Presentation on theme: "Agenda Components of Reform to Consider Requirements of a small employer Requirements of a large employer The Exchanges – What do they mean? Do we Pay."— Presentation transcript:
Agenda Components of Reform to Consider Requirements of a small employer Requirements of a large employer The Exchanges – What do they mean? Do we Pay or Play?
Changes Already in Effect Rate Review (2010) Grandfathering (2009) Small business Tax Credits (2010) “Patient Bill of Rights” (2010) Network access – PCP Choice Independent appeals process No pre-ex for kids <19 Coverage for dependents up to age 26 100% coverage for wellness/prevention No Rescissions No Annual and lifetime limits Medical Loss Ratios – MLR (2010) Defines “maximum” insurance company profits 15% Large groups 20% small groups Requires refunds to groups is profit is too high
2013 – We’re Already Here Limits on Health FSA Accounts Increases in Medicare Payroll Taxes Increases in Medicare Contribution Tax Mandatory Form W-2 Reporting (100+ ee’s) Health Care Exchange Notices
Coming Soon to a Policy Near You Guaranteed Issue - Insurers must issue a policy to any applicant, regardless of health condition. No pre-existing condition limitations. Community Rating – Everyone is charged essentially the same amount for insurance. Variations for geography, smoking and age (3:1), was 7:1.
The Individual Mandate All individuals must have coverage. If not through work or the government, then through the Individual market. The Individual’s Penalty For not having “minimum essential coverage” Not more than the price of the lowest coverage option Some exceptions Flat Fee (per person) Set at $95 for 2014 $325 in 2015 $695 in 2016 2017 tied to inflation (CPI) Percent of Income 0.5% for 2014 1% in 2015 2.5% in 2016
Bad News for Insurance Rates Bracing for rate double digits increase in 2014. (20%-60%) What’s gives? It’s the policymakers. It’s ObamaCare… Premium hikes are a consequence of policies. Premiums will rise because, in the end, everything has a price. Prohibition of traditional underwriting is a major and costly provision. Washington can try to force health plans to price insurance below cost, but then health plans will lose money and move out of markets. To keep the insurers whole, and accommodate the new rules, the cost of insurance must go higher. That re-pricing is what’s coming this fall.
Preparing for 2014 Are you Compliant with the law? How many FT employees do you have? Are you a large or small employer? Exchanges – Lots still unknown Decision Time – Do we Pay or Play?
Discrimination Are your benefits currently: Different by class of employee? Management Carve Out Have different contributions by class? Management Vs. “Others” Different waiting periods by class? Management Vs. “Others” If your answer is “YES” to any of these…then you will not be compliant with the law in 2014
What is a FT Employee? Minimum of 30 hours per week = Full Time Employee Or 130 hours per month Full Time Equivalent Employee (FTE) Total PT hours worked per month / 120 = # of FTE Seasonal: -A worker who performs labor or services on a seasonal basis, as defined by the Secretary of Labor and retail workers employed exclusively during holiday seasons.
PPACA & the Small Employer Penalties DO NOT Apply to Employers with < 50 FTEs Mandates plans must have: $2,000 Max Deductible $6,250 Maximum Out of Pocket No waiting period in excess of 90 days Qualified Health Plan Will be able to purchase group plans through the exchange
A Large Employer = 50+ FTEs Shared Responsibility Penalty (Penalty for not offering health coverage) If an employer fails to provide its full-time equivalent employees “minimum essential coverage,” Employer penalty is $2,000 annually for each full-time equivalent employee in the workforce (in excess of 30). Waiver for penalty for the first 30 FTEs Ex. – 300 FTEs then penalty for 270 FTEs ($540k) Ex. - 100 FTEs then penalty for 70 FTEs ($140k) Ex. – 60 FTEs then penalty for 30 FTEs ($60k) This penalty is non-deductible. Penalty does not offset the cost of employee coverage.
Large Employer Unaffordable Coverage Penalty Assuming an employer offers minimal essential coverage to all FTE employees and dependents When… One or more full-time employees enrolled in an exchange plan and qualifies for a tax credit or subsidy Employee’s share exceeds 9.5% of W2 income Then… Employer Penalty = $3,000 per employee receiving tax credit at the exchange
The Exchanges The only place that tax credits and cost-sharing subsidies will be available. Tax credits to 400% of Federal Poverty Level (FPL) Subsidies to 250% of FPL Tax Credits from 250% to 400% of FPL Medicaid does not entitle an individual to a subsidy or tax credit
2014…Decisions…Decisions Pay or Play? How will this change your business? We can help to answer some big questions for you… 1.Is my plan as it is today in compliance? 2.What is the real net cost of my plan today? 3.What will it cost me if I cancel my plan and send my employees to the exchanges? 4.What penalties am I subject to based on my plan today? 5.How much will it cost me to make the changes necessary to get into compliance?
Chris Gordon (520) 881-5760 office firstname.lastname@example.org Locally Owned and Operated Since 1975 (Mueller Insurance) Employee Benefits Property & Liability Insurance Individual Medical/Life/Disability Bonds Aviation Home and Auto