Presentation is loading. Please wait.

Presentation is loading. Please wait.

Presented For: AGC State Board of Directors Meeting May 3, 2013 San Francisco, California OBAMACARE IS HERE, NOW WHAT? Julie A. Pace The Cavanagh Law Firm,

Similar presentations


Presentation on theme: "Presented For: AGC State Board of Directors Meeting May 3, 2013 San Francisco, California OBAMACARE IS HERE, NOW WHAT? Julie A. Pace The Cavanagh Law Firm,"— Presentation transcript:

1 Presented For: AGC State Board of Directors Meeting May 3, 2013 San Francisco, California OBAMACARE IS HERE, NOW WHAT? Julie A. Pace The Cavanagh Law Firm, P.A Heidi Nunn-Gilman The Cavanagh Law Firm, P.A Jennifer L. Sellers The Cavanagh Law Firm, P.A

2 Health Care Demographics Julie A. Pace The Cavanagh Law Firm, P.A There are approximately 265 million non-elderly Americans  million w/ employer based coverage (55.8%)  15 million w/ individual private insurance (5.7%)  54.6 million w/ Medicaid or other State (20.5%)  47.9 million are uninsured (18%)  Nearly all elderly covered by Medicare, but still 690,000 uninsured in 2011 The Henry J. Kaiser Family Foundation, The Uninsured, A Primer: Key Facts About Americans Without Insurance Coverage (Oct. 2012) 2

3 The Big Picture Julie A. Pace The Cavanagh Law Firm, P.A Major initiatives effective 2014 Individuals must “enroll or pay” – carry coverage or pay penalties  Individuals will have access to basic health coverage through:  Employer-sponsored group health plans  Individual insurance policies offered through an Exchange  Individual insurance policies offered on private market  Government plan (Medicare, Medicaid, Veterans’ or CHIP) Employers must “pay or play” - offer medical coverage to full-time employees or pay tax penalties Array of Federal subsidies for small businesses and lower income individuals 3

4 Employer Options Julie A. Pace The Cavanagh Law Firm, P.A March 23, 2010-January 1, 2014: Continue coverage that existed as of 3/23/2010 (Grandfathered Plan) Other employer group plan  Insured  Self-funded No coverage Post January 1, 2014: Continue Grandfathered Plan Employer insured group plan Employer self-funded plan Offer Exchange plan (when available) No coverage 4

5 “Grandfathered health plan” is defined as  any group health plan or individual health insurance coverage  in which an individual was enrolled on March 23, 2010 Whether plan is “Grandfathered” is relevant to determining the coverage obligations of the employer and the plans, which may help control costs of grandfathered plans. Grandfathered Health Plan Julie A. Pace The Cavanagh Law Firm, P.A

6 Grandfathered Health Plan “New employees” and their families may enroll in a Grandfathered Health Plan after March 23, 2010 Family members may enroll in Grandfathered Health Plan after March 23,2010, if such enrollment was permitted under the terms in effect as of March 23, 2010 Julie A. Pace The Cavanagh Law Firm, P.A

7 Non-Grandfathered Health Plans Julie A. Pace The Cavanagh Law Firm, P.A Employers may offer health plans other than “grandfathered plans” before and after 2014 All non-grandfathered plans, including self-insured plans, are subject to additional coverage improvement and reporting requirements 7

8 Non-Grandfathered Health Plans Julie A. Pace The Cavanagh Law Firm, P.A Most requirements become effective for plan years after September 23, 2010, unless otherwise noted After January 1, 2014, employer-sponsored coverage must meet minimum coverage and affordability standards to qualify for the pay-or-play exemption 8

9 Collectively Bargained Agreements (CBAs) Julie A. Pace The Cavanagh Law Firm, P.A Insurance reforms do not apply to health coverage maintained pursuant to CBA ratified before the enactment date (3/23/10) until the date on which the last of the CBAs relating to the coverage terminates  Coverage requirements applicable to other Grandfathered Plans, including dependent coverage, do not apply  Any CBA coverage amendment which amends coverage solely to conform to any requirement added by the Act shall not be treated as a termination of such CBA 9

10 Coverage Requirements for Grandfathered and Non- Grandfathered Plans Julie A. Pace The Cavanagh Law Firm, P.A For plan years beginning on or after 9/23/2010:  No pre-existing condition provisions may apply to children < 19  No lifetime limits on essential health benefits and restrictions on annual limits  Regulations set out minimum annual limits through 2014 increasing each year  Plan years after September 23, 2012-December 31, 2013 minimum $2 million annual limits  Total exclusion of essential benefits not prohibited by this rule 10

11 Coverage Requirements for Grandfathered and Non- Grandfathered Plans Julie A. Pace The Cavanagh Law Firm, P.A For plan years beginning on or after 9/23/2010:  Must extend benefits to children up to age 26  Must provide uniform benefits summary information  May not rescind coverage, other than for fraud  May not have “excessive” eligibility waiting period 11

12 Coverage Requirements for Grandfathered and Non- Gathered Plans Julie A. Pace The Cavanagh Law Firm, P.A Post 2014  Pre-existing condition exclusions prohibited for all covered members  No annual dollar value limits on benefits  No eligibility waiting period greater than 90 days 12

13 Additional Coverage Requirements for Non- Grandfathered Plans Julie A. Pace The Cavanagh Law Firm, P.A In addition to the coverage requirements that apply to Grandfathered Plans, beginning with plan years starting 9/23/10 non-Grandfathered coverage must:  Cover preventive health services without cost-sharing requirements  Satisfy mandatory internal and external appeal process requirements  Quality reporting annually to Health & Human Services (HHS) Secretary 13

14 Additional Coverage Requirements for Non- Grandfathered Plans Julie A. Pace The Cavanagh Law Firm, P.A  Insured plans must account for claims/non-claim costs and rebate to enrollees if non-claims costs too high  Non-discrimination based on salary to prevent highly compensated employees from having more generous benefits than other employees  Patient protections  No restriction on selection of pediatrician, primary care physician, OB/GYN  Unrestricted access to coverage for emergency treatment  No prior authorization for obstetric/gynecological care 14

15 Preventive Health Benefits for Non-Grandfathered Plans Julie A. Pace The Cavanagh Law Firm, P.A Health Plan must cover, without any cost-sharing requirements, A & B rated evidence-based items and services currently recommended by U.S. Preventive Services Task Force  Immunizations  Pediatric preventive care and screenings  Women’s health preventive care and screenings including breast cancer screening, mammography  Screenings for high blood pressure, diabetes, high cholesterol etc.  Complete list at healthcare.gov website 15

16 Non-Discrimination Requirements for Non- Grandfathered Plans Julie A. Pace The Cavanagh Law Firm, P.A Self-insured plans already subject to separate non- discrimination provisions (including self-insured Grandfathered Plans) New non-discrimination rules will be “similar” to rules for self-insured plans  Do not go into effect until after final guidance issued Employer plans cannot favor highly compensated employees (HCE) re plan eligibility or benefits 16

