AAHRA 2014
Spring Workshop
Health Reform 2014
Where we are !
Paige Phillips, Executive Director
Alabama Association of Health Underwriters
Rick Lender –C2 Wealth Strategy
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PPACA 2014 and beyond
Employers have a lot to think about
• Keeping benefit package attractive enough to
retain current and recruit new employees
• Staying within budget while maintaining benefits
• Review options to have most up to date benefit
package
• Municipalities have to think of their own employees
as well as the businesses in their area
Key Reporting Dates: Update
• 1099 Reporting
o Repealed
• W-2 Reporting
o 2012 but Delayed if less than 250 employees
• Employer Mandate
o Delayed
• Employee Mandate
o Not delayed
• Medicare Tax Increases
o 2013
• Auto Enrollment
o Delayed
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Determine group size
Employer mandate applies to group size 50 full time
employees including full time equivalents
Part time determined:
Aggregate part time hours divide by 120 to determine
full time equivalents
Example: 20 part time X 20 hrs week
1600 hours divided by 120 = 13.3 full time
equivalents
MUST BE COUNTING EMPLOYEES NOW TO DETERMINE IF
LARGE EMPLOYER FOR 2015
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What’s Not Delayed
 Cost Sharing Limitations
o Individual & small group plans may not have
deductibles in excess of certain limits
o Self-funded & large group health plans may not
have annual out-of-pocket maximums in excess of
certain limits
 Insurance Market Rules
 90 Day waiting period for new hires
 No pre-existing condition exclusions or limitations
for plan years beginning on or after 1-1-14
 Preventive care
 Essential Health Benefits
Additional items not
delayed
•
•
•
•
•
Individual Mandate
Medicaid expansion
Approved Clinical Trials
Marketplace Notices
Transitional Reinsurance Fee and
PCORI fee
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What Must an Employer
Really Provide?
• Single Coverage
• Dependents
• Minimum Essential Value
• Affordable (W2 wages, Rate of Pay, Federal
Poverty Level)
• Information reporting on health benefits
o Final guidelines on employer reporting just
recently released
What Should Employers
Do?
• Some will think this approach works
What Should Employers
Be Doing Now
 Small Employers (<50)- research to find the best
option for your employees
 Large Employers (>50)- Get ready for 2015 employer
mandate
 Confirm Plan design meets other ACA 2014
requirements
 Watch for additional information on reporting
requirements
 Consider possible impact of nondiscrimination
requirements
 3 A’s- Accountant, Attorney and Advisor of Benefits
USE 2014 AS A
TRANSITION/TEST
YEAR
• Test employee counting strategies
• Manage work hours
• Assess liabilities and system
vulnerabilities without significant
financial consequences
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EMPLOYER REPORTING
GUIDELINES
• 6055 SMALL GROUPS UNDER 50
• 6056 LARGE GROUPS
• MUST REPORT TIN’S FOR INSURED, SPOUSE AND ALL
DEPENDENTS
o Must make concerted effort for depended TIN information
o EE’S MORE THAN 50 LESS THAN 100 HAVE UNTIL 1-1-16
o Large employers over 100 must be in compliance 1-1-15
o Report on IRS form 1095-c (employee) and 1094-c (employer transmittal)
however forms have not been drafted as of 4-1-14
o Penalty is $100 per return – max $1.5 million
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General Information for
Employees
• Employees are Generally NOT eligible for
subsidy if their employer offers affordable
coverage
( REGARDLESS OF SIZE OF EMPLOYER)
• Dependents could possibly still qualify for
subsidy
• Exchange will rely on “best available data”
such as
o Access to W2- look at 2015 return for 2014
benefit
o Household income attestation
Premium Subsidy
• Available January 1, 2014 through the
Marketplace to help individuals purchase
health insurance coverage
• If an individual receives a subsidy and is
determined over-paid - “clawback” applies
to re-pay subsidy
• Individuals will need to re-determine every
year to qualify for subsidy
Premium Subsidy depends
on income and family size
• People at or below the following income levels will
