The Affordable Care Act. Updates since Ohio Atty. Gen. Op. No

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1 The Affordable Care Act Updates since Ohio Atty. Gen. Op. No

2 State Statutes R.C Authorizes a board of township trustees to provide health insurance coverage for township officers and employees and their immediate dependents. R.C (B) A township that does not procure group health care also may reimburse a township officer or employee for any out of pocket premium. The Board shall establish a maximum payment amount that will be reimbursed.

3 Attorney General Opinion No The ACA imposes a prohibition on lifetime or annual limits on the dollar value of certain benefits. Based on the decisions of the U.S. Dept. of Labor and the IRS, if a Board of Township Trustees provides cash reimbursement for premiums for an individual market policy, the Board creates a group plan and is subject to the annual dollar limit prohibition.

4 Attorney General Opinion No The Attorney General has concluded that unless a township reimbursement plan is integrated with an existing group health plan, the reimbursement plan violates the annual dollar limit of the ACA and is prohibited, Determining whether two policies are properly integrated is very factually specific, so I would advise contacting our Office if you have any questions regarding integration.

5 ACA & Medicare An arrangement under which an employer pays or reimburses an employee for premiums for Medicare Part B or Part D is an employer payment plan. If the arrangement cover two or more employees, it is a group health plan that must meet the ACA market reform requirements, including the annual dollar limit prohibition.

6 ACA & Medicare The Township plans which reimburse for Medicare Part B and Part D violate the annual dollar limit Township employer plans may not be integrated with Medicare Part B or Part D because Medicare coverage can only be integrated with plans for employees who are enrolled in Medicare. This provision then violates the Ohio law which states that all benefits must be offered to all Township Officials and Employees and be the same for all.

7 Zane Benefits Zane Benefits Reimbursement Program asserts that it is able to comply with the dollar limit prohibition of the ACA for reimbursement plans because it is a two tiered program. The Zane Benefits Program states that a Township Official or Employee must obtain health insurance through a provider other than the Township. The Official or Employee is then reimbursed only for the premium spent on this group health plan.

8 Zane Benefits The Reimbursement Program does not violate the ACA dollar limit, because once the limits of the group plans are maximized, then a Zane Benefits Plan also covers Officials and Employees through a self-funded group health plan with no dollar limit. While this plan may not violate the Affordable Care Act it does violate R.C and , which allows the Township to obtain group health insurance or offer reimbursement, not both.

9 Cafeteria Plans R.C (A) authorizes a board of township trustees to offer health care benefits to township officers and employees through a cafeteria plan so long as the township first adopts a policy authorizing an offer or employee to receive a cash payment I lieu of a benefit otherwise offer to township officers and employees under R.C , R.C , or R.C The case payment may not exceed 25% of the cost of premiums or payments the trustees would otherwise pay.

10 Cafeteria Plans A cafeteria plan cannot be used in conjunction with an individual plan purchased in the state marketplace. 26 U.S.C.A. 125(f)(3). A cafeteria plan is considered a group health plan and therefore must be integrated with another group health plan that does not have a dollar limit to not violate the ACA. Whether a cafeteria plan will work for your Township is very fact specific and you should contact my Office to determine whether it will work for you.