17 Non-Discrimination Requirements for Non- Grandfathered Plans Julie A. Pace The Cavanagh Law Firm, P.A HCE is defined as:  One of the five highest paid officers  Top 25% highest paid employee  Shareholder who owns more than 10% of Company stock Does not prohibit offering different benefits to PT versus FT employees 17

18 Non-Discrimination Requirements for Non- Grandfathered Plans Julie A. Pace The Cavanagh Law Firm, P.A Two non-discrimination tests  Eligibility – plan must meet one of the following requirements:  At least 70% of all employees are covered;  At least 70% of all employees are eligible to participate in the plan and at least 80% of eligible benefit are covered; or  A non-discriminatory classification of employees is covered Penalties –  excise tax of $100/day  Civil action to compel it to provide non-discriminatory benefits 18

19 Non-Discrimination Requirements for Non- Grandfathered Plans Julie A. Pace The Cavanagh Law Firm, P.A Potential Strategy Option  It is discriminatory to directly pay higher percentage of premiums for managers than others.  Can provide salary increase to key employees to in recognition of higher premium costs – but cannot tie increase directly to requirement that employee use it to pay insurance premiums  Section 125 “Cafeteria Plan” would allow employees to designate premium payments with before-tax dollars so that increased wages do not increase taxes 19

20 Coverage of Adult Children Julie A. Pace The Cavanagh Law Firm, P.A For plan years after September 23, 2010, insurance plans, including Grandfathered Plans, that provide dependent coverage must:  “Continue to make such coverage available” for an adult child  Until the child (unmarried or married) turns 26 years of age Plans not required to offer dependent coverage  Post-2014 employer plan must offer dependent coverage to avoid “pay or play” penalty Child not required to be a dependent as defined by IRS Not required to cover a child of a child receiving coverage IRC amended to exclude expanded coverage from income tax 20 Julie A. Pace The Cavanagh Law Firm, P.A

21 Coverage of Adult Children For plan years beginning prior to January 1, 2014, Grandfathered health plans only required to provide coverage for older dependent if child is not eligible to enroll in an eligible employer-sponsored health plan other than the parent’s grandfathered plan Post-2014 Grandfathered health plans offering dependent coverage must expand enrollment to all dependents up to 26 Julie A. Pace The Cavanagh Law Firm, P.A

22 Coverage of Adult Children Julie A. Pace The Cavanagh Law Firm, P.A Health plan prohibited from offering dependent health coverage for adult children on different terms, including cost and coverage, than the terms provided for minor children Employers must provide adult children under 26 opportunity to enroll in first plan year on or after 9/23/2010 – so all plans now covered  Provide notice to employees no later than first day of eligibility  Leave enrollment open minimum 30 days

23 Claims and Appeals Procedures for Non- Grandfathered Plans Julie A. Pace The Cavanagh Law Firm, P.A Non-grandfathered health plans must have internal appeals process that:  Allows enrollees to appeal denial of claims or rescission of coverage  Provides enrollees detailed information about grounds for denial of claims or coverage  Notifies employees of their appeal rights  Notices must include certain information required by regs.  Ensure full and fair review of denial  Provides expedited appeals processes in urgent cases –  claimant must be notified of coverage determination (adverse or not) for “urgent care” within 72 hours

24 Claims and Appeals Procedures for Non- Grandfathered Plans Patients will also have the right to appeal some denied claims to independent external review according to state external appeals laws  Claims involving medical judgment  Claims involving rescission of coverage  Claims involving contractual or legal interpretation of contract not subject to external review process States encouraged to adopt processes that meet certain minimum standards – Uniform Health Carrier External Review Model Act If state does not adopt standards, health insurance issuers are required to implement external review processes meeting standards set by HHS Julie A. Pace The Cavanagh Law Firm, P.A

25 Claims and Appeals Procedures for Non- Grandfathered Plans All notices required by appeals procedure must be provided in “culturally and linguistically appropriate manner.”  Required to provide notices in non-English language upon request  Include in English version notice instruction on obtaining notice in non-English language  Provide telephone assistance available in second language Required if 10% or more of population in claimant’s county is literate only in same non- English language Julie A. Pace The Cavanagh Law Firm, P.A

26 Rebates for Excessive Non-Claim Costs Julie A. Pace The Cavanagh Law Firm, P.A PPACA sets maximum Medical Loss Ratio (MLR) Insurance carriers required to spend at least 80% of their premium income on health care claims and quality improvement efforts Large group plans require carrier to spend 85% of premiums on health care claims Does not apply to self-insured plans 26

27 Rebates for Excessive Non-Claim Costs Julie A. Pace The Cavanagh Law Firm, P.A Carrier who do not meet MLR standard required to issue “rebates” to participants  Can be in form of payments to participant or reduction in premiums or the costs of benefit enhancements  Can be paid only to current participants  Portion of refund attributable to employee contributions are considered “plan assets” under ERISA  Portion of rebate attributed to employer contribution may be used to reduce future employer contributions 27

28 Rebates for Excessive Non-Claim Costs Julie A. Pace The Cavanagh Law Firm, P.A Rebate generally taxable to employee if employee paid premium with pre-tax dollars Employers have 90 days from receipt of “rebate” to make distributions Distributions to employees not required to exactly reflect individual premiums paid—  employers allowed to consider the cost to the plan and the ultimate plan benefits as well as the competing interests of participants or classes of participants provided such method is reasonable, fair, and objective.  Could be as simple as evenly dividing between all participants 28

29 Market Reforms January 1, 2014 Julie A. Pace The Cavanagh Law Firm, P.A Effective for plan years after January 1, 2014  Prohibition on discrimination on the basis of health status  Health and Wellness Program safe harbor  Allow incentives of up to 30% of premium (increased from 20%)  Proposed regulations allow additional 20% incentive for programs to reduce or eliminate tobacco usage  Guaranteed availability and renewability (individuals over age 19) – no preexisting condition exclusions  Recall that all plan years on or after preexisting condition exclusions for children under 19 are prohibited  Comprehensive coverage requirements to be established 29

30 Post-2014 Options Julie A. Pace The Cavanagh Law Firm, P.A Continue Grandfather Plan Health Plan through Private Market Not subject to essential benefit requirements Qualified health plan through an Exchange  Exchanges available for small employers beginning 2014  Available for largest of employers beginning 2017  Exchange Plans required to provide essential health benefits 30

31 Max 90-Day Waiting Period for Enrollment Julie A. Pace The Cavanagh Law Firm, P.A PPACA prohibits plans from having more than 90-day waiting period for enrollment Notice provides guidance Waiting period defined as the period that must pass before the coverage for an employee or dependent who is otherwise eligible to enroll under the terms of the plan can become effective. Coverage must be provided within 90 days –  Providing coverage on first day of month after 90 days of employment would violate Act  Requirement satisfied if coverage is offered—even if employee delays enrollment 31

32 Post-2014 Options Any employer or individual may enroll in a health plan offered outside an Exchange (non-qualified health plan)  Subject to State insurance law mandates  May be subject to “pay or play” penalties if plan does not meet affordability and minimum value requirements  Not affordable if employee premium for employee only plan is greater than 9.5% of household income Employer may base analysis on employee’s own W-2 income  Minimum value = covers 60% of costs Julie A. Pace The Cavanagh Law Firm, P.A