qualify to save in 2014
o Up to $45,960 for individuals
o Up to $62,040 for a family of 2
o Up to $78,120 for a family of 3
o Up to $94,200 for a family of 4
o Up to $110,280 for a family of 5
o Up to $126,360 for a family of 6
o Up to $142,440 for a family of 7
o Up to $158,520 for a family of 8
CMS update on
Marketplace
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•
•
•
1st Open enrollment is now closed
Call Center Operates 24/7 ….150 languages
Initial open enrollment 10-1-13 thru 3-31-14
Ongoing open enrollment 10-1 thru 12-7
• If employee leaves company – they have 30
days to enroll in the exchanges or obtain
personal individual health insurance
Penalty
Flat $ Amount
Penalty
Year
• 2014
• 2015
• 2016
• After
2016
Greater
• $95
• $325
• $695
• $695, Indexed
for Inflation
% of Household
Of
Income
• 1.0
• 2.0
• 2.5
• 2.5
Potential Scams
Personal Information: Never give away personal information (Social
Security numbers, any bank account info) to random callers. Government
officials will almost always request information by mail, unless it's a call
you've made yourself to a verifiable government source.
Fake Websites: Some website advertise themselves as healthcare markets
or exchanges, and will even advertise using the state seal. HealthCare.gov
is the only perfectly reliable portal to find official state and federal
exchanges.
Unsolicited Calls: Marketplace assistants are instructed not to reach out if
someone has not explicitly asked for a call. Some scammers advertise
themselves as "navigators" who will guide you through the new program
for a small fee. Those services are available for free at the Marketplace Call
Center.
Fake Numbers: Don't rely on Caller ID or displayed numbers for trusted
information. It's relatively easy for scammers to fake (or "spoof") a Caller
ID number so it appears they're calling from Washington, D.C., for
example.
4 of the Biggest Scams
• Need New Medicare Card
• Charging for advice
• Medical Discount Plans
• Government Imposters
Don’t be surprised!!!
DOL AUDITS ON THE RISE
Every year thousands of ERISA-governed plans are
selected for audit by governmental agencies.
• United States Department of Labor (DOL)
• Internal Revenue Services (IRS)
DOL has significantly increased audit enforcement
and IRS announced it is stepping up examination
and enforcement activities and plans to
dramatically increase the number of plan returns
audited in the current and next fiscal year.
AUDITS……they are coming…
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Health Benefits Self Compliance tools
Health Benefits Self Compliance Tools
WWW.DOL.GOV
• ERISA, HIPAA, Affordable Care Act Provisions and
Other Health Care-Related Provisions
This self-compliance tool is useful for group health
plans, plan sponsors, plan administrators, health
insurance issuers, and other parties to determine
whether a group health plan is in compliance.
• http://www.dol.gov/ebsa/healthlawschecksheets.h
tml
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Penalties
Penalties range from:
• Plan administrator could be subject up to $110 per day.
• Willful violations can carry up to 10 years in prison and
$100,000 fine.
• An excise tax of $100/day/individual to whom such
failure relates.
• A penalty of up to $1,000 per failure.
• Failure to properly report the cost of employersponsored health coverage on W-2’s may result in $30 to
$100 per W-2, up to a maximum of $1.5 million.
• (BAA’s) civil penalties range from $100 to $50,000 per
violation.
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The best thing about not
planning ahead is that
failure comes as a
complete surprise, rather
than being preceded by a
period of worry and
depression
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Healthcare Reform
Websites
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•
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www.healthcare.gov
www.dol.gov (Dept of Labor)
www.irs.gov (Internal Revenue Service)
www.nfib.com (Natl Federation of Indep. Bus)
www.aldoi.gov (AL Dept of Insurance)
www.sba.gov (Small Business Administration)
• www.nahu.org ( National Association of Health
Underwriters)