Speaker Firms and Organization:
Truven Health Analytics
Thomas Halvorson
Analytic Consulting Manager, Practice Leadership
...
 If you experience any technical difficulties during today’s WebEx session, please contact our Technical Support @ 866-77...
 About an hour or so after the event, you'll be sent a survey via email asking you for your feedback on your experience w...
Welcome to the Knowledge Group Unlimited Subscription Programs. 2 Options:
FREE UNLIMITED: This program is free of charge ...
Knowledge Group Unlimited Subscription Programs.
Pricing:
Individual Subscription Fees: (3 Options)
Semi-Annual: $299 one-...
Thank you to our partner firms:

Truven Health Analytics delivers unbiased information, analytic tools,
benchmarks and ser...
Thank you to our partner firms:

WeiserMazars LLP

Butler|Snow LLP, is a full-service law firm with more than 250
attorney...
Brief Speaker Bios:
Thomas Halvorson
Tom Halvorson is a Consulting Manager within the Practice Leadership group at Truven ...
Brief Speaker Bios:
Michael W. Sheridan
Michael W. Sheridan is a partner in the Nashville, Tennessee office of Butler|Snow...
While the Internal Revenue Services (IRS) has deferred some of the reporting and penalty provisions of the Patient
Protect...
Featured Speakers:

SEGMENT 1:

SEGMENT 2:

Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Healt...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

Introduction
Tom Hal...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

•
•
•

Signed into l...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

Avoid surprises lurk...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

EXCHANGES/MARKETPLAC...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

MARKET TRENDS: SHIFT...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

WHAT THIS MEANS TO I...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

18
January 14, 2014
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

WHO IS TRUVEN HEALTH...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

In 2012, we publishe...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

AFFORDABILITY TEST &...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

•
•
•

•

Spouses ty...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

PARTIAL “PLAY” STRAT...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

HOUSEHOLD MODELING
...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

EMPLOYER CASE STUDY
...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

Beginning January 20...
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

27
January 14, 2014
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

28
January 14, 2014
SEGMENT 1:
Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

Employers offering g...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Introduction
Patricia Beaty concentrates her practice in the area ...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility – the “Play or Pay” Provisions
•
•
...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility the “Play or Pay” Provisions
•
•

B...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility the “Play or Pay” Provisions
•

Who...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility the “Play or Pay” Provisions
•
•
•
...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility the “Play or Pay” Provisions
•
•

F...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility
Continued
Determining Who Are Your
...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

•
•

Employer Shared Responsibility Determining Full Time Employee...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Hou...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Hou...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Hou...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Hou...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Hou...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Mea...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Mea...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Mea...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Mea...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Mea...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Mea...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Mea...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Exa...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

•

Employer Shared Responsibility Determining Full Time Employees
...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

•
•
•
•
•
•
•

Employer Shared Responsibility Determining Full Tim...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

•
•
•
•
•
•

Employer Shared Responsibility Determining Full Time ...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

•

Employer Shared Responsibility Determining Full Time Employees
...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Cha...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Cha...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Cha...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Reh...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Reh...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Spe...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Determining Full Time Employees
Edu...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Penalties for Not Playing
•

Decide...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Penalties for Not Playing
•

Offeri...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Considerations in Deciding to Play ...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Considerations in Deciding to Play ...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Penalties for Not Playing
Examples
...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Penalties for Not Playing
Examples
...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Penalties for Not Playing
Examples
...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Employer Shared Responsibility Considerations in Deciding to Play ...
SEGMENT 2:
Patricia L. Beaty
Partner
Krieg DeVault LLP

Disclaimer
•

These slides and the accompanying presentation are f...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Introduction
Michael W. Sheridan is a partner in the Nashville, Te...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Treasury Department’s July 2, 2013
Delay of Employer Shared Respon...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Individual mandate

73
January 14, 2014
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

The Individual Mandate
•

•

•
•

Supreme Court upheld on June 28,...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

The Individual Mandate
•
•
•

§5000A of the Internal Revenue Code ...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

The Individual Mandate
Exempt Individuals
•Individuals who lack ac...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

The Individual Mandate
Penalty Amounts
 (a) 1% of household incom...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Exchanges
or
marketplaces

78
January 14, 2014
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Exchanges or Marketplaces
•
•

Insurance marketplace where individ...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Exchanges or Marketplaces
•
•
•
•

Employers must have provided no...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Exchanges or Marketplaces

*Source: New York Times, October 27, 20...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Small Business Health
Options Program (SHOP)
Marketplace

82
Janua...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Small Business Health Options Program (SHOP) Marketplace
•
•
•

Av...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Small Business Health Options Program (SHOP) Marketplace
•

•

•

...
SEGMENT 3:
Michael W. Sheridan
Partner
Butler|Snow LLP

Small Business Health Options Program (SHOP) Marketplace
•

Tax Cr...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

Introduction
David Wasserstrum possesses ov...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

Special Considerations under the ACA
•

Min...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

Minimum essential coverage
• Beginning in 2...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

Minimum essential coverage
“Minimum Essenti...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

APPLICABLE LARGE EMPLOYER: Controlled group...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

