HEALTH CARE REFORM PROVISIONS BY SIZE OF PLAN OR EMPLOYER July 14, 2014
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1 unless 2018 Cadillac Tax: 40% excise tax on the amount by which the total cost of employersponsored health plan exceeds specified thresholds 2010 thresholds are: $10,200 for self-only coverage; $27,500 for other coverage (these figures will be adjusted for 2018) 2015 Employer mandate (aka "pay-or-play") - Potential penalties on ERs who don't offer minimum essential coverage to at least 95% of EEs who work at least 30 hrs/wk (& to dependents), or who do offer coverage but it does not meet Affordability test & minimum value requirement. Affordability test: If EE cost for self-only coverage exceeds 9.5% of: EE s W-2 income from the ER, or EE s hourly rate x 130 hrs/month, or FPL for single individual, potential penalty on employer Employer reporting requirements: must report to gov t & employees, certain plan information/terms & if employer offered minimum essential coverage Limits on cost-sharing: Out-of-pocket maximums for 2015 are different for HSAcompatible HDHPs than for other plans because based on two different indices. For 2015 OOP limits will be: --HDHP: $6,450 & $12,900 --Other plans: $6,600 & $13,200 DELAYED: see 2015 & 2016 Employer mandate (aka "pay-or-play") - Potential penalties on ERs who don't offer specified coverage. DELAYED: see entry under Affordability test: If EE cost for self-only coverage exceeds 9.5% of income. 1/1/2018 Applies in 2015 to ERs with at least 100 FTEEs and FTEs. Delayed to 2016 for ERs with EEs. Also, for 2015 only, offer of coverage may be to only 70% of FTEEs, rather than 95%. In 2015, applies only to ERs with 100 or more FTEEs or FTEs. In 2016 applies to ERs with Applies for 2015, report due in Originally effective for, report due in Delayed to 2015 or 2016 depending on ER size. Originally effective in. Delayed to 2015 or 2016 depending on ER size. Originally effective 1 st Plan Year on or after See Column. For 2015, large = 100+ Penalties only apply if at least one FT EE gets a gov't subsidy for buying insurance in an Individual See Column. For 2015, large = 100+ As of 2015, applies to ERs with at least 50 FT EEs. Employer mandate only applies to ERs with 50 or more FT EEs (and FT equivalents) Penalties only apply if at least one FT EE gets a gov't subsidy for buying insurance in an Individual penalty and no Affordability test on ERs with 99 or fewer FT EEs (and FT equivalents) penalty and no Affordability test on ERs with fewer than 50 FT EEs (and FT equivalents) Copyright LGAA, Inc. This document is not intended or provided as legal advice. 1
2 unless continued DELAYED: see entry under 2015 Employer reporting requirements: must report specified plan & coverage to gov t & employees, but some incentives in place for simplified reporting Minimum Value (MV): Employer health plans and health insurance policies must pay at least 60% of actuarial value of allowed benefits under the plan. Different standard populations for large and self-insured plans, small plans and individual policies. Health Insurance Industry Fee Fee on health insurance carriers based on market share, to fund subsidies in Individual Requirement that plans & policies provide "essential health benefits" and meet specified actuarial values annual dollar limits on essential health benefits. (Prior to, restricted annual dollar limits applied) Modified Community Rating ( Fair Health Insurance Premiums ). (California does not allow tobacco use as a rating factor, for small insured plans.) Limits on cost-sharing : Maximum deductible limits are repealed. They were going to be $2,000/$4,000 for One-yr delay of reporting requirements. Originally effective for, reporting is now effective in Would have been effective as of, so many plans already complied for plan year, before the limits were repealed Applies to employers at with at least 50 employees, even though in 2015 ERs with EEs are not subject to ER mandate penalties (unless grandfathered) (Only on insured plans, not on self-funded Also N/A to any-size self-funded plan (t required to cover EHBs, but if plan does it cannot impose annual limits on them, even if grandfathered) (Only on insured plans, not on selffunded small group & individual policies small group & individual policies small insured plans Copyright LGAA, Inc. This document is not intended or provided as legal advice. 2