33 Post-2014 Options Employer may offer multiple plans and satisfy pay- or-play if one plan meets affordability and minimum value requirements  Can offer plans that do not meet affordability requirements, as long as one plan meets affordability and minimum value  May want one minimum value low cost plan to satisfy requirement to offer affordable minimum value plan and other, richer options can be made available at greater expense to the employee  Affordability analysis is based on lowest cost option offered by employer that meets minimum value requirements Julie A. Pace The Cavanagh Law Firm, P.A

34 Requirement that Individuals Enroll or Pay Fine Julie A. Pace The Cavanagh Law Firm, P.A To avoid a penalty, individuals must have acceptable coverage from one of the following sources:  Employer-sponsored plan (including a grandfathered plan)  An individual policy (purchased through a private insurer or through an Exchange)  Government program (Medicare, Medicaid, Veterans, CHIP) 34

35 Requirement that Individuals Enroll or Pay Fine Julie A. Pace The Cavanagh Law Firm, P.A Those without coverage face the greater of a dollar penalty or a percentage of household income penalty  Dollar penalty equals ½ of the amount listed below for each uninsured dependent under the age of 18  Total dollar penalty for a family is capped at 300% of the individual penalty Penalties (per individual) phased in  2014 $95 or 1.0% Income  2015 $325 or 2.0% Income  2016 (and after) $695 (indexed annually) or 2.5% Income 35

36 Requirement that Individuals Enroll or Pay Fine Julie A. Pace The Cavanagh Law Firm, P.A Certain individuals are exempt from the fine for failing to carry insurance  Individuals who are part of a religion opposed to acceptance of benefits from a health insurance policy  Undocumented immigrants  Incarcerated individuals  Members of an Indian Tribe  Family income is below the threshold required for filing tax return  Insurance would cost more than 8% of income, after taking into consideration all employer contributions or tax credits  Individuals with short term (< 3 months) gap in coverage 36

37 Subsidies for Individuals Julie A. Pace The Cavanagh Law Firm, P.A Modest income individuals (between 100% and 400% of the federal poverty level) are eligible for subsidies to pay premiums Family of % of poverty level is over $92,000 currently and expected to be approximately $95,000 in 2014 Modest income individuals in Exchanges eligible for three subsidies  Limits on amount of income paid for premiums  Cost-sharing (copays, deductibles, etc) limits  Out-of-pocket spending limits 37

38 Subsidies for Individuals Julie A. Pace The Cavanagh Law Firm, P.A Premium subsidy only available for purchase of insurance through Exchange  Available to individuals eligible for employer coverage only if employer coverage is not affordable or does not provide required plan value Subsidy amount based on income and premium for second lowest cost silver plan in exchange for area Subsidy can be calculated and provided in advance and reconciled on tax returns 38

39 Subsidies for Individuals Julie A. Pace The Cavanagh Law Firm, P.A Subsidies available to extent premium exceeds:  Up to 133% FPL - 2% of income  % FPL 3 – 4% of income  % FPL 4 – 6.3% of income  % FPL 6.3 – 8.05% of income  % FPL 8.05 – 9.5% of income  % FPL 9.5% of income 39

40 Employers Pay or Play – 2014 & Beyond Julie A. Pace The Cavanagh Law Firm, P.A Large ERs (=50 FT equivalent EEs)  that do not offer health coverage to employees and dependents and have at least one FT EE who receives premium tax credit must pay a penalty  $2,000 per FT EE (excludes the first 30 EEs)  that do offer health coverage to employees and dependents and have at least one FT EE who receives a premium tax credit because employment-related health coverage does not provide minimum value (covers less than 60% of costs) or is not affordable (EE’s contribution to ER coverage > 9.5% of household income) must pay the lesser of  $3,000 per employee who is receiving a premium tax credit  $2,000 for each FT EE 40

41 Employers Pay or Play Julie A. Pace The Cavanagh Law Firm, P.A To calculate penalty for failure to provide employer sponsored health plan:  Per month - (1/12 x $2000) x (# of FT employees – 30)  Add together each month to obtain annual penalty To calculate penalty based on coverage that is not affordable or does not meet minimum value requirements  Per month – (1/12 x $3,000) x # of full-time employees that receive premium tax credit for insurance through an Exchange  Add together each month to obtain annual penalty Penalty amounts can be adjusted annually for inflation 41

42 Employers Pay or Play Julie A. Pace The Cavanagh Law Firm, P.A For determining whether entity is “large employer” (50 or more FTE) for “pay or play” purposes, employees are:  FT EEs (30 or more hours/week on average)  FT Equivalent Employees (total monthly part-time hours / 120)  Calculate the number of FT and FT Equivalent employees for the prior calendar year—if 50 or more the employer is subject to the “pay or play” rules  Calculate the number of FTEs each month. Add together and divide by 12 to get annual total.  Include fractions in monthly totals. In yearly total disregard fractions. (49.8 would be 49) 42

43 Employers Pay or Play Julie A. Pace The Cavanagh Law Firm, P.A IRS has proposed transitional relief for 2014 for employers to determine status as “large employer” Employer may determine its status as “large employer” by reference looking at six month consecutive period in 2013 calendar year (as opposed to entire 2013 calendar year) E.g. can use period from April 1 to September 30 to determine if employed 50 or more FTEs and period from October 1 to December 31 to make adjustments to comply with PPACA, if necessary. 43

44 Employers Pay or Play Julie A. Pace The Cavanagh Law Firm, P.A If company not in business during preceding calendar year but took over existing business, proposed regs require that predecessor employer be considered in determining with entity is covered “large employer” If company not in business for preceding calendar year, the employer will be considered a “large employer” if it is reasonably expected to employee 50 or more FTEs during the current calendar year 44

45 Employers Pay or Play Julie A. Pace The Cavanagh Law Firm, P.A Seasonal Worker Exception – exception to “large employer” status for companies only covered due to seasonal workforce Available if the FT employees plus FT equivalents are greater than 50 for less than 120 days or 4 months (not required to be consecutive) and the excess over 50 are seasonal workers Seasonal workers – performs work that is ordinarily performed at certain seasons or period of the year and which, from its nature, may not be continuous or carried out throughout the year  E.g. agricultural, holiday retail sales, etc.  Employers can use “reasonable good faith interpretation” until more guidance issued. Not available if non-seasonal workforce is 50 or more in any month 45

46 Employers Pay or Play Julie A. Pace The Cavanagh Law Firm, P.A To qualify under “pay or play” employer-sponsored health plan must provide minimum essential coverage Employer must offer coverage to “dependents”  Dependents include children up to age 26  Dependent does not include spouse  Employer can require employee to pay 100% of coverage for dependents 46

47 Employers Pay or Play Julie A. Pace The Cavanagh Law Firm, P.A Small ERs (< 50 FT equivalent EEs) are exempt from “pay or play” penalties Group health plans offered by small employers exempt from “pay or play” must still meet all of the coverage improvements and market reforms of the Affordable Care Act 47

