This presentation educated attendees on Obamacare from the employment law and employer's perspective. Topics from the presentation included the effects on different size businesses - small, medium and large employers - including relevant potential credit and penalty provisions of the Affordable Care Act which might apply to your business, the role of public programs, timeline for the effective dates of various PPACA provisions and their enforcement as well as typical information and documents sought under an audit by the United States Department of Labor.

1. PPACA/OBAMACARE:
WHAT EMPLOYERS NEED TO
KNOW
Charles R. Bailey
Bailey & Wyant, PLLC

2. What is the Affordable Care Act?


The Patient Protection and Affordable Care Act, 42
U.S.C. § 300, was passed by Congress to ensure
access to qualify affordable health care and
transform the health care system to control costs.
The Congressional Budget Office projects that after
the PPACA is paid for, 94% of all Americans will
have health coverage.

3. Elimination of Discriminatory Practices



The PPACA eliminates pre-existing conditions
exclusions for adults starting on January 1, 2014,
42 U.S.C. § 300 gg-3.
All Americans are required to have insurance which
is expected to reduce the potential additional costs
of covering these conditions. 26 U.S. C. 5000A, 42
U.S.C. § 18091.
Tax credits will ensure affordability to all families.
26 U.S.C. § 36B.

4. Elimination of Discriminatory Practices

The PPACA also eliminates:
 Lifetime
and unreasonable annual limits;
 Prohibits rescissions of health insurance policies;
 Assists individuals with pre-existing conditions;
 Requires coverage of preventative services and
immunizations;
 Extend dependent coverage up to age 26;
 Develop uniform coverage documents for apples-toapples comparisons when shopping for insurance.

5. Elimination of Discriminatory Practices

PPACA eliminations, continued:
Cap insurance company, non-medical administrative
expenditures;
 Ensure consumers have access to effective appeals process
and provide consumers a place to turn for assistance
navigating appeals process and accessing coverage;
 Create a temporary re-insurance program to support
coverage for early retirees;
 Establish an internet portal to assist Americans in identifying
coverage options;
 Facilitate administrative simplification to lower health
insurance costs. 42 U.S.C. § 300-44


6. Quality, Affordable Health Care


Starting in 2014 insurance companies may no
longer deny coverage or set rates based on health
status, medical condition, claims experience, genetic
information, evidence of domestic violence, or other
health related factors. 42 U.S.C. § 300gg-4.
Premiums may only be based on family structure,
geography, actuarial value, tobacco use,
participation in a health program, and age (3:1
ratio). Id.

7. HHS Default Standard Age Curve
Age
Premium
Rate
Age
Premium
Rate
Age
Premium
Rate
0-20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
0.635
1.000
1.000
1.000
1.000
1.004
1.024
1.048
1.087
1.119
1.135
1.159
1.183
1.198
1.214
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
1.222
1.230
1.238
1.246
1.262
1.278
1.302
1.325
1.357
1.397
1.444
1.500
1.563
1.635
1.706
50
1.786
51
1.865
52
1.952
53
2.040
54
2.135
55
2.230
56
2.333
57
2.437
58
2.548
59
2.603
60
2.714
61
2.810
62
2.873
63
2.952
64 and Older
3.000

8. Quality, Affordable Health Care


A qualified health plan offered through the
American Health Benefit Exchange, must provide
essential health benefits including cost sharing limits.
42 U.S.C. § 300gg-6.
Out-of-Pocket requirements cannot exceed those in
Health Savings Accounts, and deductibles in the
small group market cannot exceed $2,000.00 for
individuals and $4,000.00 for a family. Id.

9. Quality, Affordable Health Care

Coverage is offered at four levels with actuarial
values defining how much the insurer pays:
 Platinum
90%;
 Gold 80%;
 Silver 70%;
 Bronze 60%. Id.

A lower benefit catastrophic plan will be available
for individuals under 30 years of age and to others
who are exempt from the individual responsibility
requirement. Id.