3 unless continued Limits on cost-sharing: Out-of-pocket maximums same as for HSA-compatible HDHPs, which for will be $6,350.00/$12, See 2015 for changes effective in pre-existing condition exclusions for anyone Waiting period for coverage cannot exceed 90 days (1 st of month after 60 days of eligibility). Can start after bona fide orientation period of not more than 1 month. Mandatory coverage for clinical trials (N/A to grandfathered plans.) Extension of dependent coverage up to age 26, even if dependent has other group coverage available. Before, GF plan is not required to offer if over-age dependent has other group coverage available. Transitional Reinsurance Fee Imposed on group health plans & policies, based on number of enrollees. For, fee is $63/year /participant (employee & dependents) For 2015, fee is $44 For employees who meet certain resultsbased wellness program standards, ERs can offer financial incentives of up to 30% of the total premium or cost of coverage in the GHP, + additional 20% for tobacco cessation or reduction programs (total 50% for tobacco) Automatic enrollment in employer group health plan (but employee can opt out) - 12/31/ st Plan Year or Wellness Program on or after Delayed until after (until regulations issued) (Only applies if more than 200 full-time employees) 2013 W-2 Reporting of Health Care Coverage $2500 limit on annual Employee pre-tax contribution to Health FSA Comparative Clinical Effectiveness Research Fee (aka CER fee or PCORI Fee). $1 per member per year, 2nd year increases to $2 per member. by 1/31/2013, for the 2012 tax year 1/1/2013 due by 7/31/13, for the 2012 plan year (Employers that filed at least 250 W-2s in prior year) N/A until future guidance applies requirement to small employers Copyright LGAA, Inc. This document is not intended or provided as legal advice. 3
4 unless 2013 Continued Employers to provide tice of Health Insurance s to employees Coverage of all FDA-approved contraceptive methods, as part of preventive services for women. N/A to certain religious employers & 1-year delay for religious-affiliated employers Start capturing necessary information for W-2 Reporting of value of employer-sponsored health coverage MLR Rebates (will apply annually) MLR rebate is from the carrier, so only applies to insured plans, N/A to self-funded Benefit appeals procedures & external review procedures (GF plans are subject to existing ERISA claims & appeals rules but not to new HCR rules) Coverage of all FDA-approved contraceptive methods, as part of preventive services for women. N/A to certain religious employers & 1-year delay for religious-affiliated employers. Uniform Summary of Benefits & Coverage (SBC). SBC required for H.S.A.s or for excepted benefits such as separate dental or vision plans or most HFSAs 2011 Medical Loss Ratio (MLR): 80% for small groups, 85% for large groups; only applies to insured plans Over-the-counter (OTC) drugs no longer reimbursable by Health FSA plan, HSAs, MSAs or HRAs, unless prescribed by doctor HSAs - non-qualified distributions - penalty increases from 10% to 20%, plus income tax by October 1, /1/12 (1/1/13 for calendar year 1st 2012 payroll period, for 2012 W-2s (which must be sent by 1/31/13) (Employers that filed at least 250 W-2s in prior year) N/A until future guidance applies requirement to small employers 8/1/2012 Delayed until 2012 PY for calendar year plans 8/1/12 (1/1/13 for calendar year 1 st Open Enrollment period on or after 9/23/2012 Applies for 2011 calendar year, rebates in /1/2011 1/1/ First Plan Year on or after September 23, 2010 Extension of dependent coverage up to age 26. Before, GF plan is not required to offer if over-age dependent has other group coverage available. Copyright LGAA, Inc. This document is not intended or provided as legal advice. 4
5 unless 2010 continued First Plan Year on or after September 23, 2010 pre-existing condition exclusions for enrollees under age 19 lifetime dollar limits on "essential health benefits" (EHB) Restricted annual dollar limits on "essential health benefits" (EHB): $750,000 if PYB is -9/22/11 $1.25 mil if PYB is 9/23/11-9/22/12 $2 mil if PYB is 9/23/12-12/31/13 annual dollar limits on "essential health benefits" Preventive services first dollar coverage of specified services Patient protections: Can select pediatrician as PCP Patient protections: Cannot require referral or pre-authorization for OB/GYN Patient protections: Cannot require preauthorization or referral for emergency care Patient protections: Cannot impose additional costs or limits on out-of-network emergency care n-discrimination testing for insured plans; self-insured already subject to 105(h) nondiscrimination testing. Grandfathered Plan tice: GF plan must notify participants it is GF. Must provide with all/most notices about benefits rescissions -- except if fraud or misrepresentation t required to offer coverage, but if plan does, it cannot impose lifetime dollar limits on them, even if grandfathered. Applies to all plans that offer EHB, even if grandfathered Enforcement delayed until IRS issues final regulations not issued as 7/14/14 t applicable to grandfathered individual coverage t applicable to grandfathered individual coverage; NO annual dollar limits in, restricted annual limits before This publication is intended for general information purposes only and does not and is not intended to constitute legal advice. The reader must consult with legal counsel to determine how laws or decisions discussed herein apply to the reader s specific circumstances and obligations under the PPACA. Copyright LGAA, Inc. This document is not intended or provided as legal advice. 5
HEALTH CARE REFORM PROVISIONS BY SIZE OF PLAN OR EMPLOYER March 28, 2014
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