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Securities and Investment Advisory Services Offered through Allegheny Investments, LTD, a registered broker/dealer. Member FINRA/SIPC Stone Quarry Crossing.

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Presentation on theme: "Securities and Investment Advisory Services Offered through Allegheny Investments, LTD, a registered broker/dealer. Member FINRA/SIPC Stone Quarry Crossing."— Presentation transcript:

1 Securities and Investment Advisory Services Offered through Allegheny Investments, LTD, a registered broker/dealer. Member FINRA/SIPC Stone Quarry Crossing 811 Camp Horne Road Suite 100 Pittsburgh, PA 15237 Phone: 800-899-3880

2 2 The intent of this communication is strictly to provide general information on some key issues related to Healthcare Reform. None of this material should be construed as the definitive answer on how these rules apply to your organization. Additional facts and information or future developments may affect the information provided. Legal Counsel should be contacted on how to implement these rules within your operations.

3 3 1 Guaranteed Coverage 2 Improvement of Quality Healthcare 3 Increase Access to Quality Healthcare 4 Lowering of Healthcare Costs 5 Providing More Transparency

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5 1 Group Health Plan 2 Governmental Health Plan 3 Grandfathered Group Health Plan 4 Self-Insured Group Health Plan 5

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7 Platinum Plan Covers 90% Cost of Services 1 Gold Plan Covers 80% Cost of Services 2 Silver Plan Covers 70% Cost of Services 3 Bronze Plan Covers 60% Cost of Services 4 7

8 1.Ambulatory Patient Services 2.Emergency Services 3.Hospitalization 4.Maternity and New Born Care 5.Mental Health and Substance Abuse 6.Prescription Drugs 7.Rehabilitative and Habilitative Services 8.Laboratory Services 9.Preventive and Wellness Services and Chronic Disease Management 10.Pediatric Services, including Oral & Vision 8

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10 1. 70% OR 75% Participation Requirement2. Pay 50% of Full-Time Employee’s Premium3. Distribute Summary of Benefits Coverage4. A 90-Day Maximum Waiting Period 10

11 Employed an average of at least 50 Full-Time (FT) and Full-Time Equivalent (FTE) Employees on business days during the preceding calendar year Must count FT and Full-Time Equivalents (FTE) Employer not an ALE if the Employer’s workforce – Exceeds 50 FT& FTE Employees for 120 days or fewer – Employees in excess of 50 during a 120-day period are Seasonal Employees Seasonal Employees perform work on seasonal basis – Retail Worker during Holiday Season – Ski Instructor – Agricultural Worker 11

12 1.Add up the hours - up to 120 hours - for each FTE Employee for the month 2.Divide the total of the monthly hours above by 120. Fractions are rounded to the nearest hundredth. The result is the number of FTE’s Employees for the month 3.Add the above monthly total of FTE’s to the number of FT Employees for the month to reach the monthly total of all Employees 12

13 1.Add each monthly total of all FT & FTE’s Employees to reach the yearly total of all Employees 2.Divide this total by 12. Round down the fractions to determine the monthly average number of Employees for the year. 3.Employer will be an ALE if he has 50 or more Full Time Employees, including FTE’s, for the preceding year 13

14 Mo.JanFebMarApr MayJune JulyAug Sept OctNovDecTot FT43 516 FTE 800/ 120 6.67 80.04 Mo. Total 49.67 596.0 4 Sum of all months: 596.04 divided by 12 = 49.67 Average Number of Employees Rule on fractions: At the end of the year, round down to 49 Total FT & FTE’s Empl. Employer IS NOT an Applicable Large Employer (ALE) 14

15 Mo.JanFebMarApr MayJune JulyAug Sept OctNovDecTot FT45 540 FTE 800/ 120 6.67 80.04 Mo. Total 51.67 620.04 Sum of all months: 620.04 divided by 12 = 51.67 Average Number of Employees Rule on fractions: At the end of the year, round down to 51 Total FT & FTE’s Empl. Employer IS an Applicable Large Employer (ALE) 15

16 Mo.JanFebMarApr MayJune JulyAug Sept OctNovDecTot FT43 516 FTE 800/ 120 6.67 8.33 1000/ 120 * 8.33 86.68 Mo. Total 49.67 51.33 602.68 Sum of all months: 602.68 divided by 12 = 50.22 Average Number of Employees Rule on fractions: At the end of the year, round down to 50 Total FT & FTE’s Empl. Employer MAY BE an Applicable Large Employer (ALE), depending on classification of Seasonal/Not Seasonal Employees * For this purpose only, 4 calendar months will be treated as the equivalent of 120 days as per IRS Notice 2011-36 16

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19 Biological Children to age 26 Adopted Children to age 26 DEPENDENTS Spouses Foster Children Stepchildren NOT DEPENDENTS 19

20 1 Used for administration of Individual Policy Premium Tax Credit (PTC) 2 Employee not eligible for PTC if Group Coverage is affordable and meets MV Standard (60% Covered Medical Costs) 3 File Report with IRS by February 28, 2016 for coverage provided in 2015 4 Annual statements to Employees are due by January 31, 2016 for coverage provided in 2015 20

21 SINGLE, COMBINED FORM FOR INFORMATION REPORTING 1.Top half includes the information needed for section 6056, while the bottom half includes the information needed for section 6055 2.Employers with fewer than 50 Full-Time Employees are exempt 3.Employers that are large enough and are “self-insured” will complete both parts of the combined form for information reporting 4.Employers that are over 50 Employees, but do not “self- insure” will complete only the top section (reporting for section 6056) 5.Insurers and other providers of health coverage will complete only the bottom section (reporting for section 6055) 21

22 GENERAL METHOD  Company Transmittal Return - (IRS Form 1094-C)  Employee Statements - ( IRS Forms 1095-C) 1.Information about the Employer offering coverage, including contact information 2.The number of FT Employees for each month 3.Information about each FT Employee, including the taxpayer identification number 4.Information about health coverage offered to FT Employees, by month 5.Information on Employee’s share of the lowest cost monthly premium for self-only coverage 22

23 SIMPLIFIED OPTION FOR EMPLOYER REPORTING  Available to Employers that provide a “Qualifying Offer” to their FT Employees. 1.File Forms 1095-C providing basic information on each FT Employees on an annual basis along with a code indicating the Employee received a “Qualifying Offer” for all 12 months of the applicable year 2.Details in the IRS Final Regulations published on 3/10/14: “Information Reporting by ALEs on Health Insurance Coverage Offered Under Employer-Sponsored Plans” 3.http://federalregister.gov/a/2014-05050http://federalregister.gov/a/2014-05050 23

24 1.For Employers with at least 50, but fewer than 100 FT Employees & FTEs during business days in 2014  No ALE penalty payments will apply for any calendar month during 2015 2.EM still applies to Employers with 100 or more FT Employees & FTEs in 2015 3.Employers with over 100 Employees can avoid the Failing to Offer Coverage penalty  If during 2015 they offer coverage to 70% of FT Employees  By 2016, these Employers must offer coverage to 95% of FT Employees 24

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