAY OR PLAY FLOWCHART Federal Health Care Reform Update Revised Jan. 10,

11 EMPLOYER FINES Employers with more than 50 FTE Employees that do not offer coverage AND have at least one full-time employee receiving subsidy: Assessed annual fee of $2,000 per full-time employee Exclude 30 employees in calculating the assessment Large employers who offer coverage that is either unaffordable or inadequate and who have at least one full-time employee receiving subsidy Assessed annual fee of $3,000 for each full-time employee receiving a subsidy Maximum penalty equal to $2,000 for each full-time employee Excluding the first 30 employees from the assessment Coverage is considered unaffordable if the EMPLOYEE must contribute more than 9.5 percent of their W2 income for their portion of premium. Coverage is considered inadequate if the plan does not coverage at least 60% of a person's medical costs on average (actuarial values) Federal Health Care Reform Update Revised Jan. 10,

12 AFFORDABLE CARE ACT (ACA) Essential Health Benefits: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care Federal Health Care Reform Update Revised Jan. 10,

13 NEW BENEFIT & COVERAGE RULES Employer Impacts Essential Benefits (EHB) Metallic Levels Deductible Limits OOP Max Pre-existing Condition Exclusion Description Health Plans must provide Essential Health Benefits for individual and small group Four tiers of coverage for EHB packages: Bronze, Silver, Gold, and Platinum Required in and out of Exchange Beginning in 2014, plan deductibles may not exceed a $2,000 single / $4,000 family annual limitation OOP Limits must comply with OOP limits for HSA plans All cost sharing (including co-pays) for EHB services must count toward OOPM Beginning in 2014, pre-existing condition exclusions must be removed for all members, not just those under age 19 Small Group Large Group Self- Funded Individual Yes No No Yes Yes No No Yes Yes No No No Yes Yes Yes Yes Yes Yes Yes Yes Federal Health Care Reform Update Revised Jan. 10,

14 NEW BENEFIT & COVERAGE RULES Employer Impacts Employer Mandate and Minimum Essential Coverage Max 90 day waiting period Expanded Women s Preventive Services Description Employers 51+ must provide full time employees and dependents with minimum essential coverage to avoid paying a penalty Minimum essential coverage must: Be affordable (employee contribution must not exceed 9.5% of employees household income and Provide minimum value (employer pays more than 60% of covered plan expenses) Small Group Over 51+ only Large Group Self- Funded Yes Yes No Waiting period before coverage is in place cannot exceed 90 days Yes Yes Yes No Beginning August 2012, womens preventive benefits will be expanded to include additional screening, prenatal office visits, breast-feeding support and some contraceptives. Impact Range-.32% or $1 pmpm Yes Yes Yes Yes Individual Federal Health Care Reform Update Revised Jan. 10,

15 INDIVIDUAL MANDATE AND FINES How much are individuals penalized if they don t have Insurance? $95 or 1.0% of income above tax threshold- which ever is greater $325 or 2.0% of income above tax threshold- which ever is greater $695 or 2.5% of income above tax threshold- which ever is greater Penalty for children under 18 is ½ of individual amount Flat dollar penalty is 300% of the flat dollar amount (maximum per family) Individual Shared Responsibility payments are assessed on tax returns Short coverage gaps of less than 3 months per year are allowed Federal Health Care Reform Update Revised Jan. 10,

16 HEALTH INSURANCE EXCHANGES GOING FORWARD : 2014 All States will have Health Insurance Exchanges Online marketplace to purchase Individual and Small Group Health Insurance (small group exchange delayed until 2015) Some State Exchanges being operated by Federal Government Other States are creating and administrating their own Exchanges Some insurance carriers (varies state by state) have committed to their participation Open Enrollment starts in October 2013 Effective dates of January 1, 2014 Exchanges are the only avenue for individuals to receive a subsidy Federal Health Care Reform Update Revised Jan. 10,

17 HEALTH INSURANCE EXCHANGES Federal Health Care Reform Update Revised Jan. 10,

18 HEALTH INSURANCE EXCHANGE PLANS Bronze Gold Silver Platinum 60% 70% 80% 90% Actuarial Value Actuarial Value Actuarial Value Actuarial Value Federal Health Care Reform Update Revised Jan. 10,

19 Market Influencers After Million 30 Million 20 Million 15 Million 80 Million potentially switching coverage 30 Million Newly Insured 20 Million Purchasing through Exchanges 15 Million Affected by Medicare Increases Federal Health Care Reform Update Revised Jan. 10,

20 Pricing Today and Beginning 2014 Rating Factors Today Age Gender Health Status Claims History Medical Underwriting Group Size Industry Future State MRRF 1.0 Less Healthy & Longest Duration Groups with Highest Rate Current State High MRRF Current State Low MRRF Healthiest & Newest Groups with Lowest Rate Rating Factors Beginning 2014 Age (3:1 limit) Geography Family Structure Tobacco Use (up to 50%) Benefit Plan Design Wellness Incentive (up to 30%) Federal Health Care Reform Update Revised Jan. 10,

21 2014 Reform Premium Impact Assessment Impact of benefit expansion, pricing restrictions, taxes, and fees. New pricing rules and new product design mandates will have a significant impact on the price consumers pay for insurance in 2014 and beyond. Individual Market Small Group Market Large Group Market 116% 25-50% Rating Rules / Product +100% Ratings Healthiest Groups 25% Product 4-11% 20-25% Product 3-6% Taxes 3.8% Taxes 3.8% Taxes 3.8% Avg.Rate Increase 12% Avg Rate Increase 12% Avg.Rate Increase 15% Avg Rate Increase 15% Avg.Rate Increase 15% Avg Rate increase 15% Pre-Reform Post-Reform Pre-Reform Post-Reform Pre-Reform Post-Reform Federal Health Care Reform Update Revised Jan. 10,

22 AFFORDABLE CARE ACT (ACA) Going Forward : 2018 High Cost Cadillac Plans will pay a 40% Excise tax Plans valued at $10,200 for individual coverage or $27,500 for family policies will be subject to an excise tax of 40% Tax is on the value of the plan that exceeds these thresholds The tax will be levied on insurers and self-insured employers and not directly on employees Threshold amounts will be increased for inflation beginning in 2020 Federal Health Care Reform Update Revised Jan. 10,

23 CONTACT US YOUNGSTOWN, OH Ohio 77 W. McKinley Way Youngstown, OH T: F: LAS VEGAS, NV SAN DIEGO, CA Nevada 205 E. Warm Springs Rd Ste. 108 Las Vegas, NV T: F: California 4660 La Jolla Village Dr., Suite 500, San Diego, California, T: F: Federal Health Care Reform Update Revised Jan. 10,