June 2013
Employee Benefits Manager A&M System Office
Ellen Gerescher
The Affordable Care Act (ACA) /
The System Wellness Initiative
An HR Liaison Presentation
Important Highlights of ACA
• Employer Fees– Transitional Reinsurance Fee – Patient-Centered Outcomes Research
Institute Fee • Eligibility Changes
– 30 hours/week = full-time employee • Benefit Changes
– 90-days = maximum waiting period – All inclusive out-of-pocket maximum
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More Highlights
• Employer Penalties related to:– Minimum Essential Coverage– Minimum Value– Affordable Coverage
• Exchange Notices to Employees (Oct‘13) • Exchanges Begin
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Employer Fees
• Employer fee (per covered life, per year)
2014 Fee: $63 $2.8 Million
2015 Fee: $42 $1.9 Million
2016 Fee: $26 $1.1 Million
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Eligibility Changes
• Current benefit-eligible employee:– Works at least 20 hours/week for at least 4.5
continuous months• New definition:
– Works 30 hours or more/week• Problem areas:
– Adjunct faculty, student workers, employees with multiple positions, seasonal/ temporary employees
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Required Benefit Changes
• Full-time employees must be enrolled in health coverage no later than the 90th day of employment.
• Cap on out-of-pocket annual expenses- $6,400 per individual/$12,800 per family
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“Shared Responsibility”
• TAMUS must offer the following or be subject to a tax penalty:
– Offer “minimum essential coverage” to all or “substantially all” of its “full-time employees” and their “dependents”.
– Offer self-only coverage to its full-time employees that has “minimum value” (is adequate) and is “affordable”.
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Definitions
• Minimum Essential Coverage - basically all employer health plans.
• Minimum value - is an actuarial value calculated using the coinsurance percentage, copays, premiums and out-of-pocket maximums. Thus far, our plans are above minimum value.
• An “affordable” plan is one that does not exceed 9.5% of the employee’s hourly wage or monthly salary.
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Exchange Notice
• Must go to new employees by October 13th, and new employees within 14 days of hire date
• Notice must include information about:– Health Exchange Insurance Marketplace
– Contact information for Marketplace
– Availability of premium tax credits
– Loss of employer contribution
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System Wellness Initiative
• Objective: Invest in wellness initiatives coordinated by System members
• Process: Grants awarded covering cost of classes, webinars, and program materials over the coming 2 years
• Grants: To be eligible, each member will be required to conduct a minimum of 4 webinars and a wellness fair
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System Wellness Initiative
• Objective: Ensure employees are active in their personal health through annual exams
• Process: Employees/Spouses will be asked to have annual exams at least every 18 months; no cost to employees for services
• Premium Differential: Those who elect not to have annual exams will have premiums $30/month higher than those who do
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Thank You
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