APPLICABLE LARGE EMPLOYER: Controlled Group...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

APPLICABLE LARGE EMPLOYER: Controlled Group...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

APPLICABLE LARGE EMPLOYER: Work outside the...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

Identifying full-time employees
•

Full-tim...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

Variable hour or seasonal employees
• Varia...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

Multiemployer plans
• Employers that Contri...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

Patient-Centered Outcomes Research Institut...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

Patient-Centered Outcomes Research Institut...
SEGMENT 4:

WeiserMazars LLP

David Wasserstrum, CPA
Partner
WeiserMazars LLP

Strategies to reduce cost of employer provi...
Q&A:

SEGMENT 1:

SEGMENT 2:

Thomas Halvorson
Analytic Consulting Manager,
Practice Leadership
Truven Health Analytics

P...
Welcome to the Knowledge Group Unlimited Subscription Programs. 2 Options:
FREE UNLIMITED: This program is free of charge ...
Knowledge Group Unlimited Subscription Programs.
Pricing:
Individual Subscription Fees: (3 Options)
Semi-Annual: $299 one-...
ABOUT THE KNOWLEDGE GROUP :
The Knowledge Group, LLC is an organization that produces live webcasts which examine regulato...
Upcoming SlideShare
Loading in...5
×

The Patient Protection and Affordable Care Act: What Employers Need to Know LIVE Webcast

606

Published on

While the Internal Revenue Services (IRS) has deferred some of the reporting and penalty provisions of the Patient Protection and Affordable Care Act ("PPACA", as amended), employers need to start getting ready as the penalties for noncompliance could relating to employers' be significant. To help business owners/employers understand how PPACA’s provisions apply to them, the Knowledge Group has gathered a panel of distinguished practitioners and thought leaders to address important topics and issues related to PPACA in a substantial two-hour live webcast.

The faculty will discuss the following topics:

- Brief Background of PPACA
- Employer Shared Responsibility: The Penalties
- Small Business Health Care Tax Credit
- Form W-2 Cost of Coverage Reporting
- Health Insurance Reforms
- Automatic Enrollment
- Costs and Access
- Best Practices and Guidance
- Latest regulatory updates

To view the webcasts go to this link: http://youtu.be/vK2meDk0xVE

To learn more about the webcast visit our website: http://theknowledgegroup.org/

Published in: Education, Technology, Business
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
606
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
6
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

The Patient Protection and Affordable Care Act: What Employers Need to Know LIVE Webcast

