Affordable Care Act – Current Issues in Healthcare Reform Alice Helle - Cynthia Boyle Lande – Harold Schneebeck – BrownWinick 666 Grand Avenue, Suite 2000 Des Moines, IA

Exchanges Provide information about coverage options Facilitate purchase of health insurance by uninsured individuals Complete individual exemption determinations Eligibility: Must be a U.S. resident Must be a U.S. citizen or national Cannot be incarcerated

Exchanges – Open Enrollment Periods Initial open enrollment period began October 1, 2013 and continued through March : November 15, 2014 – February 15, 2015 Subsequent open enrollment periods: October 15 – December 7

Definitions Minimum essential coverage: includes individual market policies, job-based coverage, Medicare, and Medicaid Essential health benefits: Ambulatory patient services Emergency services Hospitalization and surgery Maternity and newborn care Mental health and substance abuse treatment Prescription drugs Rehabilitative and habilitative services and devices Lab services Preventative wellness services and chronic disease management Pediatric services, including dental and vision

Exchanges (cont.) Coverage levels Bronze (60/40) Silver (70/30) Gold (80/20) Platinum (90/10)

Iowa’s Exchange Partnership Model

“Large Employer” Mandate Obligations of Large (50+) Employer Must offer health coverage to “full-time employees” (30 hours) or pay a penalty Employers who offer coverage may still be subject to a penalty unless the coverage offered is “affordable” and provides “minimum value”

Effective Date for Mandate Originally effective 2014 Proposed regulations delayed to 2015 Final regulations issued 02/10/14 further delayed some provisions and clarified others

Highlights of Final Regulations Employers with 50 – 99 FTEs Penalties under the employer mandate are delayed to 2016 IF employer has met ALL of the following requirements since 02/09/14:

Highlights of Final Regs (cont.) Has not reduced # of employees or their hours for the purpose of falling below 99 FTEs Has not eliminated or materially reduced health coverage ER/EE premium split for EE only coverage is unchanged (or ER contribution is at least 95% of 02/09/14 level)

Highlights of Final Regs (cont.) Employers with 100+ FTEs Penalty for failure to offer coverage (the $2,000/year penalty) For 2015 only: ER must offer coverage to at least 70% (not 95%) of full-time employees Penalty is calculated by excluding first 80 employees (rather than first 30)

Highlights of Final Regs (cont.) “Seasonal Employee” defined: Customary annual period of employment is 6 months or less Period of employment should start in the same part of the year each year Ex: Ski instructors Detasselers

NASHCO

CoOportunity Health

CoOportunity Health (cont.)

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