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An independent licensee of the Blue Cross and Blue Shield Association. U7430b, 2/11 This presentation contains audio. Please make sure your speakers are.

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Presentation on theme: "An independent licensee of the Blue Cross and Blue Shield Association. U7430b, 2/11 This presentation contains audio. Please make sure your speakers are."— Presentation transcript:

1 An independent licensee of the Blue Cross and Blue Shield Association. U7430b, 2/11 This presentation contains audio. Please make sure your speakers are on. Changes and Considerations Small Group ( Under 50 Employees ) Resource Guide

2 Health Care Reform and Employers + Many major provisions take effect in 2014: ▪Individual mandate ▪Exchanges ▪Subsidies + Employers will have many new considerations: ▪Employer mandate: large employers may pay penalties ▪Calculations for determining full-time equivalent employees ▪Some tax credits may be available ▪New reporting requirements 2

3 Calculating FTEs to Determine Employer Size Number of Full-Time* Employees Total Part-time** Hours / 120 Total Full-Time Equivalent Employees (FTEs) *Full-time employees are defined as those who work at least 30 hours per week **Part-time exempts seasonal employees (employed fewer than 120 days)

4 A firm has: 25 full-time employees that work 30+ hours 10 part-time employees who all work 24 hours per week (96 hours per month, per employee) Example These part-time employees’ hours would be treated as equivalent to 8 full-time employees: 10 employees x 96 hours/120 = 1,920/120 = 8 FTEs 25 Full-time + 8 Full-time equivalents = 33 FTEs Meets Requirements of a Small Employer

5 Small Group Exemption + Small businesses with fewer than 50 full-time employees (or equivalent full and part-time employees) are EXEMPT from: ▪Penalties related to the employer mandate provision of the Affordable Care Act (ACA) ▪ACA requirement to offer affordable coverage

6 ≤ 10 Full-Time Employees ≤ 25 Full-Time Employees Maximum Average Annual Wages Up to $25,000Up to $50,000 Percentage of Premium Paid by Employer At least 50% Maximum Potential Credit Up to 35% of employer premium payment (25% for tax exempt firms) Scaled, dependent on average wages & FTEs Maximum Potential Credit 2014 – on Up to 50% of employer premium payment (35% for tax exempt firms) up to 2 years Scaled, dependent on average wages & FTEs Small Business Tax Credits – 25 or Fewer FTEs

7 Calculating Employees and Average Wages for the Small Business Tax Credit Total Number of Hours Paid in Given Year 2080FTEs Total Wages Paid in Given Year FTEs Average Annual Wages

8 BCBSNC Tax Credit Calculator

9 Reporting Requirements Reporting of enrollment in health insurance coverage Self-insured employers, insurers IRS Effective 1/31/2015 Employer requirement to inform employees of coverage option s Employers subject to Fair Labor Standards Act Distributed to Employees TBD – Delayed until future guidance issued Source: Ernst & Young LLP 2012

10 Fees & Assessments + Health Insurer Tax Fee ▪New sales tax on health insurers ▪2014 tax amount = $8 billion ▪2018 tax amount increases to $14.3 billion ▪Tax increased based on premium trend thereafter + Reinsurance Fee ▪Applies to all issuers and self-insured group health plans ▪Fees will fund reinsurance program 2014 – 2016 to stabilize premiums in individual insurance market ▪Proposed annual fee is $63 per enrollee in plan

11 Fees & Assessments, continued + Comparative Effectiveness Research Fee (PCORI) ▪Applies to insurers and self-insured for policies or plan years ending after 9/30/12 thru 10/1/19 ▪Funds research on effectiveness of medical treatments and prescription drugs –FY2013 $1 per covered life –FY2014 $2 per covered life –FY2015 on – indexed + Tax on “High Value Plans” (“Cadillac” Plans) ▪Beginning in 2018 ▪40% excise tax imposed on insurer & self-insured on total annual value of employer-sponsored coverage that exceeds $10,200/single, $27,500/family (value includes employer/employee contributions)