  1. 1. Speaker Firms and Organization: Truven Health Analytics Thomas Halvorson Analytic Consulting Manager, Practice Leadership Krieg DeVault LLP Patricia L. Beaty Partner Butler|Snow LLP Michael W. Sheridan Partner WeiserMazars LLP David Wasserstrum, CPA Partner Partner Firms: Presented By: WeiserMazars LLP Thank you for logging into today’s event. Please note we are in standby mode. All Microphones will be muted until the event starts. We will be back with speaker instructions @ 11:55am. Any Questions? Please email: Info@knowledgecongress.org Group Registration Policy Please note ALL participants must be registered or they will not be able to access the event. If you have more than one person from your company attending, you must fill out the group registration form. We reserve the right to disconnect any unauthorized users from this event and to deny violators admission to future events. To obtain a group registration please send a note to info@knowledgecongress.org or call 646.202.9344. January 14, 2014
  2. 2.  If you experience any technical difficulties during today’s WebEx session, please contact our Technical Support @ 866-779-3239.  You may ask a question at anytime throughout the presentation today via the chat window on the lower right hand side of your screen. Questions will be aggregated and addressed during the Q&A segment.  Please note, this call is being recorded for playback purposes.  If anyone was unable to log in to the online webcast and needs to download a copy of the PowerPoint presentation for today’s event, please send an email to: info@knowledgecongress.org. If you’re already logged in to the online webcast, we will post a link to download the files shortly.  “If you are listening on a laptop, you may need to use headphones as some laptops speakers are not sufficiently amplified enough to hear the presentations. If you do not have headphones and cannot hear the webcast send an email to info@knowledgcongress.org 2 and we will send you the dial in phone number.“ January 14, 2014
  3. 3.  About an hour or so after the event, you'll be sent a survey via email asking you for your feedback on your experience with this event today - it's designed to take less than two minutes to complete, and it helps us to understand how to wisely invest your time in future events. Your feedback is greatly appreciated. If you are applying for continuing education credit, completions of the surveys are mandatory as per your state boards and bars. 6 secret words (3 for each credit hour) will be given throughout the presentation. We will ask you to fill these words into the survey as proof of your attendance. Please stay tuned for the secret word.  Speakers, I will be giving out the secret words at randomly selected times. I may have to break into your presentation briefly to read the secret word. Pardon the interruption. 3 January 14, 2014
  4. 4. Welcome to the Knowledge Group Unlimited Subscription Programs. 2 Options: FREE UNLIMITED: This program is free of charge with no further costs or obligations. It includes: Unlimited access to over 15,000 pages of course material from all Knowledge Group Webcasts1. Subscribers to this program can download any slides, white papers, or supplemental material covered during all live webcasts. 2 A special discount code which will give you 50% off the purchase of all Live webcast and downloaded recordings. Free Subscription! Cost $0.00 PAID UNLIMITED: Our most comprehensive and cost-effective plan, it includes: Free Access to all LIVE Webcasts (Normally $199 to $349 for each event without a subscription). Sign up for as many as you wish. Free Access to all of Recorded/Archived Events - 1500+ hours of audio material (Normally $299 for each event without a subscription). Free CLE/CPE/CE Processing3 (Normally $49 Per Course without a subscription). Access to over 15,000 pages of course material from Knowledge Group Webcasts.1 Ability to invite a guest of your choice to attend any live webcast Free of charge. (Exclusive benefit only available for PAID UNLIMITED subscribers.) 6 Month Subscription $299 with No Additional Fees. Other options are available. Special Offer: Sign up today and add 2 of your colleagues to your plan for free. Check the “Triple Play” box on the sign-up sheet contained in the link below. 1. As a Knowledge Group Subscriber you will have access to all available course materials with the exception of materials which have been omitted or redacted from the archives as per the request of the speakers or their firms. 2. Course material is generally available one week after the live event broadcast date. 3. CE credit is subject to the approval and issuance of the governing accrediting organization. 4 January 14, 2014
  5. 5. Knowledge Group Unlimited Subscription Programs. Pricing: Individual Subscription Fees: (3 Options) Semi-Annual: $299 one-time fee for a 6 month subscription with unlimited access to all webcasts, recordings, and materials. Annual (Recommended): $499 one-time fee for a 12 month unlimited subscription with unlimited access to all webcasts, recordings, and materials. Month-to-Month: Pay $49 monthly. Cancel anytime (no commitment). GROUP Options Are Available How to sign up (3 ways): Please click the Link Below: https://gkc.memberclicks.net/index.php?option=com_mc&view=mc&mcid=form_157964 Visit our website: http://new2.knowledgecongress.org and click “Subscribe” Send an email to: info@knowledgecongress.org with “Unlimited” in the Subject 5 January 14, 2014
  6. 6. Thank you to our partner firms: Truven Health Analytics delivers unbiased information, analytic tools, benchmarks and services to the healthcare industry. Hospitals, government agencies, employers, health plans, clinicians, and pharmaceutical companies have relied on its solutions for over 30 years. Truven Health Analytics combines deep clinical, financial and healthcare management expertise with innovative technology platforms and information assets to make healthcare better, collaborating with customers to uncover and realize opportunities for improving quality, efficiency, and outcomes. Truven Health Analytics owns some of the most trusted, proven brands in healthcare such as Micromedex, Action OI and Advantage Suite. Truven Health Analytics employs approximately 2000 people worldwide and has its principal offices in Ann Arbor, Mich; Chicago; and Denver. For more information, please visit www.truvenhealth.com. For clients throughout the Midwest and across the country, Krieg DeVault provides clear, practical legal advice that takes in the big picture without losing sight of the details. That's how they approach legal challenges and how they deliver solutions that are focused on your needs, your business and your world. Krieg DeVault was founded in Indianapolis over 130 years ago, but their commitment to listening to their clients has not. Client satisfaction and loyalty have allowed them to grow from a two-lawyer general practice in the mid-1870s to their current status as a premier business-focused law firm. Financial institutions, global manufacturers, national healthcare providers, successful organizations of various sizes and market focus, as well as individuals, all rely on Krieg DeVault for solutions that create success. 6 January 14, 2014
