Every business owner, regardless of their size needs to understand the affordable health care laws (Obama Care). This presentation was presented by Todd Gordon to customers of The Virtual HR Director in May 2013. New presentations will be delivered as the law becomes clear.
1. T O D D E . G O R D O N , R H U
P R E S I D E N T , T H E B E N E F I T S G R O U P , I N C .
N A H U C E R T I F I E D P A T I E N T P R O T E C T I O N
A N D A F F O R D A B L E C A R E A C T
( P P A C A ) P R O F E S S I O N A L
Health Care Reform: Impact
on You & Your Business
2. The Individual Mandate
What are my options?
1. Employer-sponsored coverage
2. Individual coverage
Individual market exchange
„Off „ exchange
3. No coverage – pay the penalty
3. The Public Exchange/Marketplace
Individuals who buy a policy from the public exchange may
be eligible for credits and subsidies
Income range from 133% to 400% Federal Poverty Level (FPL)
Individual: $14,856 to $44,680
Family of four: $30,6565 to $92,200
Not have access to minimum essential coverage through their employer
or have access to coverage, but it is not affordable
Premium Credits – for any level plan
Cost-Sharing Subsidies – Silver Plan only
Public exchange open enrollment begins 10/1/13
4. No Coverage – Penalties for Individuals
2014
Greater of $95 or 1% of taxable income
2015
Greater of $325 or 2% of taxable income
2016
Greater of $695 or 2.5% of taxable income
2017 and beyond
Annual adjustments
5. Essential Health Benefits
Applies to:
Individual & Small Group plans
Non-grandfathered plans: On and off exchange
Does not apply to:
Large Group and ASO plans
Grandfathered plans
Benchmark plan:
Each state will select for the purposes of defining EHBs
6. Essential Health Benefits
Ambulatory patient services
Emergency services
Hospitalization
Laboratory services
Maternity & newborn care
Mental health & substance abuse disorder services
Pediatric services, including oral & vision care
Prescription drugs
Preventive & wellness services and chronic disease management
Rehabilitative and habilitative services and devices
7. Reform Related Taxes & Fees
What When Who Pays How Much
Comparative
Effectiveness
Research Fee
Plan/policy years ending
10/1/2012
Insurers of fully insured plans;
sponsors/administrators of
self-insured plans
$1 per person per year;
adjusted for subsequent years
Reinsurance
Assessment
1/1/2014 Issuers of fully insured plans Estimated at $5.25 per person
per month
Tax on high
earners
Tax year beginning 1/1/2013 Individuals .9% increase on Medicare, in
excess of $200k single/$250k
married
Tax on unearned
income
Tax year beginning 1/1/2013 Individuals 3.8% on unearned income in
excess of $200k single/$250k
married
Insurer Fees Tax year beginning 1/1/2014 Issuers of fully insured plans Estimated at 2.46% of
premium, plus state fee
High-cost
insurance tax
Tax year beginning 1/1/2018 Insurers of fully insured plans;
sponsors/administrators of
self-insured plan
40% on plan costs exceeding
“Cadillac” thresholds
8. What About Rates in 2014?
Most significant changes will be in markets for
individuals and small employers
Rating constraints
Product constraints
Benefit mandates
New taxes
Studies & Carrier Reports
Forecasting a wide range of impact
9. Options for Small Businesses
Employers who have less than 50 employees:
Offer a fully insured plan through either:
SHOP Exchange (full implementation has been delayed)
The off-exchange market
Offer an ASO (administrative services only)
Self-funded
Stop offering coverage
Employees go to exchange
Offer “non-affordable” coverage
Employees go to exchange
10. Options for Large Employer
Employer Shared Responsibility Penalty
If a “large” employer does not offer “minimum essential”
health benefits to their full-time employees, they may be
required to pay a penalty
If a plan is offered, but it does not meet the coverage levels
required, they may be required to pay a penalty
If a plan is offered, but “unaffordable”, they may be required to
pay a penalty
11. Employer “Play or Pay” Mandate
Employers with 50+ employees who DO NOT offer
coverage:
At least 1 employee obtains subsidized coverage from health
insurance exchange
Fee equal to $2,000 X the number of full-time employees minus
the first 30 employee
Employers with 50+ employees who DO offer
coverage, but coverage is not “affordable”
Assessment of $3,000 X the number of employees receiving
subsidized coverage
“Affordable” defined as employee‟s share of the premium is
greater than 9.5% of income for employee only coverage
12. Large Employer Considerations
Calculating the number of full-time and full-time
equivalent employees (FTEs)
Aggregation of common ownership
Automatic Enrollment for employers with 200+ FTEs –
delayed for 2014
Minimum essential coverage
Plan coverage must provide minimum value at least 60% of the total
allowed cost of benefits that are expected to be incurred under the
plan
HHS/IRS will provide a calculator to determine minimum value
13. Questions
Todd E. Gordon, RHU
President, The Benefits Group, Inc.
NAHU Certified Patient Protection and Affordable Care Act
(PPACA) Professional
todd@tbgatlanta.com
(770) 455-3446 ext. 207
www. tbgatlanta.com