Brught t yu by Awesme Agency Health Care Refrm Timeline On March 23, 2010, President Obama signed the health care refrm bill, r Affrdable Care Act (ACA), int law. ACA makes sweeping changes t the U.S. health care system. ACA s health care refrms, which are primarily fcused n reducing the uninsured ppulatin and decreasing health care csts, will be implemented ver the next several years. This Awesme Agency Legislative Brief prvides a timeline f the implementatin f key ACA refrms that affect emplyers and individuals. Please read belw fr mre infrmatin and cntact Awesme Agency with any questins abut hw yu can prepare fr any f the health care refrm requirements. EXPANDED INSURANCE COVERAGE 2010 Extended Cverage fr Yung Adults. Grup health plans and health insurance issuers ffering grup r individual health insurance cverage that prvide dependent cverage f children must make cverage available fr adult children up t age 26. There is n requirement t cver the child r spuse f a dependent child. This requirement applies t grandfathered and nn-grandfathered plans. Hwever, grandfathered plans need nt cver adult children wh are eligible fr ther emplyer-spnsred cverage, such as cverage thrugh their wn emplyer, until 2014. ACA als added a new tax prvisin related t health insurance cverage fr these adult children. Effective March 30, 2010, amunts spent n medical care fr an eligible adult child can generally be excluded frm taxable incme. Nte: A grandfathered plan is ne in which an individual was enrlled n March 23, 2010. A plan will retain its grandfathered status even if cvered individuals renew their cverage after March 23, 2010, family members are added t cverage r new emplyees (and their families) enrll fr cverage. A health plan will lse its grandfathered status if there are significant cuts t benefits r increases in participants ut-f-pcket spending. Grandfathered status is significant because many ACA refrms d nt apply t grandfathered plans. Access t Insurance fr Uninsured Individuals with Pre-existing Cnditins. The health care refrm law created a temprary high-risk health insurance pl prgram, called the Pre-existing Cnditin Insurance Plan (PCIP) t prvide health insurance cverage t individuals wh have been uninsured fr at least six mnths because f a pre-existing cnditin. The prgram will end in 2014, when the health insurance exchanges are scheduled t be peratinal. On Feb. 15, 2013, the Obama Administratin issued a natinwide suspensin n enrllment in the PCIP prgram due t limited funding. The enrllment suspensin tk effect immediately in 23 states where the federal gvernment administers the prgram. Hwever, state-based PCIPs may cntinue t accept enrllment applicatins thrugh March 2, 2013. Fr mre infrmatin, see https://www.pcip.gv/. Identifying Affrdable Cverage. As required by ACA, the Department f Health and Human Services (HHS) established an Internet website www.healthcare.gv - thrugh which residents f any state may identify affrdable health insurance cverage ptins in their state. The website als includes infrmatin fr small businesses abut available cverage ptins, reinsurance fr early retirees, small business tax credits, 1
and ther infrmatin f interest t small businesses. S-called mini-med r limited-benefit plans are precluded frm listing their plicies n this website. Reinsurance fr Cvering Early Retirees. ACA established a temprary reinsurance prgram t reimburse participating emplyment-based plans fr a prtin f the cst f prviding health insurance cverage t early retirees and their spuses, surviving spuses and dependents. This prgram was designed t end n Jan. 1, 2014, r earlier, if the $5 billin in funding was exhausted. Due t the prgram s ppularity, it clsed t new applicatins effective May 5, 2011. In early December 2011, HHS annunced that, because the prgram had already prvided mre than $4.5 billin in reimbursements, it wuld nt accept reimbursement requests fr claims incurred after Dec. 31, 2011. HEALTH INSURANCE REFORM Eliminating Pre-existing Cnditin Exclusins fr Children. Grup health plans and health insurance issuers may nt impse pre-existing cnditin exclusins n cverage fr children under age 19. This