  7. 7. Thank you to our partner firms: WeiserMazars LLP Butler|Snow LLP, is a full-service law firm with more than 250 attorneys representing local, regional, national and international clients from 15 offices globally. Ranked as one of America's Top 100 law firms in the BTI Power Rankings, Butler Snow is recognized as one of the nation's top law firms for client service. The firm was also named by BTI on the Short List of Go-To Law Firms and also rated as a Hidden Gem. For more information, visit www.butlersnow.com or follow Butler Snow on twitter@Butler_Snow. Since 1921, WeiserMazars LLP has provided a unique combination of foresight and experience when fulfilling client needs in accounting, tax and advisory services. WeiserMazars' team of over 100 partners and approximately 650 professionals is based out of six U.S. offices, Israel and the Cayman Islands. As the independent U.S. member firm of the Mazars Group - a prominent international accounting, audit, tax and advisory services organization with nearly 14,000 professionals in more than 70 countries on six continents - WeiserMazars represents clients of all types, including owner-managed businesses, complex, multi-national organizations and high net worth individuals in a multitude of industries. 7 January 14, 2014
  8. 8. Brief Speaker Bios: Thomas Halvorson Tom Halvorson is a Consulting Manager within the Practice Leadership group at Truven Health Analytics, specializing in statistical analysis and financial modeling. With a degree in Actuarial Mathematics from the University of Michigan, Tom assists large employers and health plans by designing plans and programs to affect positive change in their member populations. In the past, Tom has designed models to quantify the implementation of Reference-Based Pricing to promote transparency and consumerism, utilizing Truven Health's MarketScan dataset and proprietary algorithms. Today, he uses his technical abilities to create models that help employers, health plans, and brokers assess both the cost impact and competitive effects of the Affordable Care Act. Patricia L. Beaty Patricia Beaty concentrates her practice in the area of employee benefits and executive compensation. She has experience in the design, implementation and administration of single employer and multiemployer defined benefit plans as well as money purchase, profit sharing, stock bonus, employee stock ownership, performance plans, non-qualified deferred compensation plans, 401(k) and 403(b) plans, Section 125 "cafeteria" plans and Voluntary Employees' Beneficiary Association trusts (VEBAs). Ms. Beaty also audits plans for compliance failures and represents clients before the Internal Revenue Service and the Department of Labor including audits by both agencies and correction of operational failures under the IRS Employee Plans Compliance Resolution System and fiduciary issues under the Department of Labor's Voluntary Fiduciary Correction Program. She also handles issues relating to ERISA, QDROs, COBRA, HIPAA, new comparability or "cross tested" plans, cash balance plans and recent legislation affecting employee benefits. Ms. Beaty also speaks on and advices clients with respect to the Patient Protection and Affordable Care Act. 8 January 14, 2014
  9. 9. Brief Speaker Bios: Michael W. Sheridan Michael W. Sheridan is a partner in the Nashville, Tennessee office of Butler|Snow LLP. He is a frequent speaker on employer decision-making in implementation of the Patient Protection and Affordable Care Act ("ACA"). In addition to working with employers with respect to the ACA, Sheridan's corporate and business practice has an emphasis on financial services and payments companies, including payment systems and information protection and privacy issues. Prior to joining Butler|Snow, Michael served as Executive Vice President, General Counsel and Secretary of Minneapolis-based Ceridian Corporation, an international human resources, payroll, benefits administration and payments company. From 1996 to 2007, he was General Counsel for Ceridian's subsidiaries, Comdata Network, Inc. and Ceridian Stored Value Solutions, Inc., leading providers of payment, stored value and gift card products to the transportation, retail and other industries. Michael holds a bachelor of arts degree, cum laude, from Vanderbilt University and received his doctor of jurisprudence with honors from the University of Tennessee College of Law where he served as managing editor of the Tennessee Law Review. David Wasserstrum, CPA David Wasserstrum possesses over 35 years of experience in public accounting. He specializes in providing consulting, technical and compliance services in the areas of deferred compensation, employee benefits, and executive compensation. David's work includes assisting clients with all pension, compensation, and employee benefit issues, such as qualified retirement plan self-audits, nonqualified deferred compensation plan issues, equity based compensation including stock options and restricted stock, separation pay plans, health and welfare plan issues, merger and acquisition due diligence, services for not-for-profit organizations, IRS examinations, compliance programs, and DOL compliance programs. David also has extensive teaching experience. For over 20 years, David has served as an Associate and/or an Adjunct Professor for New York University, C.W. Post University, and The Stan Ross School of Accountancy at Baruch College, all at the graduate school level. ► For more information about the speakers, you can visit: http://http://www.knowledgecongress.org/speaker_2013_Patient_protection_act.html 9 January 14, 2014
  10. 10. While the Internal Revenue Services (IRS) has deferred some of the reporting and penalty provisions of the Patient Protection and Affordable Care Act ("PPACA", as amended), employers need to start getting ready as the penalties for noncompliance could relating to employers' be significant. To help business owners/employers understand how PPACA’s provisions apply to them, the Knowledge Group has gathered a panel of distinguished practitioners and thought leaders to address important topics and issues related to PPACA in a substantial two-hour live webcast. The faculty will discuss the following topics: •Brief Background of PPACA •Employer Shared Responsibility: The Penalties •Small Business Health Care Tax Credit •Form W-2 Cost of Coverage Reporting •Health Insurance Reforms •Automatic Enrollment •Costs and Access •Best Practices and Guidance •Latest regulatory updates 10 January 14, 2014