10. American Health Benefit Exchange
Program



West Virginia has opted to participate in this program.
All plans in the program are accredited for quality,
present benefit options in a standardized manner for
easy comparison, and use one simple enrollment form.
42 U.S.C. § 18041.
Individuals qualified to receive tax credits through an
Exchange must be ineligible for affordable, employersponsored insurance and any form of public insurance
coverage. 42 U.S.C. § 18071.

11. American Health Benefit Exchange
Program




West Virginia is currently developing the SHOP and
individual market exchanges which may be combined into
one exchange. SHOP exchanges will have monthly
enrollment periods.
Only Highmark BCBS is participating in the individual and
SHOP marketplaces.
4 different policies will be available through the SHOP
exchange, while 11 are available through the individual
marketplace.
West Virginia is also considering participating in a regional
exchange with other states, although this is unlikely given the
state’s rates of diabetes, obesity, and tobacco use (2nd
highest in the country).

12. West Virginia geographic ratings areas for Individual and SHOP exchanges.

13. American Health Benefit Exchange
Program



Undocumented immigrants are ineligible for
premium tax credits. Id.
The Secretary of Health and Human Services
(“HHS”) has established a public option—
Community Health Insurance Option—to which
many states have opted. Out.
The PPACA provides support for non-profit member
run insurance cooperatives. 42 U.S.C. § 18042.

14. American Health Benefit Exchange
Program

Individual states may seek to establish basic health
plans for non-Medicaid, lower-income individuals;
may seek waivers to explore other reform options;
and may form compacts with other states to permit
cross-state sale of health insurance.

15. Refundable Tax Credits


Americans with incomes between 100 and 400
percent of the Federal Poverty Level (“FPL”) are
eligible for refundable tax credits. 26 U.S.C. §
536B.
The credit is computed by a sliding scale beginning
at 2 percent of income at 100 FPL and phasing out
at 9.8 percent at 300-400 FPL. Id.

16. Refundable Tax Credits


When the employer’s offered coverage exceeds 9.8
percent of a worker’s family income, or the employer
pays less than 60% of the premium, the worker may
enroll in the Exchange and receive credits. Id.
The out-of-pocket maximums ($5,950.00 for individuals
and $11,900.00 for families) are reduced to one third
for those with incomes between 100-200 FPL, one half
for those with incomes between 200-300 FPL, and two
thirds for those with incomes in the 400 FPL. Id.

17. Refundable Tax Credits


The credits are available for eligible citizens and
legally residing aliens. Id.
Small businesses with fewer than 25 workers are
eligible for a credit providing up to 50 percent of
the total premium cost. Id.

18. Individual Mandate


Starting in 2014, most individuals are required to
maintain minimum essential coverage or pay a
penalty of $95.00 in 2014, $350.00 in 2015,
$750.00 in 2016, and indexed thereafter. 26
U.S.C. § 5000A.
For those under 18, the penalty is one-half of the
amount for adults. Id.

19. Individual Mandate


The only exception is for religious objectors, those
who cannot afford coverage, taxpayers with
incomes less than 100 FPL, Indian tribe members,
those who receive a hardship waiver, individuals not
lawfully present, incarcerated individuals, and those
not coverage for less than three months. Id.
Individuals or families with existing coverage may
retain that coverage under the “grandfather”
provision. 42 U.S.C. § 18011.

20. Individual Mandate



Employers currently offering coverage are permitted to
continue offering such coverage under the “grandfather”
provision. 29 U.S.C. § 218A.
Employer with more than 200 employers must automatically
enroll new full-time employees in coverage. Id.
An employer with more than 50 full-time employees that
does not offer coverage and has at least one full-time
employee receiving a premium assistance tax credit must
make a payment of $750.00 per full-time employee after
30 employees. 26 U.S.C. § 4980H.

21. Individual Mandate

An employer with more than 50 employees that
offers coverage but has at least one full-time
employee receiving the premium assistance tax
credit because the coverage is either unaffordable
or does not coverage 60 of the total costs, will pay
the lesser of $3,000.00 for each employee
receiving a credit or $750.00 for their full-time
employees. Id.