prvisin applies t all emplyer plans and new plans in the individual market. This prvisin will als apply t adults in 2014. Cverage f Preventive Care Services. Grup health plans and health insurance issuers ffering grup r individual health insurance cverage must prvide cverage fr certain preventive care services withut cstsharing (fr example, deductibles, cpayments r cinsurance). Grandfathered plans are exempt frm this requirement. Prhibiting Rescissins. The health care refrm law prhibits rescissins, r retractive cancellatins, f cverage, except in cases f fraud r intentinal misrepresentatin. Als, plans and issuers must prvide at least 30 days advance ntice t the enrllee befre cverage may be rescinded. This prvisin applies t all grandfathered and nn-grandfathered plans. Lifetime and Annual Limits. Grup health plans and health insurance issuers ffering grup r individual health insurance cverage may nt impse lifetime limits r unreasnable annual limits n the dllar value f essential health benefits. This requirement applies t all plans, althugh plans were allwed t request a waiver f the annual limit requirement thrugh HHS. The annual limit waiver prgram clsed t applicatins effective Sept. 22, 2011. All annual limits will als be prhibited beginning in 2014. HEALTH PLAN ADMINISTRATION Imprved Claims and Appeals Prcess. Grup health plans and health insurance issuers ffering grup r individual health insurance cverage must implement an effective prcess fr benefit claims and appeals f cverage determinatins. A plan s r issuer s internal claims and appeals prcess must cmply with the claims prcedure regulatin issued by the Department f Labr (DOL) in 2001. In additin, ACA requires plans and issuers t: Have an internal claims and appeals prcess in effect that prvides claimants with a full and fair review; Prvide infrmatin t claimants in a culturally and linguistically apprpriate manner in sme situatins; Cmply with additinal cntent requirements fr denial ntices; and Cntinue t prvide cverage t a claimant pending the utcme f the appeals prcess. This Awesme Agency Legislative Brief is nt intended t be exhaustive nr shuld any discussin r pinins be cnstrued as legal advice. Readers shuld cntact legal cunsel fr legal advice. 2
A grace perid fr sme f ACA s additinal claims and appeals requirements was prvided until plan years beginning n r after Jan. 1, 2012. Plans and issuers must als implement an external review prcess that meets applicable state r federal requirements. Nndiscriminatin Rules fr Fully Insured Plans. Fully insured grup health plans will have t satisfy nndiscriminatin rules regarding eligibility t participate in the plan and eligibility fr benefits. These rules prhibit discriminatin in favr f highly cmpensated individuals. This refrm des nt apply t grandfathered plans. This requirement was set t take effect fr plan years beginning n r after Sept. 23, 2010. Hwever, it has been delayed indefinitely pending the issuance f regulatins. The regulatins will specify the new effective date. MEDICARE/MEDICAID Rebates fr the Medicare Part D Dnut Hle. Currently, there is a cverage gap, r dnut hle, in mst Medicare Part D plans. Once the plan and participant have paid $2,930 in ttal drug csts ($2,970 fr 2013), the participant is in the cverage gap. The cverage gap ends when the participant has spent $4,700 ($4,750 fr 2013) ut f pcket fr drug csts in a calendar year. Fr 2010, ACA prvided a $250 rebate check fr all Medicare Part D enrllees wh entered the dnut hle. Starting in 2011, the health care refrm law prvides discunts n brand-name drugs and generic drug cverage in the dnut hle. The dnut hle gap will be filled by 2020. Medicaid Flexibility fr States. States are given an ptin under the health care refrm law t cver additinal individuals under Medicaid. States will be able t cver parents and childless adults up t 133 percent f the Federal Pverty Level (FPL). Small Business Tax Credit. The first phase f the small business tax credit fr qualified small emplyers began in 2010. Eligible emplyers can receive a credit fr cntributins t purchase health insurance fr emplyees. The credit is up t 35 percent f the emplyer s cntributin t prvide health insurance fr emplyees. There is als up t a 25 percent credit fr small tax-exempt rganizatins. When the health insurance exchanges are peratinal, the tax credits will increase, up t 50 percent f premiums. Indr Tanning Services Tax. An additinal tax impsed by the health care refrm law is a 10 percent tax n amunts paid fr indr sun tanning services. 