HEALTHCARE REFORM 2014 AND BEYOND WHAT S NEXT?

Transcription

1 HEALTHCARE REFORM 2014 AND BEYOND WHAT S NEXT? Associated Financial Group 1

2 AFFORDABLE CARE ACT (ACA) WHEN DID IT BECOME LAW? The ACA became law on March 23, The objective was to expand coverage, control healthcare costs and improve the healthcare delivery system. A key component was to significantly reduce the number of uninsured U.S. citizens by mandating that all individuals would have health insurance coverage. From 2010 to 2012, many components of the ACA were implemented. Most relate to administrative procedures, coverage, and plan documents (i.e. Pre-existing exclusions for children, lifetime limitations, preventative care coverage, documentation, and legal protections). 2

3 HEALTHCARE REFORM AND BEYOND Cadillac Tax Rules Individual Mandate Private Exchanges Medicaid Expansion Pay or Play (Employer Mandate) Wellness Incentives Government Reporting Medical Access Fees Plan Design Copyright 2012 by Associated Financial Group, LLC 3

4 HOW WILL HEALTHCARE REFORM IMPACT YOU IN 2014? You must have health insurance or pay the penalty Individual Mandate. The law states that all legal U.S. residents must have basic health insurance coverage if they can afford it. If you don t have insurance, you will likely pay a tax penalty. The penalty for 2014 will be $95/adult, $47.50/ child (max $285/family) or one percent of an individual s income, whichever is greater, and will rise in 2015 and

5 HOW WILL HEALTHCARE REFORM IMPACT YOU IN 2014? Getting coverage: Health insurance marketplace exchanges. Currently you have the option to purchase health insurance through an employer. Effective January 1, 2014, there will be a new and additional way to purchase health coverage. It s called the health insurance marketplace, aka exchanges. MTSD sent a notice to all active employees about the exchanges in late September. 5

6 HOW WILL HEALTHCARE REFORM IMPACT YOU IN 2014? Removal of pre-existing conditions and annual dollar limits. All restrictions on pre-existing conditions for individuals of all ages will be removed. Also, all annual dollar limits will be fully phased out in New fees. To fund several of the changes mandated by the law, new fees will be imposed on fully insured carriers and self-funded plans. Included are: Patient-centered outcomes research fee ACA insurer fee Risk adjustment administration fee ACA reinsurance fee 6

7 HOW WILL HEALTHCARE REFORM IMPACT YOU IN 2014? Expansion of Medicaid eligibility. There has been an extension of Medicaid eligibility under the ACA; not every state will be participating and some may expand beyond the base level of 133% of the federal poverty level (FPL) so it will vary significantly from state to state. Wisconsin did not expand eligibility and therefore will be set at 100% of the FPL. Financial assistance may be available. If you buy coverage through the exchange, you may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage that meets the minimum value standards. MTSD does offer essential coverage of minimum value that is affordable to its employees. 7

8 HEALTHCARE REFORM 2014 AND BEYOND Purpose: To ensure more individuals are covered under health insurance Wellness incentives employers can ask employees that do not participate in company based wellness programs to pay a higher portion of the health insurance premium Clinical Trial coverage health plans need to include coverage for employees that are participating in clinical trials Pre-existing limitation these limitations need to be removed from the health plan coverage Plan designs out-of-pocket maximums are capped at $6,350 single/$12,700 family for 2014 (includes copays, deductible, and coinsurance) 8

9 WHO IS ELIGIBLE TO PARTICIPATE IN THE PUBLIC HEALTHCARE EXCHANGE Are MTSD employees eligible to participate in the healthcare exchanges offered by the federal government? Yes* Are spouses of MTSD employees eligible to participate in the healthcare exchanges offered by the federal government? Yes* Are children of MTSD employees eligible to participate in the healthcare exchanges offered by the federal governmen? Yes* *However since MTSD plans meet the affordability requirements, the employee will not likely qualify for a federal subsidy. 9

10 AM I REQUIRED TO ENROLL IN EMPLOYER HEALTHPLAN? No You must decline coverage with MTSD if you choose coverage elsewhere. Employees can use another source of health insurance, such as insurance purchased through the exchange or coverage with your spouse through their employer. You can find additional information at 10

11 HEALTHCARE REFORM 2014 AND BEYOND Public Market / Exchange Minimal coverage standards 9.5% of household income Cadillac Tax 40% excise tax for each dollar above $10,200 single contract and $27,500 family contract HSA and HRA contributions apply Plan Design Must meet minimal coverage standard (bronze plans on exchanges) 2014 medical copays apply to maximum out-of-pockets 2015 Rx copays apply to maximum out-of-pockets Services supporting clinical trials must be included Large employers: maximum out-of-pocket can t exceed $6,350 single contract / $12,700 family contract Must offer coverage to employees who work an average of 30 hours per week Copyright 2012 by Associated Financial Group, LLC 11

12 HEALTHCARE REFORM 2014 AND BEYOND Fees Patient-Centered Outcomes Research Institute (PCORI) fee 2013: $1 per member per plan year for both medical plan and HRA 2014: $2 per member per plan year for both medical plan and HRA Temporary Transitional Reinsurance Fee (TTRP) $63 per member per year ($5.25 per month) Proposed sunset after three years 2014 carrier fees Risk Adjustment Program (RAP) Fee of $1 for member per year ACA insurer fee 2.4% - 3% of premium charged annually to fund Medicaid and subsidies Copyright 2012 by Associated Financial Group, LLC 12

13 IMPLICATIONS Copyright 2012 by Associated Financial Group, LLC 13

14 MEDICAL FSA Annual enrollment period for this plan By using this plan, contributions are deducted from your pay before it is taxed. You avoid taxes on the part of your income that you set aside for qualified eligible healthcare and dependent care expenses. - Federal, state and FICA taxes do not apply to the money you run through the plan. - You can save approximately 30 percent on each contributed dollar. Maximum annual contribution of $2,500 Your plan year is January 1 st through December 31 st Entire election available from day one of the plan year Use it or lose it Copyright 2012 by Associated Financial Group, LLC Mequon-Thiensville School District/13/Miscellaneous/Healthcare Reform - Employee Presentation #2.pptx 14

15 DEPENDENT CARE FSA Contribute pre-tax dollars to this FSA to reimburse dependent care - Daycare expenses - Expenses for the care of dependents with mental or physical disabilities You and your spouse must be working or be a full-time student Maximum annual contribution $5,000 Plan year is January 1 st through December 31 st Funds available for reimbursement as they are deducted from your pay Copyright 2012 by Associated Financial Group, LLC Mequon-Thiensville School District/13/Miscellaneous/Healthcare Reform - Employee Presentation #2.pptx 15

16 EMPLOYEE SURVEYS MTSD will be conducting two employee engagement surveys. 1) Benefits Survey Target launch Monday, October 28th Solicit feedback regarding benefit offerings through the District Approximately 50 questions minutes to complete Summarize and communicate results to employees 2) Milwaukee - Top Workplaces Survey Target launch Monday, November 18th Opportunity to provide feedback on working at MTSD Approximately 22 questions Five minutes to complete If chosen as a top workplace, company will be recognized in a special edition of the Milwaukee Journal Sentinel in May 2014 Copyright 2012 by Associated Financial Group, LLC Mequon-Thiensville School District/13/Miscellaneous/Healthcare Reform - Employee Presentation #2.pptx 16

17 QUESTIONS? Copyright 2012 by Associated Financial Group, LLC Mequon-Thiensville School District/13/Miscellaneous/Healthcare Reform - Employee Presentation #2.pptx 17