48 Employers Pay or Play Julie A. Pace The Cavanagh Law Firm, P.A In counting employees to determine coverage under the Act, the Act applies IRS and ERISA controlled group principles  Parent, brother, and sister companies can be counted as one company, depending on how the business are owned and arranged IRS proposed regulations would apply the penalty separately to each member of controlled group The 30-employee reduction of full-time employees for penalty is allocated among the members of the controlled group on basis of number of employees employed by each entity in the controller group 48

49 Employers Pay or Play Julie A. Pace The Cavanagh Law Firm, P.A ER assessments are not tax deductible Law originally required ERs to offer vouchers for EE at less than 400% of federal poverty level who choose Exchange, but provisions was repealed on April 15, 2011 in 2011 budget bill 49

50 Proposed Regulations re Transition Period IRS proposed regulations on 12/27/12 for transition period to allow employers easier transition If before 12/27/12 employer had non-calendar plan year, no penalty due for 2014 as long as offer coverage by first day of 2014 plan year (rather than 1/1/14) Large employer on calendar plan year can use six months of 2013 as look-back/measurement period to determine status of full-time employees & have 12 month stability period Julie A. Pace The Cavanagh Law Firm, P.A

51 Incentives for Small Employers to Provide EE Benefits Julie A. Pace The Cavanagh Law Firm, P.A ER criteria for tax credits  ER must pay at least 50% of EE health care coverage  ER must have no more than 25 FT Equivalent EEs  Maximum credit for ERs with 10 or fewer FT Equivalent EEs  ER must pay average wage < $50K/year  Maximum credit available for ERs that pay average wage < $25,000 Amount of tax credits  Phase I ( )  Credit up to 35% of ER contribution toward EE’s health insurance premium  Phase II (2014 and later)  Credit up to 50% of ER contribution toward EE’s health insurance premium Tax exempt entities are eligible for FICA credits 51

52 Determining Full-Time Employees For Required Health Coverage Julie A. Pace The Cavanagh Law Firm, P.A Employers are subject to a penalty only for full-time employees who are not offered minimum essential coverage, so it is imperative to understand who is considered full-time An employee is full-time under the PPACA for months in which the employee averages 30 “hours of service” per week.  IRS regulations propose that 130 hour per month be considered full time. No obligation to cover part-time or leased employees No obligation to cover independent contractors  Must truly be independent contractor  In proposed regulations, employment relationship determined under common-law control test 52

53 Determining Full-Time Employees For Required Health Coverage Julie A. Pace The Cavanagh Law Firm, P.A “Hours of Service” include both:  Hours for which the employee is paid or entitled to be paid for services rendered for employer AND  Each hour for which an employee is paid or entitled to be paid by the employer for time period in which no duties are performed due to vacation, holiday, illness, disability, or other leaves of absence  Periods of special “unpaid leave” such as FMLA leave, leave for military duty, or leave for jury duty cannot be counted against an employee to reduce his or her average hours of service An employer may use different methods of calculating hours for different employees if the classifications are reasonable and consistently applies 53

54 Determining Full-Time Employees For Required Health Coverage – Rehired Employees Julie A. Pace The Cavanagh Law Firm, P.A If employee is rehired or returns from unpaid leave or are rehired after a break of at least 26 weeks, the employer may treat them as a new employee Employer may adopt “parity rule” for breaks in employment (leave or separation) of less than 26 weeks  An individual can be treated as a new employee if the period of the break in employment is at least four weeks long and is longer than the employee’s period of employment preceding the break in service was shorter than the break in service  For example, employee worked for six weeks, did not work for employer for a period of 12 weeks, then returned to employer. The employee can be treated as a new employee because the break in service is longer than the amount of time that the individual was originally employed. 54

55 Determining Full-Time Employees For Required Health Coverage – Rehired Employees Julie A. Pace The Cavanagh Law Firm, P.A Rehire rule applies only for purposes of determining full-time status under the look-back/measurement calculations If person does not qualify as new employee under this rule, then they are considered a continuing employee and the measurement and stability period that would have applied if the employee had not had a break in service will apply upon the employee’s resumption of service 55

56 Determining Full-Time Employees For Required Health Coverage – IRS Safe Harbor Julie A. Pace The Cavanagh Law Firm, P.A IRS proposed “Safe Harbor” for determining whether variable hour employees are “full-time employees” for which the large employer must pay a penalty if it does not provide adequate employer-sponsored coverage Safe harbor is not required method of calculating whether employees are full-time, but other methods may be challenged by IRS or other and employees reclassified as full-time if employer method disapproved by IRS 56

57 Determining Full-Time Employees For Required Health Coverage – IRS Safe Harbor Key Terms Julie A. Pace The Cavanagh Law Firm, P.A We will define several terms relating to the IRS Safe Harbor with which employers should become familiar  Variable Hour Employee  Standard Measurement Period (sometimes referred to as “look back” period)  Stability Period  Administrative Period  Initial Measurement Period 57

58 Determining Full-Time Employees For Required Health Coverage-Existing Employees Standard Measurement Period Julie A. Pace The Cavanagh Law Firm, P.A Existing variable hour employees (those who cannot be determined whether will work average of 30 hours per week or more)  Employer may select “standard measurement period” (look back) of no less than three and no more than 12 months  Standard measurement period is fixed calendar period, e.g. January 1 to December 31 or January 1 to June 30 and July 1 to December 31  Employer determines average hours worked per week by dividing the total hours worked during the standard measurement period by the total number of weeks in the standard measurement period If employees hours of service = 30 hours per week or more (or 130 hours per month under IRS proposal), then the individual is considered FULL-TIME for the “stability period”. If less than 30 hours per week, then employee is PART-TIME for stability period. 58

59 Determining Full-Time Employees For Required Health Coverage-Existing Employees Standard Measurement Period Julie A. Pace The Cavanagh Law Firm, P.A Existing variable hour employees (those who cannot be determined whether will work average of 30 hours per week or more)  Employer may select “standard measurement period” (look back) of no less than three and no more than 12 months  Standard measurement period is fixed calendar period, e.g. January 1 to December 31 or January 1 to June 30 and July 1 to December 31  Employer determines average hours worked per week by dividing the total hours worked during the standard measurement period by the total number of weeks in the standard measurement period If employees hours of service = 3o hours per week or more (or 130 hours per month under IRS proposal), then the individual is considered FULL-TIME for the “stability period”. If less than 30 hours per week, then employee is PART-TIME for stability period. 59

60 Determining Full-Time Employees For Required Health Coverage-Existing Employees – Stability Period Julie A. Pace The Cavanagh Law Firm, P.A “Stability Period” must be equal to the standard measurement period, but cannot be less than six months. Person considered “full-time” is required to be covered by employer insurance coverage (or employer must pay penalty), for the entire subsequent stability period, regardless of the hours actually worked. Person found to be “part-time” is not required to be covered by employer insurance (and no penalty) for the entire subsequent stability period, regardless of hours actually worked (unless employment changed, e.g.. became fixed 40- hour employee). 60