2011 EXPANDED INSURANCE COVERAGE Cmmunity Living Assistance Services and Supprts Prgram (CLASS Act). ACA created a vluntary, lng-term care insurance prgram fr disabled adults. Althugh the prgram was technically effective Jan. 1, 2011, significant prtins were nt required t be established until 2012. On Oct. 14, 2011, the CLASS Act s implementatin was suspended due t cncerns abut the prgram s fiscal sustainability and affrdability. On Jan. 2, 2013, the CLASS Act was repealed by legislatin apprved by Cngress and signed by President Obama t avid the fiscal cliff. HEALTH PLAN ADMINISTRATION Imprving Medical Lss Ratis. Health insurance issuers ffering grup r individual health insurance cverage (including grandfathered health plans) must annually reprt n the share f premium dllars spent n health care and prvide cnsumer rebates fr excessive medical lss ratis. This Awesme Agency Legislative Brief is nt intended t be exhaustive nr shuld any discussin r pinins be cnstrued as legal advice. Readers shuld cntact legal cunsel fr legal advice. 3
Standardizing the Definitin f Qualified Medical Expenses. ACA changed the definitin f qualified medical expenses fr health savings accunts (HSAs), health flexible spending accunts (FSAs) and health reimbursement arrangements (HRAs) t the definitin used fr the itemized tax deductin. This means that expenses fr ver-the-cunter (OTC) medicines and drugs may nt be reimbursed by these plans unless they are accmpanied by a prescriptin. There is an exceptin fr insulin. Als, OTC medical supplies and devices may cntinue t be reimbursed withut a prescriptin. Cafeteria Plan Changes. ACA created a simple cafeteria plan t prvide a vehicle thrugh which small businesses can prvide tax free benefits t their emplyees. This plan is designed t ease the small emplyer s administrative burden f spnsring a cafeteria plan. The prvisin als exempts emplyers wh make cntributins fr emplyees under a simple cafeteria plan frm certain nndiscriminatin requirements applicable t highly cmpensated and key emplyees. MEDICARE/MEDICAID Medicare Part D Discunts. In rder t make prescriptin drug cverage mre affrdable fr Medicare enrllees, ACA prvided a 50 percent discunt n all brand-name drugs and bilgics in the dnut hle. It als began phasing in additinal discunts n brand-name and generic drugs t cmpletely fill the dnut hle by 2020 fr all Part D enrllees. Additinal Preventive Care Services. ACA prvided a free, annual wellness visit and persnalized preventin plan services fr Medicare beneficiaries and eliminated cst-sharing fr preventive care services beginning in 2011. Increased Tax n Withdrawals frm HSAs and Archer MSAs. The health care refrm law increased the additinal tax n HSA withdrawals prir t age 65 that are nt used fr qualified medical expenses frm 10 t 20 percent. The additinal tax fr Archer MSA withdrawals nt used fr qualified medical expenses als increased frm 15 t 20 percent. 2012 HEALTH INSURANCE REFORM Additinal Preventive Care Services fr Wmen. Beginning in 2010, nn-grandfathered grup health plans and health insurance issuers ffering grup r individual nn-grandfathered health insurance cverage were required t prvide cverage fr preventive care services withut cst-sharing requirements. Effective fr plan years beginning n r after Aug. 1, 2012, the required preventive care services include specific services fr wmen, including cntraceptives and cntraceptive cunseling. Exceptins t the cntraceptive cverage requirement apply t religius emplyers. EXPANDED INSURANCE COVERAGE Cmmunity Living Assistance Services and Supprts Prgram (CLASS Act). As nted abve, the CLASS Act, which wuld have created a vluntary lng-term care insurance prgram fr disabled adults, was technically effective Jan. 1, 2011. Hwever, significant aspects f the prgram, such as enrllment and premium payment rules, were t be established in 2012. Implementatin f the CLASS Act was suspended n Oct. 14, 2011 due t cncerns n fiscal sustainability and affrdability. HEALTH PLAN ADMINISTRATION Unifrm Summary f Benefits and Cverage. All nn-grandfathered and grandfathered health plans must prvide a unifrm summary f the plan s benefits and cverage t participants. The summary must be written This Awesme Agency Legislative Brief is nt intended t be exhaustive nr shuld any discussin r pinins be cnstrued as legal advice. Readers shuld cntact legal cunsel fr legal advice. 4
