Benefits Administrations Checklist

Transcription

1 Benefits Administrations Checklist ü Healthcare Exchange Notifications to W-2 Employees Sample letter to employees ü Medical Dues Increase for Traditional Plan for Medical Dues will increase to 23% of Effective Salary. ü Medical Dues Plan will change in Medical Dues will increase to 24.5% of Effective Salary. Employing organizations may pass along some, none, or all of up to 1.5% of Dependent Care cost to the member through salary reduction. Members may waive coverage if other qualified health coverage is available. ü There will be NO increases for Affiliated Benefits Program for ü There will be a new Pharmacy Benefits Manager, Catamaran, starting January 1, ü Call to Health which will allow participants in BOTH the Traditional Plan and Affiliated Benefits Program to qualify for a lower deductible in Requires member to take certain health actions beginning October 1, 2013 through September 30, ü New website that contains special section on Healthcare Reform. default.aspx

2 Healthcare Reform The Board of Pensions continues to implement all applicable provisions of the Patient Protection and Affordable Care Act (ACA). It monitors the law and related regulations, and assesses the impact on the Medical Plan of the PC(USA), employing organizations, and covered members. The Board is committed to helping all constituents understand their options and responsibilities under the law. Employer Requirement: Notice of Health Coverage Options The ACA requires employers to notify their employees of the availability of state health insurance marketplaces (also called exchanges) by October 1, The Board of Pensions is making the following materials available to employers to help them comply with this notification requirement. The Board also mailed a packet of information, including these materials, to all churches and other employing organizations. One-page notice (from the Board) Model notice (from the U.S. Department of Labor) Sample letter to employees Resource Chart Additional ACA Requirements Some requirements apply to employers and others affect members; therefore, the group affected is listed in parentheses after the provision. In addition, some features that were effective before 2013 are included as a reminder Small Employer Healthcare Tax Credit (employers): The Small Employer Healthcare Tax Credit, available for tax years through 2013, encourages small employers to provide healthcare coverage to their employees. Those small employers that meet the criteria may qualify for a Tax Credit of up to 25 percent of the employer s healthcare coverage costs. Exclusion of over-the-counter drugs from FSAs (members): Healthcare Flexible Spending Accounts (FSAs) may not reimburse expenses for over-the-counter drugs purchased without a prescription. Only payments for prescription drugs and insulin can be reimbursed from a healthcare FSA. Medicare preventive care coverage (members): Medicare covers 100 percent of defined preventive services for Medicare beneficiaries. These services include annual well visits, personalized prevention plans, routine vaccines, colorectal cancer screenings, and screening mammograms.

3 2012 Summary of benefits and coverage (employers and members): The Board of Pensions must provide each Medical Plan member with a summary of benefits and coverage in a format established by the U.S. Department of Health & Human Services (HHS). The summary is intended to help consumers compare health plans as they make health plan choices. This summary must be updated and distributed annually. In November 2012, the Board of Pensions mailed the first summary of benefits and coverage for the Medical Plan of the PC(USA) to all active plan members; the summary is also available on pensions.org, or by request from the Board of Pensions. Each year, the Board will mail one for the following plan year Value of healthcare coverage on W-2s (employers): Most employers are required to provide information on the value of healthcare coverage on an employee s W-2 beginning with the 2012 tax year. However, as a church plan, the Medical Plan of the PC(USA) is exempt from this reporting requirement.. Churches and other employing organizations that provide healthcare coverage to employees through another entity should contact their insurance provider or broker, as they may be required to provide covered employees with the value of that coverage beginning with their 2012 W-2s (i.e., on W-2s issued in January 2013). Notice of state health insurance marketplaces (employers): Employers must provide written notice to all employees, both full and part time, about the existence of health insurance marketplaces (formerly called "exchanges") by October 1, The Board will provide guidance on the notice. Medicare payroll tax increase for higher-income taxpayers (members): Effective for the tax year beginning January 1, 2013, a Medicare surtax of 0.9 percent will be applied to higher income earners (individuals with wages in excess of $200,000 and joint filers with wages in excess of $250,000). Medicare unearned income tax on higher-income taxpayers (members): Effective for the tax year beginning January 1, 2013, higher-income taxpayers (individuals with wages in excess of $200,000 and joint filers with wages in excess of $250,000) will pay a 3.8 percent Medicare tax on unearned income (e.g., investment income). Limit on FSA contributions (members): Beginning January 1, 2013, contributions to all healthcare Flexible Spending Accounts (FSAs) are limited by federal law to $2,500 a year.

4 2014 Launch of state health insurance marketplaces (employers and members): The ACA requires each state to establish a health insurance marketplace, form or join a coalition with other states to create regional marketplaces, or offer access to a federally facilitated marketplace. The health insurance marketplaces will enable qualified small employers and individuals to purchase qualified healthcare coverage. Small employers (those with 50 or fewer employees) will be able purchase coverage for their employees on the state health insurance marketplaces. The cost of coverage from a health insurance marketplace will vary by region and the level of coverage chosen. Reduction in waiting periods for Medical Plan enrollment (employers): Beginning January 1, 2014, the ACA sets a limit on waiting periods for enrollment in health plan coverage of 90 days from the date of eligibility for coverage. The Benefits Plan will be amended effective January 1, 2014 to comply with the ACA limit. Prohibition of annual and lifetime treatment reimbursement limits for essential benefits (members): Starting in 2014, health plans must remove all annual and lifetime dollar limits for essential health benefits 10 categories of benefits that all plans participating in a health insurance marketplace must cover (e.g., emergency room care, outpatient services, mental health and substance abuse services, prescription drugs, and lab services). Pre-existing conditions (members): Beginning in 2014, health plans and insurers may no longer deny coverage to anyone who has a pre-existing condition (that is, a medical condition that occurred before the person was enrolled in his or her current health coverage). Annual limits for out-of-pocket costs (members): Under the ACA, each year the federal government will establish a dollar cap on the out-of-pocket expenses a covered person may incur for essential health benefits provided in network. Once a person reaches the maximum limit, health plans, including the Medical Plan of the PC(USA), must pay 100 percent of allowed charges for medically necessary services. For 2014, the ACA-prescribed out-of-pocket maximums are $6,350 for member-only coverage; $12,700 for family coverage. Under the government s definition, these out-of-pocket costs include doctor visit copays, deductibles, and copayments. (To review your current copayment maximum under the Medical Plan and how it is calculated, see the 2013 Healthcare Deductibles and Copayment Maximums chart in Guide to Your Healthcare Benefits.) The Board of Directors of the Board of Pensions has amended the Medical Plan, effective January 1, 2014, so that your maximum out-of-pocket cost will not exceed the limits required by the ACA.

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