22. The Role of Public Programs


Under the PPACA, Medicaid is expanded to lower
income persons with the federal government assuming
responsibility of must of the expansion costs. 42 U.S.C.
§ 18051.
It provides enhanced federal support for the Children’s
Health Insurance Program (“CHIP”), simplifies Medicaid
and CHIP enrollments, improves Medicaid services,
provides new options for long-term services and
supports, improves coordination for dual-eligibles, and
improves Medicaid quality for patients and providers.
42 U.S.C. § 1396a.

23. The Role of Public Programs


On January 1, 2014, all children, parents, and
childless adults who are not entitled to Medicare
and who have family incomes up to 133 percent of
FPL will be eligible for Medicaid. Id.
Between 2014 and 2016, the federal government
will pay 100 percent of the cost of covering newly
eligible individuals. Id.

24. The Role of Public Programs


In 2017 and 2018, states that initially covered less
of the newly eligible population will receive more
assistance than states that covered at least some
non-elderly, non-pregnant adults. Id.
States are required to maintain the same income
eligibility levels through December 31, 2013, for all
adults, and this requirement is extended through
September 30, 2019, for children currently in
Medicaid. Id.

25. The Role of Public Programs



The income eligibility requirements for CHIP must
also be maintained at current incomes levels by
States through September 30, 2019. Id.
Individuals must be able to apply for and enroll in
Medicaid, CHIP, and the Exchange through state-run
websites. Id.
Each program coordinates enrollment procedures to
provide seemless enrollment for all programs. Id.

26. The Role of Public Programs


Hospitals will be permitted to provide Medicaid
services during a period of presumptive eligibility
to members of all Medicaid eligibility categories.
Id.
States will be able to offer community based
attendant services and supports to Medicaid
beneficiaries with disabilities who would otherwise
require care in a hospital, nursing facility, or
intermediate care facility for the mentally retarded.
42 U.S.C. § 1396a.

27. The Role of Public Programs


State’s disproportionate share hospital (“DSH”)
allotments are reduced by 50 percent once a state’s
uninsurance rates decrease by 45 percent. 42
U.S.C. § 1396r-4.
As the rates decrease, the State’s DSH allotments
are reduced by a corresponding amount, however,
at no time are a state’s allotments reduced by more
than 65 percent compared to its FY2012 allotment.
Id.

28. Improving the Quality and Efficiency of
Care



FY2013, a value-based purchasing programs for hospitals
will link Medicaid payments to quality performance on
common high-cost conditions such as cardiac, surgical, and
pneumonia care.
The Physician Quality Reporting Initiative extends through
2014, with incentives for physicians to report Medicare
quality data—in return for feedback reports starting in
2012. 42 U.S.C. § 1396w-4.
FY2014, long-term care hospitals, inpatient rehabilitation
facilities and hospice providers will participate in valuebased purchasing with quality measure reporting, with
penalties for non-participating providers. 42 U.S.C. §
1395ww.

29. Prevention of Chronic Disease and
Improving Public Health

The HHS Secretary is charged with convening a
national public/private campaign to raise
awareness for activities to promote health and
prevent disease across and individual’s lifespan.

30. Prevention of Chronic Disease and
Improving Public Health

This includes programs:
 For
the operation and development of School Based
Health Clinics 42 U.S.C. § 280h-4;
 For oral healthcare prevention education campaign 42
U.S.C. § 280k;
 Medicare coverage with no co-payments or deductibles
for an annual wellness visit and development of a
personalized prevention program 42 U.S.C. § 1395x;

31. Prevention of Chronic Diseases and
Improving Public Health

Programs, continued:
 Waive
coinsurance and deductibles for most
preventative services, Medicare will cover 100 percent
of the cost Id.;
 Authorizes the HHS secretary to modify coverage of
any Medicare-covered preventative service for
consistency with the U.S. Preventative Services Task
Force recommendations;

32. Prevention of Chronic Diseases and
Improving Public Health

Programs, continued:
Provide states with an enhanced match if the state Medicaid
program covers (1) any clinical preventative services
recommended with a grade of “A” or “B” by the U.S.
Preventative Services Task Force and (2) adult immunizations
recommended by the Advisory Committee on Immunization
Practices without cost sharing;
 Required Medicaid coverage for counseling and
pharmacotherapy to pregnant women for cessation of
tobacco abuse;
 And grant awards to States for Medicaid Beneficiaries
incentives to participate in incentive programs for healthy
lifestyles. Id.


33. Prevention of Chronic Disease and
Improving Public Health


The Center for Disease Control also may provide grants
to State and large local health departments to conduct
pilot programs in the 55 to 64 year old population to
evaluate chronic disease risk factors, conduct evidencebased public health interventions, and ensure that
individuals identified with chronic disease or at-risk for
chronic disease receive clinical treatment to reduce risk.
PPACA § 4108.
The CDC will also evaluate wellness programs and
provide an education campaign and technical
assistance to promote the benefits of worksite health
promotion. PPACA § 4303.

34. Healthcare Workforce



The PPACA provides for competitive grants to establish State
partnerships to completed comprehensive workforce
planning and to create health care workforce development
strategies. 42 U.S.C. § 294r.
The Nursing Student Loan Program is increased and years
for nursing schools to establish and maintain student loan
funds are updated. 42 U.S.C. § 297b.
A loan repayment program is available for pediatric
subspecialties, providers of mental and behavioral health
services, Health Professional Shortage Area, a Medically
Underserved Area, or a Medically Underserved Population.
29 U.S.C. § 297n.

35. Transparency and Program Integrity


The PPACA includes new requirements for providing
information to the public on the health system and
promotes new requirements to combat fraud and
abuse in public and private programs. 42 U.S.C. §
1396O-6.
Physician owned hospitals who do not have provider
agreements prior to February 2010 are not
allowed to participate in Medicare. 42 U.S.C. §
1985u.

36. Transparency and Program Integrity


Drug, device, biological and medical supply
manufacturers must report gifts and other transfers of
value made to a physician, physician medical practice,
a physician group practice, and/or a teaching hospital.
Id.
Patients must be informed by the referring physician
that imaging services may be obtained from a person
other than the referring physician, a physician who is a
member of the same group practice, or an individual
who is supervised by the physician or by another
physician in the group. 42 U.S.C. § 1395m.

37. Effect on Small and Large Businesses


The PPACA imposes different requirements on
employers, depending on their size and whether
they currently offer health insurance to their
workers. 42 U.S.C. § 4980H.
The law does not apply to employers with less than
50 workers, but does provide health insurance
alternatives to them through state-based Small
Business Health Options Program (“SHOP
Exchanges”). Id.

38. Effect on Small and Large Businesses



Employers with 50 to 100 workers may face new
requirements related to workers’ health insurance coverage,
but will also have access to SHOP exchange options. Id.
Employers with more than 100 workers may have new
requirements related to their workers’ coverage and will not
have access to SHOP exchanges before 2017. PPACA §
1311(b)(1)(B).
Large employers may experience higher costs associated
with increased take-up of the policies they offer their
workers, due to the new requirements for individuals to
obtain health insurance coverage. PPACA § 1302.

39. Small Employers


The PPACA provides some financial assistance (i.e.
tax credits) for some small employers to maintain or
begin offering coverage to their workers. 26 U.S.C.
§ 4980H.
These credits, available in 2010, provide an offset
of a portion of the purchase of insurance by lowwage employers with 25 or fewer workers. 26
U.S.C. § 45R.

40. Small Employers


These credits can provide up to 35 percent of the
employer’s premium contribution, and are available
through 2014. Id.
Credits for up to 50 percent of the employer’s
contribution will be available on January 1, 2014,
for coverage purchased through the exchange. Id.

41. Small Employers


Waiting periods must not exceed 90 days and
insurance must eliminate lifetime and annual benefit
limits.
All small group market plans are required to meet
essential benefit requirements, be rated consistent
with rating limits in the law, and limit deductibles to
$2,000.00 for individuals and $4,000.00 for family
coverage (unless other employer contributions offset
additional deductible amounts). 29 U.S.C. § 45R.

42. Small Employers


Annual cost sharing for the plans is limited to the
current Health Savings Account Limits ($5,959.00
for individuals and $11,900.00 for families).
Small employers currently offering coverage can
continue providing this coverage to their workers,
with their current policies being “grandfathered” in
and exempt from most of the law’s regulatory
reforms and new essential benefit definitions.
PPACA § 1251.

43. Small Employer



Once an employer terminates a grandfathered policy,
any new coverage purchased through the small group
market is subject to the regulatory reforms and benefit
minimums. Id.
In 2014 all small employers will have the option of
purchasing insurance coverage for their workers through
the new SHOP exchanges.
The states may combine the SHOP and individual
exchanges or develop separate exchanges. Id.

44. Small Employer



These regulations are intended to make small group
and individual markets coverage more inclusive and
accessible for all, regardless of health status. Id.
Those with lower health care needs who purchase in the
new market outside grandfathered plans will share in
the costs associated with their less healthy counterparts.
Id.
Healthier individuals will experience higher premiums
but lower administrative costs with offset some, if not
all, of those higher costs.

45. Small Business

Reforms to the individual market will help workers
by providing guaranteed issue, subsidies for
purchasing coverage for those with modest incomes,
and federal regulatory minimums (e.g. new limits on
rating variations and prohibitions against preexisting condition exclusion periods, rescissions,
lifetime or annual benefit limits, and medical
underwriting). 26 U.S.C. § 4980H.

46. Small Business

Small group and nongroup health insurance will be
risk adjusted to ensure one pool of enrollees is not
disadvantaged by enrollment of disproportionate
numbers of individuals with high medical needs.

47. Medium Business



Employers of 50 or more workers will be accessed financial
penalties if their workers obtain subsidized health insurance
coverage through health insurance exchanges open to those without
employer-based coverage. 26 U.S.C. § 4980H.
If only one employee receives a subsidy through an exchange, the
employer will be assessed $3,000.00 for each employee receiving
a subsidy or $2,000.00 per full-time employee, whichever is less.
Id.
In order for these penalties to apply, a worker would have to face a
premium contribution requirement under the firm’s plan of more than
9.5 percent of his or her family’s income then choose to purchase
coverage through the nongroup exchange. 26 U.S.C. § 36B.

48. Medium Business


Employers with 50 to 100 workers have the same
option as their smaller counterparts to purchase
coverage for workers and their dependants through
the health insurance exchanges.
These employers may also purchase new coverage
outside the exchange if they prefer, or not offer
coverage at all. 26 U.S.C. § 4980H.

49. Medium Business


The essential benefits delineated in the law, as well as
the insurance regulatory reforms on rating and limits on
deductibles and out-of-pocket maximums, apply to this
portion of the market as well.
Employers may retain the health insurance policies they
provided at the law’s enactment under the
“grandfather” provisions, exempting them from most of
the new insurance regulations and benefit maximums.
PPACA § 1251.

50. Large Business




Large businesses are subject to penalties for employee
enrollment in exchanges. 26 U.S.C. § 4980H.
Any employer with one employee enrolling in an exchange
will be assessed the same penalties as medium businesses.
Id.
Employers with more than 200 workers are automatically
required to offer health insurance to all workers and to
automatically enroll all full-time workers and all previously
enrolled workers in a plan each year. 29 U.S.C. § 218a.
Workers have the option to opt out of they choose. Id.

51. Large Business


Employers may also choose to decrease their
contributions to employee premiums to keep the
company’s insurance spending from changing
significantly. 26 U.S.C. § 125.
Large businesses also have new tax requirements
when offering prescription drug benefits to their
retirees. 26 U.S.C. § 45R.

