bacc ohio - healthcare reform presentation 2013

The Hitchhiker’s Guide to Obamacare

Jamie Debenham October 25, 2013

AGENDA

• Individuals• Small Employers < 50

EE’s• Large Employers > 50

EE’s • Q & A


INDIVIDUALS

Federal Mandate: All Citizens and Legal Residents must

purchase health insurance by January 1, 2014 or be subject to a fine.


INDIVIDUALS

Consequences for Non Compliance

• If individual health insurance NOT purchased by January 1, 2014, fine imposed:

• 2014: $95 per adult/$47.50 per child, up to $285 for a family or 1% of family income, whichever is greater.

• 2015: $325 per adult/$162.50 per child, up to $975 for a family or 2% of family income, whichever is greater.

• 2016 and beyond: $695 per adult/$347.50 per child up to $2,085 for a family or 2.5% of family income.


INDIVIDUALS

Public Exchange (“Marketplace”)•Subsidy available to those who qualify

• Family with income between 133%-400% of FPL (Federal Poverty Level), will qualify for subsidy on a sliding scale basis.

Private Exchange• Offered through private insurance companies

• More choices and coverage options available than public exchange

• Subsidy not available through private exchange


INDIVIDUALS

Important Dates:

October 1, 2013 – Open Enrollment Starts January 1, 2014 – Individual Mandate Effective March 31, 2014 – Open Enrollment Closes


SMALL EMPLOYERS

Under 50 FTE’sFull-time Equivalents (FTE’s) – All full-time employees and all part-time employees (including seasonal employees) who are not full-time employees are included in the calculation.


SMALL EMPLOYERS

•Subject to “Community Rating” Beginning with Renewals after January

2014

•Cost Control Strategy Early Renewal prior to January 2014


SMALL EMPLOYERS

Purchasing Options for Small Group Health Insurance

Access to SHOP (Small Business Health Options Program)

• Full implementation of SHOP delayed until 2015• SHOP opens October 1st with limited offerings (for

January 2014 Renewals)

Direct Purchase through Carriers• Subject to “Community Rating” with renewals after

January 2014


SMALL EMPLOYERS

Dependent Coverage Available Until Age 28•Age 26 – Federal Mandate•Age 28- State (Ohio) Mandate

* Note – coverage for dependents between ages 26 and 28 (Ohio mandate) will be different than for dependents ages up to 26 (Federal Mandate)


SMALL EMPLOYERS New Fees Associated with Health Insurance Premiums

• PCORI Fee (Patient Centered Outcomes Research Institute) 2013 2018 $2.00 x Avg. Number of Employees

• Re-Insurance Fee 2013 2016 $63 Annual Fee Per Employee ($5.25 per Month per Employee)Market Share Fee

Based on Market Share of Insurer


SMALL EMPLOYERS

Preventative Services Covered at 100% *

* Excludes “grandfathered” plans until January 2014


SMALL EMPLOYERS

Small Business Health Care Tax Credit is Available to Certain Qualifying Businesses

• Employer with < or = 25 Employees

• Employer with < $50,000 average

Employee wage


SMALL EMPLOYERS

SBC (Summary of Benefits Coverage)•Must be given to each eligible Employee within 30 days of renewal or date of hire

Exchange Notice •Must be given to every Employee by October 1, 2013 or within 14 days of hire


SMALL EMPLOYERS Consequences of Non-

Compliance

• Individual Employees must seek coverage elsewhere or pay penalty under Federal Individual Mandate

• Currently no financial consequences at this time for Employer who chooses to not offer health benefits to employees (but may suffer retention consequences and lose good employees)


LARGE EMPLOYERS

Large Group = 50+ FTE’s

What is an FTE?

Full Time Equivalent – all full time Employees plus all part-time employees (including seasonal employees) are included in the calculation.


LARGE EMPLOYERS

Federal Mandate: (Delayed Until 1/2015)

Large Group Plan offering:• Must Provide “Minimum Essential Coverage”

• Minimum of 60% actuarial value• Must Be “Affordable”

• Cannot charge more than 9.5% of Family Income for Single Coverage Health Insurance

• Safe Harbor - No more than 9.5% of Employee’s W-2 income must go toward cost of single coverage Health Insurance


LARGE EMPLOYERS

W-2 Reporting Requirement

Beginning with the Calendar Year 2012 W-2 Forms, Employers with more than 250 W-2 Filings for proceeding year must report cost of the benefits provided on each Employee’s W-2


LARGE EMPLOYERS

Consequences of Non Compliance If Employer Does Not Offer Health Insurance:

• If Employee goes to Public Exchange and qualifies for federal subsidy, a $2,000 fine per FTE is assessed (minus the first 30 FTE’s)• Example: Company ABC with 100 FTE’s does not offer

health insurance. Employee X goes to Public Exchange and qualifies for subsidy on health insurance purchased.

Fine levied is: $2,000 x (100-30) = $140,000


LARGE EMPLOYERS

Consequences of Non ComplianceIf Employer offers Health Insurance but Plan does not comply with mandate standards of “Minimum Essential Coverage” or “Affordable”:

• If Employee goes to Public Exchange and qualifies for federal subsidy, a $3,000 fine per FTE is assessed• Example: Company ABC with 100 FTE’s offers non-

qualifying health insurance. Ten Employees go to Public Exchange and qualifies for Subsidies on health insurance purchased.

Fine levied is: $3,000 x (10) = $30,000


LARGE EMPLOYERS Important Dates

January 1, 2012Employer must provide a SBC (Summary of Benefits Coverage) to all Employees at renewal.

October 1, 2013Employer must provide all Employees (and new hires) with an electronic or printed copy of Marketplace Notice.


Questions?


Thank you!
