The Affordable Care Act (ACA)

The Affordable Care Act (ACA)

The Devil's in the Detail!! 10

What is this Health Care Change Stuff Anyway? The Affordable Care Act (ACA) Patient Protection and Affordable Care Act (PPACA ) Health Care Reform (HCR) Obamacare Insurance Compliance Employer Shared Responsibility

What Does the Law Require? The law requires employers to provide affordable minimum essential health insurance coverage to full-time employees or face financial penalties

Medical Plan Must Be Affordable The medical insurance Single premium charged cannot exceed 9.5% of the employee s monthly computed wages for at least one of your plans In other words, the monthly premium for Single medical coverage cannot exceed 9.5% of an employee s hourly rate X 130 hours

Medical Plan Must Be Affordable Currently our Single premium for an employee is $129 per month In order for our plan to be deemed affordable, an employee must be making at least $10.45 per hour ($10.45 x 130 hours x 9.5% = $129.05)

Who is Considered a Fulltime Employee? An employee is considered fulltime if he/she averages at least 30 hours/week during a calendar month or at least 130 hours/month over the look back period (6 months for 2013 and 12 months for 2014 and thereafter) This includes hours actually worked plus hours for which the employee is entitled to pay because of sick leave, holiday, vacation, military duty, short/long-term disability, etc.

Who is Considered a Fulltime Employee? This requirement results in a few ripple effects: Tracking of all employees hours to determine benefit eligibility Eliminating the grandfather status for benefit eligibility Ensuring employee information in Paycor is accurate

Who is Considered a Fulltime Employee? Our current process determines eligibility based on what hours an employee is likely to work. This new process uses actual hours during a look-back period that includes hours actually worked plus hours for which the employee is entitled to pay.

Fees Two non-avoidable fees are included in the health care reform bill: Non- profit Patient Centered Outcomes Research Institute: By 7/31/2013 all insured and self-funded plans will pay $1/member (employee, spouse, and child) to fund comparative effectiveness research of medical treatments Fees will increase to $2/member to be paid by 7/31/2014

Fees Transitional Reinsurance Programs: Fees will be assessed annually to fund the program during the three-year period 2014-2016. Fees for 2014 are $63 per member (employee, spouse, or child = $170,541). The cost will be shared: $1 will be charged to the Single premium, $2 for the Single + 1 premium, and $3 to the Family premium for both the Employee & Employer; diocese will pay the other third of the cost.

Future ACA Items to Monitor HHS Mandate For 2018: A 40% excise tax is levied on Cadillac Plans For 20??: Uncertain effective date for autoenrollment provision For 20??: Employers must file a Quality of Health Care Report with HHS.

Changes to Current Health Plan Claims have been rising drastically over the last several months, which indicate premiums could rise as high as 12% versus the traditional 8% over the past several years. In order to maintain the traditional 8% premium increase, a few changes will be made to the plan coverage.

Changes to Current Health Plan Implement a deductible before any benefits would be covered - $250 for Single & $500 for Family (exception: preventative and wellness services) Implement a co-insurance of 90% versus current 100% Increase the current out-of-pocket maximum by $500 for both the Single ($1,500)and Family ($2,500) coverage

Changes to Current Health Plan Increase the current emergency co-pay from $75 to $150 Increase the current urgent care co-pay from $35 to $50 Change current Tier II ($45) and Tier III ($75) pharmacy co-pays to a percentage (25% Tier II & 40% Tier III) with minimum ($50 for Tier II; $80 for Tier III) and maximum ($75 for Tier II; $125 for Tier III) amounts

Implement a New Base Plan Implement a $1,500 Single and $3,000 Family deductible before any benefits would be covered (exception: preventative and wellness services) Implement a co-insurance of 70% for Plan and 30% for member Out-of-Pocket Maximum: $3,000 for Single and $6,000 for Family

Implement a New Base Plan Primary Office Visit: $20 co-pay Specialist Office Visit: $60 co-pay Emergency co-pay: $250 Urgent Care: $75 Pharmacy: Tier I Co-pay:$10 Tier II Co-pay: 25% (min $50 max $75) Tier III Co-pay: 40% (min $80 max $125)

Implement a New Base Plan Mail Order Pharmacy: Tier I Co-pay:$30 Tier II Co-pay: 25% (min $125 max $185) Tier III Co-pay: 40% (min $200 max $310)

Where Do We Go From Here? Implement a new system through Paycor called Time on Demand which will be used to track hourly employees hours for the upcoming look back period, which will run from October 1, 2013 through September 30, 2014 for 2015 benefit eligibility.