61 Determining Full-Time Employees For Required Health Coverage—Existing Employees Example Julie A. Pace The Cavanagh Law Firm, P.A EXAMPLE: Company A elects to have a 12-month standard measurement period, from November 1, 2012 to October 31, For each employee, the Company must take the total hours of service and divide by 52 weeks. The employees determined to be full-time by working an average of 30 hours per week (or 130 hours per month), must be provided with health insurance for the stability period of January 1, 2014 to December 31, 2014, regardless of the hours worked by the employee in The employees determined not to be full-time (work less than 30 hours per week or 130 hours per month), are not required to be provided health insurance (and employer not liable for a penalty) for the stability period of January 1, 2015 to December 31, 2015, regardless of the hours worked (unless the employee actually obtains some type of full-time status). 61

62 Determining Full-Time Employees For Required Health Coverage—Existing Employees Administrative Period Julie A. Pace The Cavanagh Law Firm, P.A Employers are permitted to have an “administrative period” of no more than 90 days (NOT 3 months) between the “standard measurement period” and the related “stability period” to allow the employer to determine which employees are eligible for coverage and to enroll employees  To avoid gaps in coverage, the administrative period must overlap with the previous stability period  Example: Standard measurement period of November 1 to following October 31 Administrative period of November 1 to December 31 Stability period of January 1 to December 31 62

63 Determining Full-Time Employees For Required Health Coverage – IRS Proposed Transition Method Julie A. Pace The Cavanagh Law Firm, P.A IRS proposed regulations would allow employer who wants to use a 12- month standard measurement period and stability period to use a shorter period (no less than six months) in 2013 for determining 2014 coverage 2013 standard measurement period must be at less 6 months long, start no later than July 1, 2013, and end no earlier than 90-days before the first plan year beginning on or after January 1, 2014  Employers using full 12 month measurement period to determine 2014 eligibility are not subject to these requirements Employers likely need 2-3 months administrative time, so should be planning for a 6-month standard measurement period in 2013 that begins in April or May 63

64 Determining Full-Time Employees For Required Health Coverage—Differing Measurement Periods Julie A. Pace The Cavanagh Law Firm, P.A An employer may use stability and standard measurement periods that are differ in length or in their starting or ending dates for:  Collectively bargaining employees versus non-collectively bargained employees;  Salaried employees versus hourly employees.  Employees of different entities.  Employees located in different states. 64

65 Determining Full-Time Employees For Required Health Coverage—New Employees Julie A. Pace The Cavanagh Law Firm, P.A If employee is reasonably expected at time of hire to work an average of 30 hours or more per week, they are full-time at the point of hire If it is not reasonably determinable at time of hire whether employee will work average of 30 hours or more per week at time of hire, they are variable hour employee 65

66 Determining Full-Time Employees For Required Health Coverage—New Employees Initial Measurement Period Julie A. Pace The Cavanagh Law Firm, P.A Employer selects “Initial Measurement Period” of no less than three months and no more than twelve months No insurance requirement for the “initial measurement period” plus administrative period of no more than 90 days, but the total of the initial measurement period and administrative period cannot extend beyond the last day of the first full calendar month beginning on or after the employee’s first anniversary of employment.  E.g. employee hired January 5, 2014—insurance must be provided if employee eligible by March 1, 2015  Allows employer selecting 12-month measurement period to forego coverage for new variable hour employee for up to 13+ months 66

67 Determining Full-Time Employees For Required Health Coverage—New Employees Overlapping Standard Measurement Period Julie A. Pace The Cavanagh Law Firm, P.A Employer must include a new employee in the standard measurement period with ongoing employees for the first full standard measurement period that begins after the employee start date. For example, if an employee is hired on March 10, 2014 and the employers standard measurement period is January 1 to December 31, the employee would be included in the standard measurement period that begins January 1, New employee who is full-time based on initial measurement period must be treated as FT for the related stability period, even if the employee is determined to be part-time based on overlapping standard measurement period Employee determined not to be full-time based on initial measurement period but determined to be full-time based on overlapping standard measurement period must be treated as full-time employee during the stability period associated with the standard measurement period 67

68 Determining Full-Time Employees For Required Health Coverage—IRS Examples Julie A. Pace The Cavanagh Law Firm, P.A Example 1. Facts. The employer uses a standard measurement period of 12 months beginning on October 15 and a stability period of 12- months beginning January 1. For new variable hour employees, Employer B uses a 12-month initial measurement period that begins on the start date and applies an administrative period from the end of the initial measurement period through the end of the first calendar month beginning on or after the end of the initial measurement period. Employer B hires Employee Y on May 10, Employee Y’s initial measurement period runs from May 10, 2014, through May 9, Employee Y works an average of 30 hours per week during this initial measurement period. Employer B offers coverage to Employee Y for a stability period that runs from July 1, 2015 through June 30,

69 Determining Full-Time Employees For Required Health Coverage—IRS Examples Julie A. Pace The Cavanagh Law Firm, P.A Conclusion. Employee Y works an average of 30 hours per week during his initial measurement period and Employer B uses (1) an initial measurement period that does not exceed 12 months; (2) an administrative period totaling not more than 90 days; and (3) a combined initial measurement period and administrative period that does not last beyond the final day of the first calendar month beginning on or after the one-year anniversary of Employee Y’s start date. Accordingly, from Employee Y’s start date through June 30, 2016, Employer B is not subject to any payment under § 4980H [the Affordable Care Act] with respect to Employee Y, because Employer B complies with the standards for the initial measurement period and stability periods for a new variable hour employee. Employer B must test Employee Y again based on the period from October 15, 2014 through October 14, 2015 (Employer B’s first standard measurement period that begins after Employee Y’s start date). 69

70 Determining Full-Time Employees For Required Health Coverage—IRS Examples Julie A. Pace The Cavanagh Law Firm, P.A Example 2 Facts. Same as Example 1, except that Employer B uses an 11-month initial measurement period that begins on the start date and applies an administrative period from the end of the initial measurement period until the end of the second calendar month beginning after the end of the initial measurement period. Employer B hires Employee Y on May 10, Employee Y’s initial measurement period runs from May 10, 2014, through April 9, Employee Y works an average of 30 hours per week during this initial measurement period. Employer B offers coverage to Employee Y for a stability period that runs from July 1, 2015 through June 30, Conclusion. Same as previous example. 70

71 Determining Full-Time Employees For Required Health Coverage—IRS Examples Julie A. Pace The Cavanagh Law Firm, P.A Example 3 Facts. Same as Example 1, except that Employee Y works an average of 28 hours per week during the period from May 10, 2014 through May 9, 2015 and Employer B does not offer coverage to Employee Y in Employer B tests Employee Y again based on Employee Y’s hours from October 15, 2014 through October 14, 2015 (Employer B’s first standard measurement period that begins after Employee Y’s start date). Conclusion. From Employee Y’s start date through the end of 2015, Employer B is not subject to any payment under § 4980H [the Affordable Care Act], because Employer B complies with the standards for the measurement and stability periods for a new variable hour employee with respect to Employee Y. 71