  11. 11. Featured Speakers: SEGMENT 1: SEGMENT 2: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics Patricia L. Beaty Partner Krieg DeVault LLP SEGMENT 3: SEGMENT 4: Michael W. Sheridan Partner Butler|Snow LLP David Wasserstrum, CPA Partner WeiserMazars LLP WeiserMazars LLP 11 January 14, 2014
  12. 12. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics Introduction Tom Halvorson is a Consulting Manager within the Practice Leadership group at Truven Health Analytics, specializing in statistical analysis and financial modeling. With a degree in Actuarial Mathematics from the University of Michigan, Tom assists large employers and health plans by designing plans and programs to affect positive change in their member populations. In the past, Tom has designed models to quantify the implementation of Reference-Based Pricing to promote transparency and consumerism, utilizing Truven Health's MarketScan dataset and proprietary algorithms. Today, he uses his technical abilities to create models that help employers, health plans, and brokers assess both the cost impact and competitive effects of the Affordable Care Act. 12 January 14, 2014
  13. 13. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics • • • Signed into law in March 2010 by President Obama Describes new mandates and associates penalties in all corners of the healthcare arena Has survived a number of challenges:  Presidential Election  Supreme Court  Over 30 votes to repeal the act in Congress The ACA is here to stay; here is what you need to know… 13 January 14, 2014
  14. 14. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics Avoid surprises lurking after 2014 14 January 14, 2014
  15. 15. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics EXCHANGES/MARKETPLACE • ACA called for the creation of an Insurance Marketplace in each of the States & D.C. (often called “Public Exchanges”)  Leverage existing health plans to provide a menu of benefit options for individuals  Exchanges also created for small (<50 employees) employers  Slated to be available for large employers beginning in 2018 15 January 14, 2014
  16. 16. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics MARKET TRENDS: SHIFTING RISK • The uncertainty and flux created by the ACA has created opportunities for parties to share risk and potential rewards 16 January 14, 2014
  17. 17. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics WHAT THIS MEANS TO INDIVIDUALS • • • • Individuals must be insured or face penalties  Greater of $95 per individual in household or 1% of household income in 2014  Exemptions have been granted for a number of reasons  Currently, failure to pay this penalty will only lead to garnished tax refunds Generous federal subsidies should make insurance for low income individuals “affordable”  Those ineligible for subsidies may see premium increases in individual Exchange market (or not!) Individuals with insurance will see reduced cost sharing (none) on preventive services, contraception, and other screenings Young adults can remain on their parents plan regardless of education-status until the age of 26 17 January 14, 2014
  18. 18. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics 18 January 14, 2014
  19. 19. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics WHO IS TRUVEN HEALTH? HEALTHCARE Information and decision support tools for healthcare and information professionals, researchers, scientists, consumers OVER 200 EMPLOYERS GE, Verizon, GM, Boeing, Eastman Chemical, State of Tennessee OVER 100 HEALTH PLANS CIGNA, HCSC. OVER 3,000 HOSPITALS Triad, Cedars-Sinai, MSHA FEDERAL GOVERNMENT CMS, AHRQ, CDC, SAMHSA, VA, DOD PHARMA All major U.S. pharma companies OVER 25 STATE GOVERNMENTS North Dakota, South Carolina, Georgia 19 January 14, 2014
  20. 20. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics In 2012, we published a white paper on the financial implications of PPACA based on our data-driven model http://interest.truvenhealth.com/forms/EMPPayorPlayWhitePaper 20 January 14, 2014
  21. 21. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics AFFORDABILITY TEST & MINIMUM ACTUARIAL VALUE • In addition to offering essential benefits, benefit options must meet a minimum actuarial value (MAV) of 60% • Employees must be offered at least one option that satisfies MAV, and has total employee premium contributions no more than 9.5% of the employee’s W-2 wage • This affordability test is applied only to employee-only coverage  This opens up new strategies for spouses and dependent child coverage 21 January 14, 2014
  22. 22. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics • • • • Spouses typically cost more than employees (34% more in 2011**) Many spouses enjoy coverage through their own employer’s plan Financial necessity has compelled many employers to reevaluate spouse and dependent subsidy levels in the past few years Some employers are beginning to implement spousal surcharges or exclusions for spouse’s with own employer coverage * NBGH/Towers Watson. 2013. Reshaping Healthcare: Best Performers Leading the Way ** 3q12 MarketScan Semi Annual Employer Norms Report , p. 44 22 January 14, 2014
  23. 23. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics PARTIAL “PLAY” STRATEGY • Employers with low-wage employees are re-examining group health premium contribution rates  Low cost plan may fail Affordability test for low wage employees  These employees will be eligible for subsidy on Exchange  The 3,000 penalty may be less than the net healthcare cost to the employer  The employee may have lower premium costs, post subsidy, on the Exchange  Potential “win-win” for employer and employee 23 January 14, 2014
  24. 24. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics HOUSEHOLD MODELING  Eddie and his family live in Spokane, WA and Eddie works at a local retailer • Eddie and his family live in Philadelphia, PA and Eddie works at a local retailer. His wife, Rachel, works part-time at a nearby gas station • Combined, the family has a household income of $38,000 (163% of Federal Poverty level for a family of 4) • Eddie has elected the lowest premium available in the CDHP at $2400 annually  Eddie passes the 9.5% affordability test and is ineligible for subsidies on the Public Exchange • Truven Health’s modeling at the household level projects that Eddie would pay over $11,000 in premiums for a Silver Exchange plan  With subsidies, the same Silver plan would cost Eddie $1150  With subsidies, a Bronze plan would be free! 24 January 14, 2014
