Healthcare
Reform
A look into the Affordable
Care Act (ACA) and what
it means to you.
Presented by
Bill Scuorzo
President & CEO
About BCG Advisors
BCG Advisors
Employee Benefits
Medical, Dental,
Life, LTD, Vision,
Voluntary Benefits,
COBRA
Risk Management
General Liability,
Workers Comp,
D&O, Auto, Bonds,
Student Accident
Human Resources
Employee Handbook,
FMLA, Policy
Writing,
On boarding,
ACA Overview
•
The 2,407 page Patient Protection and Affordable Care Act
(H.R. 3590), also known as the Senate bill, was signed
March 23, 2010. It was amended by the 153 page Health
Care and Education Affordability Reconciliation Act of
2010 (H.R. 4872), commonly known as the Reconciliation
Bill, signed March 30, 2010.
•
The law builds upon our current employer based health
insurance model that covers 83% of Americans today and
hopes to add coverage for 30 million uninsured
individuals. This will be accomplished by providing
financial assistance through subsidies or tax credits for low
income individuals and small businesses, and by
expanding Medicaid. The Congressional Budget Office, the
CBO, said that as a result 94% of Americans will have
access to health care.
Major provisions affecting
employers who offer group health
benefits
•
Dependents covered to age
26
•
Preventive Care Coverage
•
Coverage for Pre-Existing
Conditions
•
Medical Loss Ratio
•
Waiting Period Maximum
•
•
Minimum Essential
Coverage
Fees & Taxes on Group
Plans
•
Exchanges
•
Small Business Tax Credits
•
Employer Mandate
•
Elimination of Pre-Existing
Conditions
Dependents covered to age 26
The DU26 provision became effective with the first benefit
period after 9-23-2010 which is six months after the
enactment date of the law signed 3-23-2010.
Minimum Loss Ratio
A MLR of 85% applies to large group plans and 80% for
individual and small group plans (100 and below).
Maximum Waiting Period
Effective 1-1-2014, waiting periods in excess of 90 days are
prohibited for all size group health plans.
Minimum Essential Coverage
The tem “essential benefits package” means, with respect
an health plan, coverage that:
•
Provides for “essential health benefits”
•
Limits cost sharing for such coverage; and
•
Provides either bronze, silver, gold or platinum level of
coverage (i.e., benefits that are actuarially equivalent to
Bronze 60%, Silver 70%, Gold 80% or Platinum 90%
(respectively) of the full actuarial benefits provided under
the plan.
•
Effective January 1, 2014, all in-network out-of-pocket
amounts (deductible, copayments, and coinsurance) will
accumulate to the annual Out-of-Pocket maximum.
•
Annual Maximums on Deductibles
Elimination of Pre-Existing Conditions
Your insurance company can't turn you down or charge you more
because of your pre-existing health or medical condition like
asthma, back pain, diabetes, or cancer. Once you have insurance,
they can't refuse to cover treatment for your pre-existing
condition.
Preventive Care Coverage
•
Preventive care coverage at no out-of-pocket cost on most health
plans. These preventive services help to put the focus on wellness,
early detection and prevention instead of treatments and cures.
Fees & taxes on group plans
Health Insurance Provider Fee
Transitional Reinsurance Fee
Exchanges
An online marketplace where employers and individuals
can shop for insurance
Public Exchanges
Individual and Group (SHOP)
Shop is the Small Business Marketplace
Private Exchanges
Created by private industry such as insurance carriers &
Brokers
Small Business Tax Credits
Can you claim the credit?
•
Must purchase insurance through SHOP
•
Employer must pay at least 50 percent of the cost of single (not
family) health care coverage for each of your employees.
•
Less than 25 full-time equivalent employees (FTEs).
•
Average wages of less than $50,000 (as adjusted for inflation
beginning in 2014) per year.
The credit you receive works on a sliding scale. The smaller the
business or charity, the bigger the credit. So if you have more than
10 FTEs or if the average wage is more than $25,000 (as adjusted
for inflation beginning in 2014), the amount of the credit you
receive will be less
Employer Mandate
The employer mandate fee (officially called an Employer Shared Responsibility
Payment) is a per employee fee for employers with over 50 full-time equivalent
employees who don't offer health coverage to full-time employees.
•
The employer mandate is based on full-time equivalent employees, not
just full-time employees.
•
The fee is based on whether or not you offer affordable health insurance to
your employees that provides minimum value (explained below).
•
The annual fee is $2,000 per employee if insurance isn't offered (the first 30
full-time employees are exempt).
•
If at least one full-time employee receives a premium tax credit because
coverage is either unaffordable or does not cover 60 percent of total costs,
the employer must pay the lesser of $3,000 for each of those employees
receiving a credit or $750 for each of their full-time employees total.
•
The fee is a per month fee due annually on employer federal tax returns
starting in 2015 for small businesses with 100 or more full-time equivalent
employees(2016 for those with 50-99). So the per month fee is 1/12 of the
$2,000 or $3,000 per employee.
•
Unlike employer contributions to employee premiums, the Employer
Shared Responsibility Payment is not tax deductible
What responsibilities do employers
have that offer group offer coverage
•
Provide a Summary of Benefits & Uniform Glossary
•
W2 Reporting for employers who issued more than 250
W2’s in the previous calendar year.
•
Provide Exchange Notices to Employees
Closing
•
Bill Scuorzo
•
President & CEO
•
BCG Advisors
•
Office (888) 685-9229 ext. 111
•
Cell (973) 464 – 7461
•
BScuorzo@BCGAdvisors.com