in easily understd language and is limited t fur duble-sided pages. Any mid-year changes t the infrmatin cntained in the summary must be prvided t participants 60 days in advance. ACA indicated that plans wuld be required t start prviding the summary by March 23, 2012, but this deadline was pushed back. Plans and issuers must start prviding the summary by the fllwing deadlines: Issuers must prvide the summary t health plans effective Sept. 23, 2012; Plans and issuers must prvide the summary t participants and beneficiaries wh enrll r reenrll during an pen enrllment perid starting with the first day f the first pen enrllment perid that begins n r after Sept. 23, 2012; Plans and issuers must prvide the summary t participants wh enrll fr cverage ther than thrugh an pen enrllment perid (fr example, newly eligible individuals and special enrllees) starting with the first day f the first plan year that begins n r after Sept. 23, 2012. Reprting Health Cverage Csts n Frm W-2. ACA requires emplyers t disclse the value f the health cverage prvided by the emplyer t each emplyee n the emplyee s annual Frm W-2. This requirement was effective, but ptinal, fr the 2011 tax year and is mandatry fr later years fr mst emplyers. This requirement is ptinal fr small emplyers (thse filing fewer than 250 Frm W-2s) at least fr the 2012 tax year and will remain ptinal until further guidance is issued. Emplyers that file at least 250 Frms W-2 must cmply with this reprting requirement fr 2012 (fr W-2 Frms that must be issued by the end f January 2013) and future years. Medical Lss Rati Rebates. Spnsrs f fully insured plans will receive rebates by Aug. 1, 2012 if they qualify fr a rebate frm their health insurance issuers due t the medical lss rati (MLR) rules. The MLR rules require insurance cmpanies t spend a certain percentage f premium dllars n medical care and health care quality imprvement, rather than administrative csts. Any prtin f a rebate that is a plan asset must be used fr the exclusive benefit f the plan s participants and beneficiaries. This may include, fr example, reducing participants premium payments. Cmparative Effectiveness Research (CER) Fees. Effective fr plan years ending n r after Oct. 1, 2012, issuers and spnsrs f self-insured health plans must pay CER fees t fund health care research. The CER fees d nt apply fr plan years ending n r after Oct. 1, 2019. Thus, fr calendar year plans, the CER fees will be effective fr the 2012 thrugh 2018 plan years. Fr plan years ending befre Oct. 1, 2013 (that is, 2012 fr calendar year plans), the research fee is $1 multiplied by the average number f lives cvered under the plan. The fee ges up t $2 fr plan years ending n r after Oct. 1, 2013 and befre Oct. 1, 2014, and will be indexed fr future years. CER fees must be reprted and paid by July 31 f each year, and will generally cver plan years that end during the preceding calendar year. The first pssible due date fr paying CER fees is July 31, 2013. HEALTH PLAN ADMINISTRATION 2013 Administrative Simplificatin. Beginning in 2013, health plans must adpt and implement unifrm standards and perating rules fr the electrnic exchange f health infrmatin t reduce paperwrk and administrative burdens and csts. Fr example, effective Jan. 1, 2013, health plans must cmply with HHS s perating rules fr electrnic health care transactins regarding eligibility fr health plan cverage and health care claim status. This Awesme Agency Legislative Brief is nt intended t be exhaustive nr shuld any discussin r pinins be cnstrued as legal advice. Readers shuld cntact legal cunsel fr legal advice. 5