72 Determining Full-Time Employees For Required Health Coverage—IRS Examples Julie A. Pace The Cavanagh Law Firm, P.A Example 4 Facts: Employer uses a six-month standard measurement period, starting each May 15 and November 15, with six-month stability periods associated with those standard measurement periods starting January 1 and July 1. For new variable hour employees, Employer C uses a six month initial measurement period that begins on the start date and applies an administrative period that runs from the end of the initial measurement period through the end of the first full calendar month beginning after the end of the initial measurement period. Employer C hires Employee Z on May 10, Employee Z’s initial measurement period runs from May 10, 2014, through November 9, 2014, during which Employee Z works an average of 30 hours per week. Employer C offers coverage to Employee Z for a stability period that runs from January 1, 2015 through June 30,

73 Determining Full-Time Employees For Required Health Coverage—IRS Examples Julie A. Pace The Cavanagh Law Firm, P.A Conclusion. Employer C uses (1) an initial measurement period that does not exceed 12 months; (2) an administrative period totaling not more than 90 days; and (3) a combined initial measurement period and administrative period that does not last longer than the final day of the first calendar month beginning on or after the one-year anniversary of Employee Z’s start date. From Employee Z’s start date through June 30, 2015, Employer C is not subject to any payment under § 4980H [the Affordable Care Act], because Employer C complies with the standards for the measurement and stability periods for a new variable hour employee with respect to Employee Z. Employer C must test Employee Z again based on Employee Z’s hours during the period from November 15, 2014 through May 14, 2015 (Employer C’s first standard measurement period that begins after Employee Z’s start date). 73

74 Determining Full-Time Employees For Required Health Coverage—IRS Examples Julie A. Pace The Cavanagh Law Firm, P.A Example 5 Facts. Same as Example 4; in addition, Employer C tests Employee Z again based on Employee Z’s hours during the period from November 15, 2014 through May 14, 2015 (Employer C’s first standard measurement period that begins after Employee Z’s start date), during which period Employee Z works an average of 28 hours per week. Employer C continues to offer coverage to Employee Z through June 30, 2015 (the end of the initial stability period based on the initial measurement period during which Employer C worked an average of 30 hours per week), but does not offer coverage to Employee Z from July 1, 2015 through December 31, (ii) Conclusion. Employer C is not subject to any payment under § 4980H [the Affordable Care Act] with respect to Employee Z for

75 Determining Full-Time Employees For Required Health Coverage—2014 Transition Rule Julie A. Pace The Cavanagh Law Firm, P.A IRS proposed rules providing for transition rule for 2014 Solely for purposes of 2014 stability period, employers may select a stability period of 12 months and a shorter measurement period if:  measurement period is not less than six months  measurement period begins no later than July 1, 2013  measurement period ends no earlier than 90 days before the first day of the plan year beginning on or after January 1, 2014  Ex: Employer with fiscal year plan beginning April 1 could use measurement period of July 1, 2013 to December 31, 2013 and administrative period ending March 31,

76 Determining Full-Time Employees For Required Health Coverage—Employer Considerations Julie A. Pace The Cavanagh Law Firm, P.A Composition of workforce – whether more stable full-time or more variable hour employees – should be considered in determining standard measurement period and stability period. Rate of turnover may influence standard measurement period  12 month standard measurement likely better for industries with many variable hour employees and high turnover Size of workforce may influence administrative period— larger workforce may require longer administrative period 76

77 Proposed Substantial Compliance Provision Julie A. Pace The Cavanagh Law Firm, P.A IRS released proposed regulations on the employer pay-or- play requirements on December 28, 2012 Generally follows guidance previously issued regarding calculating full-time employees Proposed regulations add a potential “substantial compliance” provision  Employers satisfy the pay-or-play requirements if they offer minimum essential coverage to 95% of their full-time employees, i.e. no more than 5% of full-time employees (or no more than 5 employees if 5 is greater than 5%) are not offered affordable minimum essential coverage  This would allow employers some room for error when calculating full- time employees 77

78 IRS Proposed Anti-Abuse Rule Julie A. Pace The Cavanagh Law Firm, P.A Would impose penalty on employers who attempt to structure their workforce to avoid being covered by ACA “pay or play” requirements  For example, employer hires employees directly for 20 hours per week and leases employees through leasing Company for 20 hours per week If worker performs same services directly for the employer and through an employee leasing company, then all hours are attributed to the employer for purposes of the “pay or play” penalty If employee provides services to the same employer through two or more employee leasing companies, all hours are attributed to the client employer if employer controls work 78

79 Minimum Value of Employer-Sponsored Plan Julie A. Pace The Cavanagh Law Firm, P.A Employer plan must provide “minimum value” to avoid “pay or play” penalties. Actuarial value must be at least 60%. Actuarial value of a health plan is the measure of the percentage of health care costs that the plan is expected to cover.  HHS study found 98% of individuals currently covered by employer plan are in plan with actuarial value in excess of 60% IRS Notice – Requests comments on various approaches to determining whether employer health plan provides “minimum value” of 60% of costs 79

80 Minimum Value of Employer-Sponsored Plan Julie A. Pace The Cavanagh Law Firm, P.A IRS Notice – Proposals for determining actuarial value  Actuarial value calculator (“AV Calculator”) or minimum value calculator (“MV Calculator”) provided by HHS and Treasury Department – ER input information  Safe harbor checklists that do not use calculations or assistance of actuary  For plans with non-standard features that makes use of AV calculator or MV calculator impossible, the certification of a certified actuary Actuarial value could be based on four core categories:  Physician and mid-level practitioner care  Hospital and emergency room services  Pharmacy benefits  Laboratory and imaging services 80

81 Affordability Safe Harbor Julie A. Pace The Cavanagh Law Firm, P.A PPACA generally requires employer to pay tax penalty if full-time employee receives federal subsidy because the employer coverage is either not affordable or does not provide minimum value Coverage is affordable if the employee’s required contribution to the plan does not exceed 9.5% of the employee’s household income Household income = modified adjusted gross income of employee and any member of employee’s family 81

82 Affordability Safe Harbor Julie A. Pace The Cavanagh Law Firm, P.A Employer not necessarily aware of employee’s household income, so may not be able to determine if coverage offered is affordable IRS proposes safe harbor where affordability of employer coverage is satisfied if the premium meets one of the following:  W-2 Safe Harbor – EE’s annual premium contribution does not exceed 9.5% of EE’s wages reported in box 1 of W-2  Rate of Pay Safe Harbor – EE’s monthly premium contribution does not exceed 9.5% of EE’s hourly rate of pay x 130 or (for salaried EE) their monthly salary  Federal Poverty Limit (FPL) Safe Harbor – EE’s annual premium contribution does not exceed 9.5% of federal poverty level 82

83 Union/Multiemployer Plans After 2014 Julie A. Pace The Cavanagh Law Firm, P.A Definition of multi-employer plan  Plan that is maintained pursuant to a collective bargaining agreement and has a joint board of trustees that represents the employees and employers. Government has requested comments on how the “pay or play” requirements should apply to employers in multi- employer plans 83

