BACC II Preliminary results Based on the BACC II Conference Tallinn, Estonia 6-7 September 2012
BACC Ohio - Healthcare Reform Presentation 2013
-
Upload
british-american-chamber-of-commerce-ohio -
Category
Business
-
view
388 -
download
0
Transcript of 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
Jamie Debenham October 25, 2013
INDIVIDUALS
Federal Mandate: All Citizens and Legal Residents must
purchase health insurance by January 1, 2014 or be subject to a fine.
Jamie Debenham October 25, 2013
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.
Jamie Debenham October 25, 2013
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
Jamie Debenham October 25, 2013
INDIVIDUALS
Important Dates:
October 1, 2013 – Open Enrollment Starts January 1, 2014 – Individual Mandate Effective March 31, 2014 – Open Enrollment Closes
Jamie Debenham October 25, 2013
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.
Jamie Debenham October 25, 2013
SMALL EMPLOYERS
•Subject to “Community Rating” Beginning with Renewals after January
2014
•Cost Control Strategy Early Renewal prior to January 2014
Jamie Debenham October 25, 2013
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
Jamie Debenham October 25, 2013
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)
Jamie Debenham October 25, 2013
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
Jamie Debenham October 25, 2013
SMALL EMPLOYERS
Preventative Services Covered at 100% *
* Excludes “grandfathered” plans until January 2014
Jamie Debenham October 25, 2013
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
Jamie Debenham October 25, 2013
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
Jamie Debenham October 25, 2013
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)
Jamie Debenham October 25, 2013
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.
Jamie Debenham October 25, 2013
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
Jamie Debenham October 25, 2013
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
Jamie Debenham October 25, 2013
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
Jamie Debenham October 25, 2013
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
Jamie Debenham October 25, 2013
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.
Jamie Debenham October 25, 2013
Questions?
Jamie Debenham October 25, 2013
Thank you!
Jamie Debenham October 25, 2013