Limiting Health Flexible Savings Accunt Cntributins. Effective fr plan years beginning after Dec. 31, 2012, ACA limits the amunt f salary reductin cntributins t health FSAs t $2,500 per year, indexed by CPI fr subsequent years. Emplyee Ntice f Exchanges. By March 1, 2013, emplyers must prvide a ntice t emplyees regarding the availability f the health care refrm insurance exchanges. HHS has indicated that it plans n issuing mdel exchange ntices in the future fr emplyers t use. On Jan. 24, 2013, the Department f Labr (DOL) annunced that emplyers will nt be held t the March 1, 2013, deadline. They will nt have t cmply until final regulatins are issued and a final effective date is specified. The DOL expects that the timing fr distributin f ntices will be the late summer r fall f 2013, which will crdinate with the pen enrllment perid fr Exchanges. HIPAA Certificatin. By Dec. 31, 2013, emplyers with grup health plans must certify that their plans cmply with certain HIPAA rules n electrnic transactins. HHS intends t issue mre guidance n this requirement in the future. Eliminating Deductin fr Medicare Part D Subsidy. Currently, emplyers that receive the Medicare Part D retiree drug subsidy may take a tax deductin fr their prescriptin drug csts, including csts attributable t the subsidy. The deductin fr the retiree drug subsidy will be eliminated in 2013. Increased Threshld fr Medical Expense Deductins. ACA increases the incme threshld fr claiming the itemized deductin fr medical expenses frm 7.5 percent f incme t 10 percent. Hwever, individuals ver 65 wuld be able t claim the itemized deductin fr medical expenses at 7.5 percent f adjusted grss incme thrugh 2016. Additinal Medicare Tax fr High Wage Wrkers. ACA increases the Medicare hspital insurance tax rate by 0.9 percentage pints n wages ver $200,000 fr an individual ($250,000 fr married cuples filing jintly). The tax is als expanded t include a 3.8 percent tax n net investment incme in the case f taxpayers earning ver $200,000 ($250,000 fr jint returns). Medical Device Excise Tax. ACA establishes a 2.3 percent excise tax n the first sale fr use f a medical device. Eye glasses, cntact lenses, hearing aids, and any device f a type that is generally purchased by the public at retail fr individual use are exempted frm the tax. CER Fees. Fr plan years ending n and after Oct. 1, 2012 and befre Oct. 1, 2019, self-insured plans and issuers must pay fees per cvered life. The initial fee is $1 per cvered life, increasing t $2 per cvered life fr plan years ending n r after Oct. 1, 2013 (and adjusted annually fr later plan years). The first pssible payments are due n July 31, 2013. 2014 COVERAGE MANDATES Individual Cverage Mandates. ACA requires mst individuals t btain acceptable health insurance cverage r pay a penalty, beginning in 2014. The penalty will start at $95 per persn fr 2014 and increase each year. The penalty amunt increases t $325 in 2015 and t $695 (r up t 2.5 percent f incme) in 2016, up t a cap f the natinal average brnze plan premium. After 2016, dllar amunts are indexed. Families will pay half the penalty amunt fr children, up t a cap f three times the adult penalty fr that year. Individuals may be eligible fr an exemptin frm the penalty if they cannt btain affrdable cverage. Legal challenges t the health care refrm law have fcused n whether Cngress had the cnstitutinal authrity t enact the individual cverage mandate. This Awesme Agency Legislative Brief is nt intended t be exhaustive nr shuld any discussin r pinins be cnstrued as legal advice. Readers shuld cntact legal cunsel fr legal advice. 6