  25. 25. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics EMPLOYER CASE STUDY • • • CHALLENGE: Determining the financial outcomes of both group health and Public Exchanges for a large employer and their employees – for the next 8 years ACTION: We utilized the PPACA Impact Model to aggregated employee-level household information, allowing for granular evaluation of business units and plan risk migration RESULT: Determined that lower wage individuals were also lower risk, and so partial Exchange migration was not beneficial for this employer “These decisions have huge employee relations and retention implications and a misstep in approach could have serious adverse impact on business operations.” 25 January 14, 2014
  26. 26. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics Beginning January 2018 a non-deductible excise tax for high-cost “Cadillac” plans will be levied on both insured and self-funded employers 40% tax applied to accrual / premium rates in excess of statutory thresholds. Premium thresholds for active employees: $10,200 for individual coverage $27,500 for family coverage These thresholds are increased for retiree groups by $1,650 for individual coverage, and $3,450 for family In subsequent years, these thresholds are indexed to CPI It is likely healthcare trends exceed standard inflation 26 January 14, 2014
  27. 27. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics 27 January 14, 2014
  28. 28. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics 28 January 14, 2014
  29. 29. SEGMENT 1: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics Employers offering group health will pay $63 per member in 2014 for Transitional Reinsurance and $2 per member for PCORTF Large (50+ Employees) electing to not offer group health will have to pay a $2,000 penalty for every full time employee Exiting group health may also have a profound impact on the overall compensation structure of employers, affecting their ability to recruit and retain talent Employers that are currently very engaged in total workforce management may find data hard to come by if claims are paid via Public Exchange 29 January 14, 2014
  30. 30. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Introduction Patricia Beaty concentrates her practice in the area of employee benefits and executive compensation. She has experience in the design, implementation and administration of single employer and multiemployer defined benefit plans as well as money purchase, profit sharing, stock bonus, employee stock ownership, performance plans, non-qualified deferred compensation plans, 401(k) and 403(b) plans, Section 125 "cafeteria" plans and Voluntary Employees' Beneficiary Association trusts (VEBAs). Ms. Beaty also audits plans for compliance failures and represents clients before the Internal Revenue Service and the Department of Labor including audits by both agencies and correction of operational failures under the IRS Employee Plans Compliance Resolution System and fiduciary issues under the Department of Labor's Voluntary Fiduciary Correction Program. She also handles issues relating to ERISA, QDROs, COBRA, HIPAA, new comparability or "cross tested" plans, cash balance plans and recent legislation affecting employee benefits. Ms. Beaty also speaks on and advices clients with respect to the Patient Protection and Affordable Care Act. 30 January 14, 2014
  31. 31. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility – the “Play or Pay” Provisions • • Beginning January 1, 2015, employers must choose between providing health coverage to full-time employees (FTEs) at minimum cost and benefit levels, or the assessment of a federal tax penalty Only “applicable large employers” as defined in the ACA are subject to the penalty assessment; employers with fewer than 50 FTEs are exempt 31 January 14, 2014
  32. 32. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility the “Play or Pay” Provisions • • Both full-time and part-time employees must be included in calculating employer size for application of penalty provisions Employee is considered a full-time employee if working 30 or more hours per week 32 January 14, 2014
  33. 33. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility the “Play or Pay” Provisions • Who are Employees?  Not defined in the ACA  IRS guidance provides that “common law employees” are employees  Will not include a leased employee (414(n)), a greater than 2% S Corporation shareholder, a partner in a partnership or a sole proprietor  Consider consequences if independent contractor later determined to be common law employee 33 January 14, 2014
  34. 34. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility the “Play or Pay” Provisions • • • • • How Do You Define Who is a Full Time Employee? Full-time employee is one who works, on average, 30 or more hours per week. Because determined on monthly basis, may use monthly equivalent of 130 hours per month Hours are generally hours for which paid or entitled to payment Definition is similar to the hours of service definition used for purposes of determining vesting under a qualified retirement plan 34 January 14, 2014
  35. 35. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility the “Play or Pay” Provisions • • For hourly employees, determination of hours is relatively simple – count hours For those for whom hours are not maintained (salaried employees) - may use equivalencies:  Eight hours per day or  Forty hours per week  Employer determines which to use and for which categories  May not use these equivalencies if it does not reflect actual hours worked – 12 hours shifts in hospitals for example 35 January 14, 2014
  36. 36. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Continued Determining Who Are Your Full-Time Employees Penalties 36 January 14, 2014
  37. 37. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP • • Employer Shared Responsibility Determining Full Time Employees Why? Potential Penalty Assessment Determination has been made that an employer is an “applicable large employer” for the purpose of whether or not the employer may become subject to penalties.  Employer will need to determine which of its employees are considered “full-time employees” for the purpose of applying the penalty rules, whether any penalties apply for a particular month and the amount. 37 January 14, 2014
  38. 38. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Hours of Service • Penalties are calculated based on the number of “full-time employees”.  Imperative that an employer understand which of its employees are considered “full-time” and for which months.  Statute defines a full-time employee as an employee who was employed on average at least 30 hours of service per week or 130 hours of service per calendar month.  What is an hour of service? • Each hour for which the employee is paid, or entitled to payment, for the performance of duties for the employer; AND 38 January 14, 2014
