{PPACA: Update} Not for Profit December 11 & 12, 2013

Transcription

1 {PPACA: Update} Not for Profit December 11 & 12, 2013

2 Agenda Plans that must comply Reforms currently in place 2013 compliance deadlines 2014 compliance deadlines Future compliance deadlines 2

3 Plans That Must Comply 3

4 Plans Subject to Health Care Reform Health care reform s health plan rules generally apply to group health plan coverage Exceptions Excepted benefits Retiree-only plans Group health plans covering fewer than 2 employees Excepted Benefits Accident or disability income coverage Separate dental and vision plans Liability insurance Some FSAs 4

5 Grandfathered Plans Grandfathered plan: group health plan or health insurance coverage in which an individual was enrolled on March 23, 2010 Certain health care reform provisions don t apply to grandfathered plans, even if coverage is later renewed A plan can lose grandfathered status by making changes after March 23, 2010 that exceed the regulatory limits for design or employee cost Plans will have to analyze status and changes at each renewal 5

6 Which Rules Don t Apply to Grandfathered Plans? Patient protections Nondiscrimination rules for fully-insured plans (effectively applies to all plans per Notice ) Preventive care coverage New appeals process Quality of care reporting Insurance premium restrictions 6

7 Which Rules Don t Apply to Grandfathered Plans? Guaranteed issue and renewal of coverage Nondiscrimination based on health status/in health care Comprehensive health insurance coverage Limits on cost-sharing Coverage for clinical trials Comment: Very few group and individual plans remain Grandfathered Of limited benefit to most employers and individuals 7

8 Reforms Currently in Place 8

9 Reforms Currently in Place Dependent coverage up to age 26 No lifetime limits/restrictions on annual limits No rescissions No pre-existing condition exclusions for children No cost sharing for preventive care (non-gf plans) No reimbursement for OTC drugs without prescription Medical loss ratio rules Form W-2 reporting 9

10 2013 Compliance Deadlines 10

11 2013 Compliance Deadlines Uniform Summary of Benefits and Coverage (SBC) No cost-sharing for preventive care services for women Health FSA contribution limits Whistleblower Protections Patient-Centered Outcomes Research Institute Fee Notice of Exchange (October 1, 2013) 11

12 2014 Compliance Deadlines 12

13 Individual Mandate Effective Jan. 1, 2014: Individuals must enroll in qualified health coverage or pay a penalty Penalty amount: Greater of a flat dollar amount or a percent of income 2014 = $95 or 1% 2015 = $325 or 2% 2016 = $695 or 2.5% Family penalty capped at 300% of the adult flat dollar penalty or bronze level Exchange premium Some exceptions apply 13

14 Health Insurance Exchanges Health insurance Exchanges will be established in each state (by the state or the federal government) State action: 17 (and D.C.) declared state-based Exchange 7 Partnership Exchange 26 default to federal Exchange Deadlines Open enrollment: 10/1/13 Fully operational: 1/1/14 14

15 Health Insurance Exchanges Small Business Health Option Program (SHOP) SHOP federally facilitated for Small Businesses as of Nov. 29, per HHS - delayed until Nov Small employers = up to 50 employees Before 2016, states can define small employers as having up to 50 employees In 2017, states can allow employers of any size to purchase coverage through Exchange Individuals can be eligible for tax credits Limits on income and government program eligibility Employer plan is unaffordable or not of minimum value 15

16 Large Employer Responsibility Subject to Pay or Play rules Delayed for one year, until 2015 penalties will not apply in 2014 Future guidance may impact the rules Applies to employers with 50 or more full-time and full time equivalent employees in prior calendar year Penalties may apply if the employer: Fails to offer minimum essential coverage to substantially all FT employees (and dependents) - $2000 penalty Offers coverage that is either not affordable or does not provide minimum value - $3,000 for each employee who receives subsidized coverage through an Exchange, capped at $2,000 per FT employee (excluding first 30 employees) 16

17 Employer Reporting Employers will have to report certain information about health coverage to the government and individuals Applies to: Applicable large employers generally, employers with at least 50 full-time equivalent employees Delayed for one year, until 2015 Treasury plans to issue additional regulations during the summer of

18 Other Requirements Effectively Delayed Until Limits on True Out of Pocket (TrOOP) - Deductibles may not exceed $2,000 (single coverage) or $4,000 (family coverage) - Limits indexed for inflation - Waiting periods may not exceed 90 days beginning with 2014 plan year - Employers can use up to a 12-month measurement period to determine FT status for variable hour employees - Annual limits eliminated - Preexisting condition exclusions prohibited - Wellness rewards increased 18

19 New Fees/Taxes Patient Centered Outcomes Research Institute (PCORI) - all plans - effective plan years after Sept paid each July - expires for plan years ending after October 1, 2019 Reinsurance Program Fee - effective January 1, imposed on health insurance issued and self-funded plans proposed rate: $5.25/employee/month ($63/year) - no expiration noted Health Insurance Tax -applies to insured plans - expected to be 2% to 3% of premium - no expiration date noted 19

20 Future Compliance Deadlines 20

21 Future Compliance Requirements 2018 Cadillac Plan Tax Nondiscrimination Rules Coming for Fully-Insured Plans could be issued shortly Automatic Enrollment Rules 21

22 Thank you. Ed Murphy, President Plante Moran Group Benefit Advisors Plante Moran 2601 Cambridge Court, Suite 500, Auburn Hills, MI Direct Dial: