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Disclaimer Please note that this presentation and any discussion generated from this presentation is for informational purposes only. This should not be construed as legal or tax advice. Please seek a qualified lawyer or tax advisor should you need specific advice.
A Quick Note on Fully Insured Vs. Self Insured Plans
ObamaCare Vs. Affordable Care ActAffordable Care Act What Does The General Public Know?
Employee Vs. Employer Employee Mandate January 1, 2014 Must HAVE coverage Employer Mandate January 1, 2015 Must OFFER coverage
Employee Side- Individual Mandate Individuals must have coverage or pay a penalty ○ Penalty is assessed when you file your personal income tax return and is based on your household income ○ 2014 ranges from $95 per person to $285 per family ○ 2015 ranges from $325 per person to $975 per family ○ 2016 ranges from $695 per person to $2,085 per family How to get coverage Coverage will come from a government run marketplace or their employer’s plan
Employee Side- Marketplaces
Employee Side- Marketplace Rates
Employee Side- Subsidies If you have qualified Employer Coverage, Medicaid or Medicare you won’t qualify $$ Amount Determined at the State level and if Medicaid programs were expanded in that state FL Medicaid WAS NOT expanded Also Based on Income Level, # of Children, Smokers vs. Non-smokers, etc. IRS Reporting Requirements ○ Penalty for false information
Employee Side- Coverage Expansion Young Adults remain on plan until age 26 Insurance cannot drop you when you are sick Prevention against gender discrimination Life-time Limits and Annual Maximums can’t be set Pre-existing Condition Exclusions not allowed Essential Health Benefits defined Free preventative services
Employer Side- Three Tiers Employer Mandate Healthcare must be Offered to all Full Time Employees ○ Defined as anyone regularly working more than 30 hours per week ○ Delayed Until January 1, 2015 Coverage must be Affordable ○ W-2 reporting Coverage must be Essential ○ ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.* ○ https://www.healthcare.gov/glossary/essential-health-benefits/ https://www.healthcare.gov/glossary/essential-health-benefits/
How Do We Pay For This? Taxes, taxes and more taxes Watch out for Fully-Insured Vs. Self-Insured ○ Taxes differ under each type of plan Individual mandate shared responsibility tax ○ Penalty tax if you don’t have coverage Employer taxes ○ PCORI Fee ( )*- $2/covered life- annual ○ Re-Insurance Fee ( ) $5.25/covered life- monthly ○ Cadillac Tax (2018) Excise Tax of 40% on High Value Plans * Fees are funded by ICUBA
Florida Tech Changes Identify Who Is Eligible Healthcare must be offered to ALL FTE’s FTE = anyone that regularly works more than 30 hours per week Starts April 1, 2015 Ensure Plans are Compliant ICUBA plans are certified as Essential and GOLD LEVEL Educate The Employees Controlling Claims Costs, Wellness Programs, What Do We Get For Free ○ Monthly Seminars Coming in 2014 and beyond
Florida Tech Changes Open Enrollment is EARLY January 21 st and January 22 nd ○ Hartley Room from 9:00am - 7:00pm On-line Enrollment January 21 st - February 5 th ○ Computers will be available from 8am-5pm every day in the Human Resources Office ○ Make sure to update your ICUBA online account