  39. 39. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Hours of Service • Each hour for which the employee is paid, or entitled to payment, on account of a period of time during which no duties are performed due to vacation, holiday, illness, incapacity (including disability), layoff, jury duty military duty, or leave of absence (uncapped except in case of employer that is an educational organization, in which case cap is 501 hours)  must also credit certain unpaid leaves of absence  FMLA, USERRA, jury duty (averaging method) • Hourly Employees • Must calculate actual hours of service from records of hours worked and for non-worked hours for which employee entitled to payment 39 January 14, 2014
  40. 40. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Hours of Service • Non-Hourly Employees  3 options 1. same as hourly employees 2. equivalency method of 8 hours of service for each day the employee is entitled to payment (hours worked or not worked such as vacation, etc.) 3. equivalency method crediting 40 hours of service per week for each week the employee is entitled to payment (hours worked and not worked such as vacation, etc.) 40 January 14, 2014
  41. 41. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Hours of Service • May apply different methods for different classifications of non-hourly employees so long as classifications are reasonable and consistently applied. • May change method for each calendar year. • IRS has stated that an employer may not use an equivalency method if the result is to substantially understate an employee’s hours of service in such a way as to cause an employee not to be treated as full-time.  Example: nurse works three days (12 hours per day) a week, actual hours are 36 per week, using 8 hours for each day results in only 24 hours which is less than the 30 for full-time status. NOTE: All hours of service performed for all entities treated as a single employer under the controlled and affiliated service group rules must be taken into account. 41 January 14, 2014
  42. 42. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Hours of Service • Additional guidance expected – IRS has requested comments on how to determine fulltime status where an employee’s hours are limited (airline pilots), not coordinated with hours worked (commissioned sales people) or untracked (adjunct professors). Until more guidance issued must use a reasonable method. IRS has stated that it would be unreasonable to not consider class preparation time for adjunct professors and travel time for a traveling salesman compensated on commission. 42 January 14, 2014
  43. 43. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Measurement Periods • Applicable Time Periods  Impracticable to determine which employees are “full-time” in real time for purpose of providing qualified health coverage - so IRS came up with system using a measurement, administrative and stability period for purpose of determining whether an employee is full-time for the purpose of the penalties. 43 January 14, 2014
  44. 44. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Measurement Periods • • • Look-back period during which you calculate an employee’s hours of service and determine whether they averaged 30 or more hours per week during that period. Must be 3 to 12 consecutive calendar months in length. New employees who are reasonably expected at their start date to be employed an average of 30 hours of service per week must be offered coverage at or before the conclusion of the employee’s initial 3 months of employment in order for the employer to avoid being subject to a penalty for that 3-month period. 44 January 14, 2014
  45. 45. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Measurement Periods • Initial Measurement Period for new variable hour and seasonal employees who have not been employed for one full standard measurement period. For now, seasonal employees are treated as variable hour employees.  Requirement:  Must begin between the employee’s start date and the first day of the next month.  The IMP and the administration period combined cannot extend beyond the last day of the first month following the employee’s 1-year anniversary (13 months and a fraction of a month). 45 January 14, 2014
  46. 46. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Measurement Periods • Standard Measurement Period for on-going employees who are employees who have been employed for at least one full standard measurement period.  3 to 12 months in length  Must be uniform for all employees within applicable category  Permitted categories: collectively bargained and non-collectively bargained, salaried and hourly employees, employees covered by different collective bargaining agreements and employees in different states. 46 January 14, 2014
  47. 47. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Measurement Periods • Stability Period  Period for which an employee’s status as a full-time or part-time employee, based on hours during the measurement period, is locked-in.  Status cannot be changed during this period regardless of the number of hours the employee works during the stability period.  Stability period begins at the end of the measurement or administrative period. 47 January 14, 2014
  48. 48. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Measurement Periods • • Employee averages 30 or more hours per week:  Stability period must be the longest of: (a) 6 months; (b) length of the initial measurement period; or (c) the length of the standard measurement period.  Length must be the same for new employees and ongoing employees. Employee averages less than 30 hours per week:  Stability period for ongoing employees can be no longer than the standard measurement period.  Stability period for new employees (VH and Seasonal) can be no longer than the initial measurement period and the employee’s status must be redetermined during the first overlapping standard measurement period. 48 January 14, 2014
  49. 49. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Measurement Periods • Administrative Period  Optional – not required to have one.  Begins at the end of the measurement period and ends before the beginning of the next stability period.  The period of time during which an employer calculates the number of hours during the measurement period, provides enrollment materials and conducts the open enrollment process.  Cannot exceed 90 days. 49 January 14, 2014
