PATIENT PROTECTION AND AFFORDABLE CARE ACT(AKA HEALTH CARE REFORM)

WHAT IS IT Law enacted in March 2010 Purpose: ensure that almost everyone living in

the United States has comprehensive medical coverage

PROVISIONS

Coverage for adult children to age 26 Prohibition on lifetime dollar limits on

essential benefits Restriction on annual dollar limits on essential

benefits No pre-existing condition exclusions on

children under 19 No cost sharing on certain preventive care Contraceptive coverage required

Provisions (cont’d) Patient-Centered Outcomes Research

Fee (CER Fee) MLR rebates Summary of Benefits and Coverage

Must be provided to all New Hires and current employees (and in a specific format)

FOR EMPLOYERS If provide health insurance to

employees: Must provide to full time employees (defined

as working 30 or more hours a week) Must be affordable

3 safe harbors (W-2 wages, Rate of Pay or Federal Poverty level)

Must provide minimum essential coverage Plan’s share of total allowed costs of benefits provided

under the plan must be at least 60% of such costs (a measure of benefits, not premium amounts)

FOR EMPLOYEES Individual Mandate (all individuals must

have health insurance coverage as of January 1, 2014)

Health insurance coverage can be obtained through: Employer Federal or State Exchanges

Kansas – no state exchange, defer to Federal Approved providers are Coventry and Blue Cross/Blue Shield

Private insurance company

Penalties for Non-Compliance Employer

If coverage is not affordable or doesn’t meet Minimum value Lesser of $3000 per full time employee receiving the tax

credit or $2000 per full time employee (minus first 30)

Employee 2014: $95/person up to $285 per family or 1.0% of adjusted

gross income 2015: $325/person up to $975 per family or 2.0% of adjusted

gross income 2016: $$695/person up to $2085 per family (indexed) or 2.5%

of adjusted gross income Full responsibility for all medical costs incurred

Cadillac Tax 2018: Tax levied if premium levels

exceed $10,200 for single and $27,500 for employee+1/family

40% tax will be levied Tax paid by insurance provider but

probable impact on premiums

BCC Action Steps Taken Identified 28 hours/week for part time

employees Identified maximum loads for adjunct

faculty Established Measurement periods for

compliance purposes

Measurement Periods Initial Measurement period

12 month period beginning with the 1st of month following first day of hire

Standard Measurement period November 1 – October 31

Administrative Period (2 months after the end of each measurement period)

Analysis of Hours Worked Analysis completed for each employee

for each measurement period If employee averages 30 hours or more

per week then must offer health insurance for the following 12 months

For Further Information

More information about Health Care Reform:

www.healthcare.gov