On June 28, 2012, the U.S. Supreme Curt addressed these legal challenges and upheld the individual cverage mandate as cnstitutinal. This means that the mandate will g int effect in 2014 as planned, unless it is repealed by Cngress. Emplyer Cverage Requirements. Emplyers with 50 r mre emplyees that d nt ffer cverage t their emplyees will be subject t penalties if any emplyee receives a gvernment subsidy fr health cverage. The penalty amunt is up t $2,000 annually fr each full-time emplyee, excluding the first 30 emplyees. Emplyers wh ffer cverage, but whse emplyees receive tax credits because the cverage is unaffrdable r des nt prvide minimum value, will be subject t a fine f $3,000 fr each wrker receiving a tax credit, up t an aggregate cap f $2,000 per full-time emplyee (excluding the first 30 emplyees). Emplyers will be required t reprt t the federal gvernment n health cverage they prvide. HEALTH INSURANCE EXCHANGES ACA prvides fr health insurance exchanges t be established in each state in 2014. Individuals and small emplyers will be able t shp fr insurance thrugh the exchanges. Small emplyers are thse with n mre than 100 emplyees. If a small emplyer later grws abve 100 emplyees, it may still be treated as a small emplyer. Hwever, states may limit emplyers participatin in the exchanges t businesses with up t 50 emplyees until 2016. Large emplyers with ver 100 emplyees are t be allwed int the exchanges in 2017. States have three ptins with respect t their exchanges. They can (1) establish and run a state-based exchange, (2) have HHS establish a federally facilitated exchange (FFE) fr their residents r (3) partner with HHS s that sme FFE functins can be perfrmed by the state. The health care refrm legislatin prvided that wrkers wh qualified fr an affrdability exemptin t the cverage mandate, but did nt qualify fr tax credits, culd use their emplyer cntributin t jin an exchange plan. This requirement is knwn as the free chice vucher prvisin. The federal apprpriatins bill signed by President Obama n April 15, 2011, eliminated the free chice vucher prvisin frm health care refrm. HEALTH INSURANCE REFORM Additinal health insurance refrm measures will be implemented beginning in 2014. Guaranteed Issue and Renewability. Health insurance issuers ffering health insurance cverage in the individual r grup market in a state must accept every emplyer and individual in the state that applies fr cverage and must renew r cntinue t enfrce the cverage at the ptin f the plan spnsr r the individual. Pre-existing Cnditin Exclusins. Effective Jan. 1, 2014, grup health plans and health insurance issuers may nt impse pre-existing cnditin exclusins n any cvered individual, regardless f the individual s age. Insurance Premium Restrictins. Health insurance issuers in the individual and small grup markets will nt be permitted t charge higher rates due t heath status, gender r ther factrs. Premiums will be able t vary based nly n age (n mre than 3:1), gegraphy, family size and tbacc use. The rating limitatins will nt apply t health insurance issuers that ffer cverage in the large grup market unless the state elects t ffer large grup cverage thrugh the state exchange (beginning n r after 2017). Als, these restrictins d nt apply t grandfathered cverage. Nndiscriminatin Based n Health Status. Grup health plans and health insurance issuers ffering grup r individual health insurance cverage (except grandfathered plans) may nt establish rules fr eligibility r cntinued eligibility based n health status-related factrs. Nndiscriminatin in Health Care. Grup health plans and health insurance issuers ffering grup r individual insurance cverage may nt discriminate against any prvider perating within their scpe f This Awesme Agency Legislative Brief is nt intended t be exhaustive nr shuld any discussin r pinins be cnstrued as legal advice. Readers shuld cntact legal cunsel fr legal advice. 7
practice. Hwever, this prvisin des nt require a plan t cntract with any willing prvider r prevent tiered netwrks. It als des nt apply t grandfathered plans. Plans and issuers als may nt discriminate against individuals based n whether they receive subsidies r cperate in a Fair Labr Standards Act investigatin. Annual Limits. Restricted annual limits will be permitted until 2014. Hwever, in 2014, the plans and issuers may nt impse annual limits n the cverage f essential health benefits. Excessive Waiting Perids. Grup health plans and health insurance issuers ffering grup r individual health insurance cverage will nt be able t require a waiting perid f mre than 90 days. Cverage fr Clinical Trial Participants. Nn-grandfathered grup health plans and