12 Employer Considerations Keeping Coverage Dropping Coverage Medical Trend New ACA Requirements Penalty Replacement Cost Employee perception of value lost

13 Coverage Options Source: Deloitte Consulting LLP: HR Executive Series 7/11/12 ACA Compliant Plan Employer continues offering coverage that is compliant with ACA Defined Contribution Plan Employer provides funding that employee uses to purchase their choice of health insurance Exchange Employer uses Exchange to provide health insurance coverage Small Employers (50 and below) Small Employer 2016 (100 and below) Large Employers in 2017 (State option)

14 Existing Provisions (Already in Effect) Provision Individual Market Small Group Market Large Group Market Self- Insured Grandfathered Children’s Pre- existing Conditions (2010) Yes Does not apply to individual coverage, but applies to all other grandfathered coverage Rescissions (2010)Yes Lifetime Limits (2010)Yes Annual Limits Restrictions (2010) Yes Does not apply to individual coverage, but applies to all other grandfathered coverage Preventive Care (2010) Yes No Age 26 Adult Children (2010) Yes Medical Loss Ratio (2011) Yes NoYes Unreasonable Rate Review (2011) Yes No

15 Future Provisions Provision Individual Market Small Group Market Large Group Market Self- Insured Grandfathered Modified Community Rating (2014) Yes No Essential Health Benefits (2014) Yes No Actuarial Value (2014) Yes Same as Essential Health Benefits No Out of Pocket Maximum (2014) Yes No Annual Limits – eliminated (2014) Yes Does not apply to individual coverage, but applies to all other grandfathered coverage Clinical Trials Coverage (2014) Yes No Employer Mandate (Pay or Play) (2014) No Yes Yes, if applicable large employer Yes

16 Future Provisions Provision Individual Market Small Group Market Large Group Market Self-InsuredGrandfathered High-cost Plan Excise Tax (Cadillac Tax) (2018) NoYes, remitted by issuer Yes, remitted by plan administrator Yes Nondiscrimination rules for insured plans (TBD) NoYes Similar prior requirement No, though self- insured plans must observe prior requirement regardless of grandfather status

17 + ONLY non-grandfathered small group and individual plans must cover + 10 categories 1.Ambulatory patient services 2.Emergency services 3.Hospitalization 4.Maternity and newborn care 5.Mental health and substance use disorder services, including behavioral health treatment 6.Prescription drugs 7.Rehabilitative and habilitative services and devices 8.Laboratory services 9.Preventive and wellness and chronic disease management; and 10. Pediatric services, including oral and vision care Essential Health Benefits

18 + Exchanges and premium tax credits may make individual coverage more affordable for a firm’s employees + Recruitment and retention may be more difficult if employers don’t offer coverage + ACA includes several provisions to help employers establish or continue wellness programs: ▪In 2014, employers are allowed to apply up to a 30 percent premium contribution differential (HHS may raise this to 50%). ▪In 2014, $200 million over a 5 year period will be available for wellness grants for employers with fewer than 100 employees that work 25 hours or more per week. Other Considerations

19 Key Considerations & Next Steps for Employers + Assess impact of health care reform provisions on workforce ▪Do your employees value your company differently, if it doesn’t provide health insurance as a benefit? + Determine applicability of employer penalties ▪Small Employer Groups (fewer than 50 full time employees) are EXEMPT + Consider other financial and tax implications + Assess your current benefit designs + Prepare for complying with tax and other reporting requirements

20 An independent licensee of the Blue Cross and Blue Shield Association. ®, SM Marks of the Blue Cross and Blue Shield Association. SM1 Mark of Blue Cross and Blue Shield of North Carolina. © 2013 BCBSNC. All rights reserved. Thank You! This document is for educational and discussion purposes only and is NOT intended to provide legal advice. This document reflects information gathered to date. Please note that due to the changing nature of health care reform, BCBSNC recommends continued monitoring of legislation and regulations related to the topics contained herein.


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