52. Large Business


The Medicaid Modernization Act of 2004 provided
subsidy payments to corporations equal to 28
percent of their costs for retiree prescription
benefits. 42 U.S.C. § 1305.
Prior to the MMA all payments for retiree health
benefits were tax deductible at 100 percent
regardless of whether the employer paid the full
amount or a retiree received a subsidy from the
government. Id.

53. Large Business



These subsidies continue but firms no longer can
take tax deductions for payments the government
makes. Id.
Large businesses may not purchase coverage
through the SHOP exchanges until 2017. 26 U.S.C.
§ 36B.
In 2017, states can, in their discretion, permit large
employers to obtain coverage through the
exchanges. Id.

54. Large Business


The University of Virginia recently announced that it
was discontinuing health insurance coverage to spouses
of employees with access to employer sponsored health
insurance. This was based upon UVA being subject to
the “Cadillac tax”, which imposes an excess tax on the
university. The PPACA will still costs UVA $7.3 million in
increased costs for health care.
UPS also announced it was dropping coverage for
15,000 spouses who have coverage available through
their employer.

55. Transitional Reinsurance Fee



The purpose of this fee is to stabilize the premiums
in the individual health insurance market between
2014 and 2016.
This fee will be accessed against both insured and
self-funded group health plans.
The fee is currently set at $63.00
 per
employee and eligible dependent enrolled in a
policy,
 Former employees and their dependents receiving
COBRA continuation coverage,

56. Transitional Reinsurance Fee



For fully funded insurers the fee is paid by insurers. For
self-funded plans, third party administrators remit the fee
on behalf of their clients.
This fee does not apply to retirees enrolled in Medicare and
receiving supplemental coverage from their former
employers. The fee will be accessed on retired employees
not yet eligible for Medicare and receiving health care
coverage from their former employers.
Exempted plans include HCFSAs, HSAs, stand-alone dental
and vision plans, most EAPs, disease management and
wellness plans.

57. Definition of Full-Time Employee

IRS January 2, 2013, Proposed Regulations:
Measurement, Administration and Stability Periods to
Determine Status as a Full-Time Employee for Purposes
of the Employer Mandate:

Standard measurement period: 3 months to 12 months
determine status during measurement period. That status
then applies during the:
Subsequent stability period, regardless of employees number of
hours during the stability period. At least 6 calendar months; no
shorter than measurement period.
 Administrative period. Up to 90 days, overlaps prior stability
period.


59. Definition of Full-Time Employee

IRS January 2, 2013, Proposed Regulations:
Measurement, Administration and Stability Periods
to Determine Status as a Full-Time Employee for
Purposes of the Employer Mandate:
 Basic
rules: New Employee Reasonably Expected to
Work 30 or more Hours per week as of Start Date and
not a seasonal employee.
 Employer must offer coverage at or before the end of
the employee’s initial three full calendar months of
employment.

60. Definition of Full-Time Employee

IRS January 2, 2013, Proposed Regulations:
Measurement, Administration and Stability Periods
to Determine Status as a Full-Time Employee for
Purposes of the Employer Mandate:
 New
“Variable Hour Employee” or “Seasonal
Employee”
 Cannot
determine at start date whether employee is
reasonable expected to work on average at least 30 hours
per week over the initial measurement period

61. Definition of Full-Time Employee

IRS January 2, 2013, Proposed Regulations: Measurement,
Administration and Stability Periods to Determine Status as
a Full-Time Employee for Purposes of the Employer
Mandate:

Initial Measurement and Administrative Periods for New Variable
Hour Employee and New Seasonal Employee



Initial measurement period: a period that begins on any date
between the employee’s start date and the first day of the first
calendar month following the employee’s start date and is between 3
and 12 months long
Initial administrative period: not longer than 90 days
Initial measurement period plus initial administrative period cannot
exceed beyond last day of first calendar month following first
anniversary of employment start date.