84 Union/Multiemployer Plans After 2014 Julie A. Pace The Cavanagh Law Firm, P.A Safe Harbor – employer in union plan will not be treated as having failed to offer coverage if:  The employer is required by a CBA to make contributions to a multi- employer plan for the employee  Coverage under the multiemployer plan is offered to the full-time employees  The coverage offered to the employees meets the affordability and minimum value standards The multiemployer plan must comply with the 90-day limitation on waiting period 84

85 What is a Health Care Exchange? Julie A. Pace The Cavanagh Law Firm, P.A A marketplace of health insurance issuers (traditional, for-profit insurance companies and non-profit cooperatives) that will offer QHPs to individuals/small ERs  Exchanges will be operational by January 1, 2014 for individuals and small employers  Open enrollment set to start October 1, 2013  “Small employer” defined by the State for state exchange  Large employers (100 or more employees) may be eligible to purchase coverage through Exchanges in

86 Who Creates an Exchange? Each state must create an Exchange (funded by $6 billion in federal grants) Establish one or more state or regional Exchange Partner with the federal government to create Exchange Merge with other state Exchanges Exchange must be a government agency (existing or new) or non-profit established by the state If state does not create exchange, federal government create exchange for the state Julie A. Pace The Cavanagh Law Firm, P.A

87 Who Creates an Exchange? States wishing to create Exchange required to obtain approval from HHS States required to disclose their plans to HHS by December 14, 2012  17 states plus DC are pursing State-created Exchange  7 states are pursuing a state/federal partnership  26 states do not intend to create state exchange Julie A. Pace The Cavanagh Law Firm, P.A

88 What is the Goal of an Exchange? Enhance consumer choice Creation of single risk pools “Apples to apples” comparison of health insurance coverage Create competition for customers on equal terms to lower premiums Julie A. Pace The Cavanagh Law Firm, P.A

89 What are the Features of an Exchange? Julie A. Pace The Cavanagh Law Firm, P.A Issuers must be certified by the Exchange Issuers must offer at least one silver plan and one gold plan Issuers must agree to charge the same rates whether plan is sold in Exchange or outside of the Exchange Rating system based on quality and price 89

90 Additional Features of an Exchange Enrollee satisfaction system Insurers barred from basing premiums on health status, gender and other factors. Premiums may vary based on age, with the spread constrained to a 3:1 ratio, and based on tobacco use up to a 1.5:1 ratio. Premiums may also vary by geographic area and family size Each plan must offer “essential benefits” Julie A. Pace The Cavanagh Law Firm, P.A

91 Multi-tier Exchange with Different Levels of Coverage Julie A. Pace The Cavanagh Law Firm, P.A  Every tier covers essential benefits  % of covered benefits costs ranges 60% to 100%  Out-of-Pocket limit for all tiers capped at $6,250 (individual)/$ 12,500 (family) (indexed annually)  Tiers labeled Bronze, Silver, Gold, Platinum, and Catastrophic  Bronze = covers 60% of full value of plan benefits  Silver = 70%  Gold = 80%  Platinum = 90%  Catastrophic = minimum plan available to people under 30 or otherwise exempt from pay or plan mandate 91

92 Exchanges – Essential Benefits Essential benefits include  Ambulatory patient services  Emergency services  Hospitalization  Maternity and newborn care  Mental health and substance abuse  Prescription drugs  Rehabilitative and habilitative services and devices  Laboratory services  Preventative and wellness services  Pediatric services, including oral and vision care Julie A. Pace The Cavanagh Law Firm, P.A

93 Exchanges – Essential Benefits Essential benefits include  Ambulatory patient services  Emergency services  Hospitalization  Maternity and newborn care  Mental health and substance abuse  Prescription drugs  Rehabilitative and habilitative services and devices  Laboratory services  Preventative and wellness services  Pediatric services, including oral and vision care Julie A. Pace The Cavanagh Law Firm, P.A

94 Excise Tax on “Cadillac Plans” Julie A. Pace The Cavanagh Law Firm, P.A Cadillac Plan is any plan whose costs, i.e. premiums exceed established threshold  Premium of $10,200/year for single-only coverage (as adjusted annually)  Premium of $27,500/year for family coverage (as adjusted annually)  For qualified retirees and those in high-risk jobs threshold is $11,850/$30,950 (as adjusted annually)  High risk professions include firefighters, police, and miners 94

95 Excise Tax on “Cadillac Plans” Tax = 40% of “excess benefit”  Excess benefit is the aggregate value of the health plan in excess of the established threshold Paid by “coverage provider,” i.e. insurance company for insured plans and employer for self-funded plans Effective January 1, 2018 Julie A. Pace The Cavanagh Law Firm, P.A

96 Retiree Provisions – Medicare Part D Julie A. Pace The Cavanagh Law Firm, P.A Medicare Part D  No ER deduction for retiree drug subsidy beginning 2013  Closing the “Donut Hole” on prescription coverage  The “Donut Hole” is the amount Medicare enrollees spend on prescriptions after exceeding the coverage limit but before reaching a level that qualifies them for catastrophic coverage 96

97 Retiree Provisions – ER Subsidies Subsidy for group plans providing medical coverage to early retirees (55-64) and their spouses  Applies June 1, 2010 to January 1, 2014  Plan sponsor must apply to Health and Human Services and HHS must certify plan before ER eligible for subsidy  Plan sponsor eligible for reimbursement of 80% of claims by retiree and family between $15,000 and $90,000 Julie A. Pace The Cavanagh Law Firm, P.A

98 HSA/FSA Changes Julie A. Pace The Cavanagh Law Firm, P.A Effective January , most over the counter medications and drugs not covered by FSA/HRA/HSA unless individual has a prescription  Medical devices and supplies that are not medications continue to be covered  Insulin continues to be covered without prescription Beginning for plan years starting January 1, 2013, or later, FSA contributions will be limited to $2,500  IRS reconsidering use-it-or-lose it for FSA Excise tax on non-medical HSA distributions increased from 10% to 20% 98

99 Notice to Employees Julie A. Pace The Cavanagh Law Firm, P.A Employers subject to FLSA must provide written notice to current and new employees  Identify the Exchange and how to contact  If employer’s health plan is not sufficiently valuable, notify of the existence of premium subsidies and cost-sharing reductions  If the employee enrolls in an Exchange plan, indicate that the employee may lose any employer subsidy in the employer plan  Effective date originally March 13, 2013 – delayed until further regulations or guidance issued 99

100 Notice to Employees Julie A. Pace The Cavanagh Law Firm, P.A Summary of Benefits and Coverage  Required beginning in plans years starting on or after September 23, 2012  Must contain minimum information regarding health plan benefits and coverage identified in regulations  DOL EBSA has created template for notice to be customized by employer/plan 100

101 Auto Enrollment Julie A. Pace The Cavanagh Law Firm, P.A Large employers (200+ FTEs) must automatically enroll new employees in the lowest cost health plan when the employee becomes eligible if the employer offers a health plan Employees may opt out; advance notice of enrollment and opt out is required Not effective until after regulations are issued by DOL  DOL does not expect to have regulations finalized by