insurance plicies will nt be able t terminate cverage because an individual chses t participate in a clinical trial fr cancer r ther life-threatening diseases r deny cverage fr rutine care that they wuld therwise prvide just because an individual is enrlled in such a clinical trial. Cmprehensive Benefits Cverage. Health insurance issuers that ffer health insurance cverage in the individual r small grup market will be required t prvide the essential benefits package required f plans sld in the health insurance exchanges. This requirement des nt apply t grandfathered plans. Limits n Cst-sharing. Nn-grandfathered grup health plans will be subject t limits n cst-sharing r ut-f-pcket csts. Out-f-pcket expenses may nt exceed the amunt applicable t cverage related t HSAs and deductibles may nt exceed $2,000 (single cverage) r $4,000 (family cverage). These amunts are indexed fr subsequent years. Final guidance frm HHS prvides that the deductible requirement will apply nly t plans in the insured small grup market, while the ut-f-pcket cst limit will apply t all nngrandfathered health plans. Risk-spreading Mechanisms. The health care refrm law includes refrms related t the allcatin f insurance risk thrugh reinsurance, risk crridrs and risk adjustment. The purpse f these refrms, which becme effective in 2014, is t prtect against risk selectin and market uncertainty as insurance changes and the health insurance exchanges are implemented. Under reinsurance prgram, which will perate frm 2014 thrugh 2016, health insurance issuers and third party administratrs (TPAs) will be required t make cntributins based n a federal cntributin rate established by HHS. States may cllect additinal cntributins n tp f the federal cntributin rate. EMPLOYER WELLNESS PROGRAMS Under health care refrm, the rules fr emplyer wellness prgrams will be changed slightly. Existing wellness regulatins under HIPAA permit wellness incentives f up t 20 percent f the ttal premium, as lng as the prgram meets certain cnditins. Under health care refrm, the ptential incentive increases t 30 percent f the premium in 2014 fr emplyee participatin in the prgram r meeting certain health standards. Emplyers must ffer an alternative standard fr thse emplyees whm it is unreasnably difficult r inadvisable t meet the standard. Fllwing a gvernmental study n wellness prgrams, the incentive may be increased t as much as 50 percent. Individual Health Care Tax Credits. ACA makes premium tax credits available thrugh the exchanges t ensure peple can btain affrdable cverage. Credits are available fr peple with incmes abve Medicaid eligibility and belw 400 percent f pverty level wh are nt eligible fr r ffered ther acceptable cverage. The credits apply t bth premiums and cst-sharing. Small Business Tax Credit. The secnd phase f the small business tax credit fr qualified small emplyers will be implemented in 2014. These emplyers can receive a credit fr cntributins t purchase health insurance fr emplyees, up t 50 percent f premiums. This Awesme Agency Legislative Brief is nt intended t be exhaustive nr shuld any discussin r pinins be cnstrued as legal advice. Readers shuld cntact legal cunsel fr legal advice. 8
Health Insurance Prvider Fee. The health care refrm law impses an annual, nn-deductible fee n the health insurance sectr, allcated acrss the industry accrding t market share. The fee des nt apply t cmpanies whse net premiums written are $25 millin r less. 2018 HIGH COST PLAN EXCISE TAX A 40 percent excise tax is t be impsed n the excess benefit f high cst emplyer-spnsred health insurance. This tax is als knwn as a Cadillac tax. The annual limit fr purpses f calculating the excess benefits is $10,200 fr individuals and $27,500 fr ther than individual cverage. Respnsibility fr the tax is n the cverage prvider which can be the insurer, the emplyer r a third-party administratr. There are a number f exceptins and special rules fr high cverage cst states and different jb classificatins. This Awesme Agency Legislative Brief is nt intended t be exhaustive nr shuld any discussin r pinins be cnstrued as legal advice. Readers shuld cntact legal cunsel fr legal advice. 9