62. Definition of Full-Time Employee

IRS January 2, 2013, Proposed Regulations: Measurement,
Administration and Stability Periods to Determine Status as a FullTime Employee for Purposes of the Employer Mandate:

Initial Stability Period for New Variable Hourly Employee



Initial stability period same as similarly situated ongoing employee
Perform on average 30 hours of service per week during the initial
measurement period: stability period must be at least 6 consecutive calendar
months but no shorter than the duration of the initial measurement period.
Fail to perform on average 30 hours of service per week during the initial
measurement period: stability period during which this employee will not be
treated as a full-time employee cannot be more than one month longer than
the initial measurement period and cannot exceed the remainder of the
standard measurement period + administrative period in which the initial
measurement period ends.

63. Definition of Full-Time Employee

IRS January 2, 2013, Proposed Regulations:
Measurement, Administration and Stability Periods to
Determine Status as a Full-Time Employee for Purposes
of the Employer Mandate:

Subsequent Measurement and Stability Periods for New
Variable Hourly Employee

When a new variable hour employee completes an entire
standard measurement period, then the new variable hour
employee must be tested for that standard measurement period
as an ongoing employee.

64. 90 day waiting period

IRS Notice 2012-59:
 The
waiting period must pass before coverage for an
employee or dependent who is otherwise eligible to
enroll under the terms of the plan are effective.
 Conditions for eligibility that are not based solely on
the passage of time are permitted (i.e., employee must
work full-time or work a specified number of hours in a
work period to earn coverage in an eligibility period).

65. 90 Day Waiting Period

IRS Notice 2012-59:
 An
employer may use a measurement period permitted
in Notice 2012-59 to determine when a employee
satisfies the plan’s full-time eligibility condition and will
not violate the 90 day limit on waiting periods if
coverage is made effective no later than 13 months
from the employee’s start date, plus if the employee’s
start date is not the first day of a calendar month, the
time remaining until the first day of the next calendar
month.

66. Timeline for Provisions


On January 1, 2013, all Medicare payroll taxes
increased 0.9 percent (no indexing of inflation, for
a total of 2.35 percent) on wages in excess of
$200,000.00 for individuals and $250,000.00 for
married joint filers. 26 U.S.C. § 105.
Employers are required to withhold wages paged
to any employee in excess of these amounts
regardless of the employee’s filing status or
spouse’s income. Id.

67. Timeline for Provisions


Medicare tax on individuals equal to 3.8 percent on
the lesser of (i) net investment income (including
interest, dividends, royalties, rents, and passive
income); (ii) the excess of modified income over the
threshold amounts. Id.
Salary reduction contributions to a health FSA
offered through a cafeteria plan are limited to
$2,500.00 Id.

68. Timeline for provisions

October 1, 2013
 Employers
required to give existing employees and all
new employees information regarding the existence of
exchanges, availability of subsidies if the employee
purchases coverage through the exchange, and loss of
employer contribution toward the cost of coverage if
the employee purchases coverage through the
exchange. 29 U.S.C. § 218b.
 Failure to provide this notice results in a $100.00 a day
fine until the notice is sent.

69. Timeline for Provisions

January 1, 2014:
All U.S. citizens are required to have “minimum essential
coverage. “ PPACA 1302.
 Employers with more than 50 employees who do not offer
insurance will be assessed 1/12th of $2,000.00 per month
for each full-time employee in the workforce 42 U.S.C. §
4980H (delayed until January 1, 2015).
 Guaranteed issue, rating restrictions, elimination of annual
limits for essential level of plan benefits, elimination of
coverage waiting periods in excess of 90 days delayed until
January 1, 2015.


70. Timeline for Provisions

January 1, 2017:
 States
may permit employers with more than 100
employees to enroll their employees in SHOP
exchanges. PPACA § 1334.

January 1, 2018:
 All
existing plans must cover approved preventative
care and check-ups without copays.

71. Questions?