102 Taxes on High Income Individuals Julie A. Pace The Cavanagh Law Firm, P.A Increases the health insurance (HI-Medicare) portion of the FICA tax from 1.45% to 2.35% on wages in excess of $200,000 ($250,000 for a joint return, $150,000 for married filing single) Additional 3.8% tax on lesser of:  net investment income (interest, dividends, royalties, rents, passive income)  Modified adjusted gross income in excess of $200,000 ($250,000 for a joint return, $150,000 for married filing singly) Both provisions are effective on January 1,

103 Taxes on High Income Individuals Julie A. Pace The Cavanagh Law Firm, P.A No employer match on the 0.9% increase in HI (Medicare) Tax that applies January 1, 2013 Individuals are liable for additional tax if earning $200,000 filing singly or $250,000 married filing jointly Additional tax is only on the income earned above the threshold 103

104 Additional Medicare Taxes on High Income Individuals Julie A. Pace The Cavanagh Law Firm, P.A Employer must withhold if it pays individual more than $200,000, regardless of individual's filing status Employees whose have additional Medicare tax withheld from pay but do not owe tax due to filing status can obtain refund from federal government Employer cannot honor request not to withhold additional Medicare tax Employer who does not withhold is liable for tax if employee does not pay it IRS proposed regulations to allow employers to correct errors in withholding 104

105 W-2 Reporting Requirements Julie A. Pace The Cavanagh Law Firm, P.A Employers required to report the total cost of the health insurance plan they sponsor on the employee’s W-2  Includes the employer and employee contribution  Informs employees of cost of their health care  Does not make benefit taxable income Large employers required to report on 2012 W-2 (provided to employees in 2013) Small employers (fewer than 250 employees) not required to comply with requirements until 2014 or until further guidance is issued

106 Employer Action Items Julie A. Pace The Cavanagh Law Firm, P.A Determine if your company has 50 full time employees under the full time employee equivalent test Consider budgets, and whether it would make more sense to discontinue offering group health plans and pay the penalty for all full time employees if a single employee decides to obtain health insurance either through private insurance or an exchange and receives a tax credit. If the company intends to continue to provide a grandfathered plan, talk to the company’s current insurer to ensure that any plan modifications comply with new requirements. 106

107 Employer Action Items Julie A. Pace The Cavanagh Law Firm, P.A Consider offering different plans with different levels of benefits with each plan providing minimum essential coverage and the least expensive plan being affordable under the affordability test. Review and update plan document and summary plan description as necessary. Review and update FSA and HSA plan documents as necessary. Review and update handbook policies 107

108 Employer Action Items Julie A. Pace The Cavanagh Law Firm, P.A Develop talking points for meetings with employees to discuss health benefit options. Develop a waiver form for any employees who decide not to participate in the company's sponsored health insurance. 108

109 Handbook & Plan Document Revisions Julie A. Pace The Cavanagh Law Firm, P.A Define full-time and part-time in handbook Define variable hour employee Review benefits policies, Summary Plan Descriptions and Plan Documents to determine if new definitions needed 109

110 Plan Amendments Julie A. Pace The Cavanagh Law Firm, P.A Complying with certain provisions of the Affordable Care Act may require amendments to current health plans. Employers should work with counsel and insurance companies to ensure plan and plan documents comply with Affordable Care Act requirements 110

111 QUESTIONS?? Julie A. Pace The Cavanagh Law Firm, P.A Julie A. Pace The Cavanagh Law Firm, P.A Heidi Nunn-Gilman The Cavanagh Law Firm, P.A Jennifer L. Sellers The Cavanagh Law Firm, P.A

112 Julie A. Pace The Cavanagh Law Firm, P.A Julie A. Pace The Cavanagh Law Firm, P.A Julie Pace has been interviewed and quoted on immigration and employment law in news media across the nation, including ABA Journal, Forbes, Wall Street Journal, Business Week, The New York Times, CNN, NPR, Associated Press, USA Today, L.A. Times, CBS News, Fox News, and Arizona publications. Ms. Pace is a frequent speaker and author on a variety of employment topics. She is Co-Editor-in-Chief of three books on immigration and employment law -- Employment Verification: An Employer's Guide to Immigration, Form I-9 and E- Verify; Arizona Human Resources Manual; Model Policies and Forms for Arizona Employers, all published by American Chamber of Commerce and Industry HR Compliance Library. Ms. Pace is a recipient of Arizona Business Magazine’s 2008 Centers of Influence Award, which recognizes the ten leading attorneys, accountants, and bankers in Arizona. Ms. Pace is also a Fellow of the Litigation Counsel of America. She has served as Judge Pro Tem for the Arizona Court of Appeals and is a former judicial law clerk to the Honorable Joe W. Contreras of the Arizona State Court of Appeals. Ms. Pace is a fourth generation Arizonan. Julie A. Pace

113 Julie A. Pace The Cavanagh Law Firm, P.A JULIE A. PACE is a partner in the Phoenix office of The Cavanagh Law Firm PA. Ms. Pace’s practice is concentrated in representing companies in immigration compliance, commercial litigation, construction, and employment law, with particular emphasis in the defense of sexual harassment, employment discrimination, wrongful discharge suits, EEOC and ACRD charges, matters involving OSHA, ICE, OFCCP, DOL, DOT, NLRB, ADA, FMLA, ERISA, I-9s, E-Verify, Davis-Bacon, wage and hour laws, conducting sexual harassment investigations, and providing training to managers and employees. She also counsels employers on noncompete contracts, confidentiality agreements, employee discipline, drug testing, accommodation of disabled individuals, safety policies, affirmative action plans, wage conformances and wage determinations, and other related human resource policies and procedures. Ms. Pace also handles issues involving the Affordable Health Care Act and addresses the changes and options it presents to companies. Her Davis-Bacon and prevailing wage practice includes counseling and training on state and federal prevailing wages and benefits requirements, coverage and applicability of prevailing wage laws, coverage exemptions, worker classification and pay issues, addressing wage determinations, wage surveys, and representation of employers before the Department of Labor Wage and Hour Division and similar state agencies. Ms. Pace has been described by Arizona Business Magazine as the "go to" lawyer in Arizona for businesses on immigration issues. She has handled hundreds of I-9 audits, addresses E-Verify issues, and has provided I-9 and immigration compliance training for thousands of supervisors. She has chaired the Immigration Committee of the Arizona Chamber of Commerce and Industry. For over the past two decades, Ms. Pace has regularly represented companies in OSHA proceedings. She has been working on fall protection issues since the fall protection standard went into effect in She has handled hundreds of OSHA matters and numerous fatalities in the workplace. She received her J.D. degree, cum laude, from Arizona State University, where she was also Symposium and Articles Editor of the Arizona State Law Journal. She received her B.S. degree in Business Administration, magna cum laude, from Arizona State University. Ms. Pace can be reached at or Julie A. Pace


Download ppt "Presented For: AGC State Board of Directors Meeting May 3, 2013 San Francisco, California OBAMACARE IS HERE, NOW WHAT? Julie A. Pace The Cavanagh Law Firm,"

Similar presentations


Ads by Google