HIRE QUEST, LLC AFFORDABLE CARE ACT

Overview Employers must offer health insurance that is affordable and provides minimum value to their full-time employees and their children up to age 26 or be subject to penalties. This is known as the employer mandate. It applies to employers with 50 or more full-time employees, or full-time equivalents, and will be phased in during 2015 and 2016 based on employer size. Employers must offer health insurance that is affordable and provides minimum value to their full-time employees and their children up to age 26 or be subject to penalties. This is known as the employer mandate. It applies to employers with 50 or more full-time employees, or full-time equivalents, and will be phased in during 2015 and 2016 based on employer size. 5

 Full-Time Employee – An individual who averages at least 30 hours of service per week (130 hours per month)  Minimal Essential Coverage (MEC) – An employer group health plan that covers “medical care” (amounts paid for the “diagnosis, cure, mitigation, treatment, or prevention of disease…”) Definitions Under the ACA

Variable-Hour Employee –An employee whose full-time status cannot be reasonably determined at the start of employment or over a look-back period because the individual’s employment is variable and uncertain.

Definitions Under the ACA “Seasonal worker” – means a worker who performs labor or services on a seasonal basis, as defined by the Secretary of Labor, including (but not limited to) workers covered by 29 CFR (s)(1) and retail workers employed exclusively during holiday seasons.

 Nonvariable-Hour Employee – An employee is considered nonvariable-hour when the staffing firm can reasonably determine at the start of employment that the employee will work full-time on an ongoing basis  E.g.. Temp to perm, pay-rolling and long term assignments Definitions Under the ACA

–Note that assignments exceeding 13 weeks may be considered full-time unless variable-hour factors are present. Unless seasonal employment. –Staffing firms must offer coverage to full-time, non- variable employees within 90 days of employment or pay penalties.

Definitions Under the ACA –For example, a staffing firm can reasonably expect that an employee will be considered variable-hour because he or she will be offered short-term assignments (generally less than 13 weeks) with different clients with gaps in between assignments

Overview Employees who work 30 or more hours per week are considered full-time Unless they are categorized as variable. This chart shows how the employer mandate will be phased in based on employer size. 12

Employer mandate and penalties Employers subject to the employer mandate are required to offer coverage that provides “minimum value” and is “affordable.” The following chart explains these requirements and the penalties that apply if they are not met: Employers subject to the employer mandate are required to offer coverage that provides “minimum value” and is “affordable.” The following chart explains these requirements and the penalties that apply if they are not met: 13

Employer mandate and penalties 14

Example of Penalty The employer does not offer coverage to full-time employees The penalty is $2,000 per employee, excluding the first 30 employees. The employer does not offer coverage to full-time employees The penalty is $2,000 per employee, excluding the first 30 employees. 15

Determination Form The determination form will be our tool for identifying full time and variable employees. The form will be sent to the customer for completion. The completed forms will be uploaded into HQWebConnect under the customers job site record. The determination form will be our tool for identifying full time and variable employees. The form will be sent to the customer for completion. The completed forms will be uploaded into HQWebConnect under the customers job site record. 16

The Look-Back Rule The “look-back” is a measurement period during which an employee must work full-time (average of at least 30 hours per week) before the employer must play or pay Staffing companies may use a look-back period of up to 12 months to determine which of their full-time employees are eligible for benefits

Self-Funded 60% (MVP) Our Minimum Value Plan with Aggregate coverage also includes the benefits from the self-funded MEC program. MVP consists of co-payments up to $1,850 out of pocket maximum, then 100% coverage above that. Additionally, MVP incorporates the MEC benefits at 100% for preventive services. Our Minimum Value Plan with Aggregate coverage also includes the benefits from the self-funded MEC program. MVP consists of co-payments up to $1,850 out of pocket maximum, then 100% coverage above that. Additionally, MVP incorporates the MEC benefits at 100% for preventive services. 18

Self-Funded 60% (MVP) An employer must only offer a 60% Minimum Value Plan, which meets the government’s 60% average of allowed costs, at affordable costs, in order to avoid the $3,000 penalty per employee who is eligible for subsidies on the Exchange, who waives off the employer plan, and who purchases coverage on the Exchange. 19

Self-Funded 60% (MVP) Under the Centers for Medicare and Medicaid Services (CMS) Safe Harbor rule, the employer can’t charge an employee who would otherwise be eligible for a subsidy on the Exchange more than 9.5% of that employee’s W2, Box 1 income for single coverage under the Minimum Value Plan. An employer may charge any amount for dependent coverage within an MVP. Under the Centers for Medicare and Medicaid Services (CMS) Safe Harbor rule, the employer can’t charge an employee who would otherwise be eligible for a subsidy on the Exchange more than 9.5% of that employee’s W2, Box 1 income for single coverage under the Minimum Value Plan. An employer may charge any amount for dependent coverage within an MVP. 20

MVP Summary 21

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MVP Exclusions Hospital inpatient services are not covered by the plan. This means any inpatient service billed by the hospital. Ambulatory Surgical Center Services are not covered. Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services are not covered with the exception of services covered under the MEC benefits. Hospital inpatient services are not covered by the plan. This means any inpatient service billed by the hospital. Ambulatory Surgical Center Services are not covered. Mental/Behavioral Health and Substance Abuse Disorder Outpatient Services are not covered with the exception of services covered under the MEC benefits. 24

MVP Exclusions Rehabilitative Speech Therapy services are not covered. Rehabilitative Occupational and Rehabilitative Physical Therapy services are not covered. Skilled Nursing Facility services are not covered Outpatient Surgery Physician/Surgical services are not covered. Specialty drugs are not covered. Rehabilitative Speech Therapy services are not covered. Rehabilitative Occupational and Rehabilitative Physical Therapy services are not covered. Skilled Nursing Facility services are not covered Outpatient Surgery Physician/Surgical services are not covered. Specialty drugs are not covered. 25

MVP Exclusions Charges that are not for the care or treatment of an accident or illness except as specifically provided for in this plan. Treatment made necessary as the result of illegal use of narcotics or use of hallucinogens in any form unless prescribed by a physician or as provided herein. Charges that are not for the care or treatment of an accident or illness except as specifically provided for in this plan. Treatment made necessary as the result of illegal use of narcotics or use of hallucinogens in any form unless prescribed by a physician or as provided herein. 26

MVP Exclusions Treatment made necessary by or a disability arising from war, declared or undeclared, or any act of war. An act of terrorism will not be considered an act of war, declared or undeclared. Treatment or services provided by anyone other than a healthcare provider as defined herein unless specifically stated in the plan. Treatment made necessary by or a disability arising from war, declared or undeclared, or any act of war. An act of terrorism will not be considered an act of war, declared or undeclared. Treatment or services provided by anyone other than a healthcare provider as defined herein unless specifically stated in the plan. 27

MVP Exclusions Investigatory and experimental treatment, services, and supplies. Organ transplants. Investigatory and experimental treatment, services, and supplies. Organ transplants. 28

QUESTIONS? 29