Disclaimer

Please note that this presentation and any
discussion generated from this presentation
is for informational purposes only.

This should not be construed as legal or tax
advice. Please seek a qualified lawyer or
tax advisor should you need specific
advice.
A Quick Note on Fully Insured Vs. Self Insured Plans
What Does The General Public Know?
ObamaCare Vs. Affordable Care Act
Employee Vs. Employer

Employee Mandate January 1, 2014
 Must HAVE coverage

Employer Mandate January 1, 2015
 Must OFFER coverage
Employee Side- Individual Mandate

Individuals must have coverage or pay a penalty
○ Penalty is assessed when you file your personal income
tax return and is based on your household income
○ 2014 ranges from $95 per person to $285 per family
○ 2015 ranges from $325 per person to $975 per family
○ 2016 ranges from $695 per person to $2,085 per family

How to get coverage
 Coverage will come from a government run
marketplace or their employer’s plan
Employee Side- Marketplaces
www.healthcare.gov
Employee Side- Marketplace Rates
Employee Side- Subsidies
 If you have qualified Employer Coverage,
Medicaid or Medicare you won’t qualify
 $$ Amount Determined at the State level and if
Medicaid programs were expanded in that state
 FL Medicaid WAS NOT expanded
 Also Based on Income Level, # of Children,
Smokers vs. Non-smokers, etc.
 IRS Reporting Requirements
○ Penalty for false information
Employee Side- Coverage Expansion
 Young Adults remain on plan until age 26
 Insurance cannot drop you when you are sick
 Prevention against gender discrimination
 Life-time Limits and Annual Maximums can’t be set
 Pre-existing Condition Exclusions not allowed
 Essential Health Benefits defined
 Free preventative services
Employer Side- Three Tiers

Employer Mandate
 Healthcare must be Offered to all Full Time Employees
○ Defined as anyone regularly working more than 30 hours per
week
○ Delayed Until January 1, 2015
 Coverage must be Affordable
○ W-2 reporting
 Coverage must be Essential
○ ambulatory patient services; emergency services;
hospitalization; maternity and newborn care; mental health and
substance use disorder services, including behavioral health
treatment; prescription drugs; rehabilitative and habilitative
services and devices; laboratory services; preventive and
wellness services and chronic disease management; and
pediatric services, including oral and vision care.*
○
https://www.healthcare.gov/glossary/essential-health-benefits/
How Do We Pay For This?

Taxes, taxes and more taxes
 Watch out for Fully-Insured Vs. Self-Insured
○ Taxes differ under each type of plan
 Individual mandate shared responsibility tax
○ Penalty tax if you don’t have coverage
 Employer taxes
○ PCORI Fee (2014-2018)*- $2/covered life- annual
○ Re-Insurance Fee (2014-2016) $5.25/covered life- monthly
○ Cadillac Tax (2018) Excise Tax of 40% on High Value Plans
* Fees are funded by ICUBA
Florida Tech Changes

Identify Who Is Eligible
 Healthcare must be offered to ALL FTE’s
 FTE = anyone that regularly works more than 30
hours per week
 Starts April 1, 2015

Ensure Plans are Compliant
 ICUBA plans are certified as Essential and GOLD
LEVEL

Educate The Employees
 Controlling Claims Costs, Wellness Programs, What
Do We Get For Free
○ Monthly Seminars Coming in 2014 and beyond
Florida Tech Changes

Open Enrollment is EARLY
 January 21st and January 22nd
○ Hartley Room from 9:00am - 7:00pm
 On-line Enrollment January 21st- February 5th
○ Computers will be available from 8am-5pm every
day in the Human Resources Office
○ Make sure to update your ICUBA online account
Questions