  50. 50. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Examples • SMP = October 15 – October 14 • SP = January 1 – December 31 • AP = October 14 – December 31 • Employee A averaged 30 hours of service/wk during SMP 10/15/15 -10/14/16 and all prior SMPs. Employee B averaged less than 30 hrs. during SMP 10/15/15 - 10/14/16 but averaged 30 hrs. during all prior SMPs. • Employee A is an on-going, full-time employee for 1/1/17 - 12/31/17 SP and must be offered coverage for that period. • Employee B is also an on-going employee for the 1/1/17 - 12/31/17 SP but is not considered a fulltime employee for that period and employer not required to offer coverage for that period. 50 January 14, 2014
  51. 51. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP • Employer Shared Responsibility Determining Full Time Employees Examples Same as prior example  12 mo. IMP with 1 and partial mo. AP  Employee C hired 5/10/15  IMP 5/10/15 - 5/9/16; AP 5/10/16 - 6/30/16; SP 7/1/16 - 6/30/17  Employee C averages 30 hrs/wk during IMP. Employee C must be offered coverage for the entire SP.  Employee C would be tested again by looking at hours for the 10/15/15 - 10/14/16 (the first SMP that begins after C’s start date). 51 January 14, 2014
  52. 52. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP • • • • • • • Employer Shared Responsibility Determining Full Time Employees Examples IMP - begins on start date, length 6 months AP - end of IMP through end of 1st month beginning after end of IMP SP - January 1-June 30 Employee D hired 10/10/15 IMP 10/10/15 - 4/9/16; AP 4/10/16 - 5/31/16; SP 6/1/16 - 11/30/16 Employee D averages 30 hr/wk during IMP must be offered coverage for the entire SP 6/1/16 11/30/16. Employee D must be tested again by looking at hours during the period 1/1/16 - 6/30/16 (first SMP that begins after start date) 52 January 14, 2014
  53. 53. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP • • • • • • Employer Shared Responsibility Determining Full Time Employees Examples Continue with Employee D – same facts Employee D averages <30 hrs/wk 1/1/16 - 6/30/16 Employee D not considered full-time for the SP 7/1/16 - 12/31/16 Employee D must continue to be offered coverage through 11/30/16 (the end of the initial SP based on the IMP). Employee D need not be offered coverage for the SP 7/1/16 - 12/31/16 which means he need not be covered in December of 2016. He would need to be retested during MP 7/1/16 – 12/31/16 to determine if he receives coverage 1/1/17. 53 January 14, 2014
  54. 54. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP • Employer Shared Responsibility Determining Full Time Employees Change in Status What happens where an employee has a change in employment status?  If an on-going employee’s (employed for one full standard measurement period) status changes before the end of a stability period, the change will not affect the employee’s status as full-time or not full-time for the remainder of the stability period.  If a new employee has a status change during his initial measurement period such that had the employee started his employment under this new status he would have been reasonably expected 54 January 14, 2014
  55. 55. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Change in Status • to avg. 30 or more hours per week and therefore would not have been treated as a variable hour employee, the employee will be considered full-time on: 1. the first day of the 4th month following the change in employment status, or 2. if earlier and the employee averages 30 or > hours per week during the initial measurement period, the first day of the 1 st month following the end of the IMP (including any associated administrative period). 55 January 14, 2014
  56. 56. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Change in Status: Example • Example: Employer A, 12 mo. IMP begins on date of hire, AP=end of IMP through end of the first calendar month beginning on or after the end of the IMP. John is a new variable hour employee hired 5/10/15.  IMP would be 5/10/15-5/10/16  AP would be 5/10/16-6/30/16 Effective 9/15/2015 John is promoted to a position where he is reasonably expected to work at least 30 hours per week. 56 January 14, 2014
  57. 57. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Change in Status: Example • • • The first day of the 4th month following John’s change in status is January 1, 2016; The first day of the month following John’s IMP and its associated AP is July 1, 2016 (IMP 5/10/155/10/16, AP 5/10/16-6/30/16). Because January 1, 2016 is before July 1, 2016, John will be treated as a full-time employee for penalty purposes as of January 1, 2016. 57 January 14, 2014
  58. 58. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Rehired Employees • • • Two methods of determining whether the employee will be a continuing employee and thus retain his status as full-time or not full-time upon re-employment: 1. 26 week break – if the employee had at least 26 consecutive weeks without an hour of service he can be treated as a new employee. 2. Rule of Parity – must elect (not sure how yet) if want to use a break shorter then 26 weeks 58 January 14, 2014
  59. 59. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Rehired Employees • if the employee’s number of weeks during which no services were performed is at least 4 weeks long and if it exceeds the number of weeks he was employed immediately preceding the period during which no services were performed, the employee can be treated as a new employee. 59 January 14, 2014
  60. 60. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Special Unpaid Leaves of Absence • Averaging rule for “Special Unpaid Leave” – FMLA, USERRA and Jury Duty 2 Options: 1. Average hours by excluding break; or 2. Impute hours during the break at a rate equal to the average weekly hours of service for weeks that are not part of the break. 60 January 14, 2014
  61. 61. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Determining Full Time Employees Educational Organizations • • • Averaging rule, similar to special unpaid leave, to prevent periods during which classes are not in session from artificially reducing an employees hours during a measurement period. 2 Options for Employer: 1. exclude any break when calculating hours during the measurement period; or 2. impute hours for the break at rate equal to the average weekly hours for weeks other than the break. Note: An educational organization is not required to take into account more than 501 hours of service for all breaks during a single calendar year. 61 January 14, 2014
  62. 62. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Penalties for Not Playing • Decide Not to Offer Minimum Essential Coverage to Employees  If one or more full-time employees receive a premium subsidy through an exchange, the employer is subject to a monthly penalty equal to the number of full-time employees in excess of 30 multiplied by 1/12 of 2,000 or $166.67 for each applicable month. 62 January 14, 2014
  63. 63. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Penalties for Not Playing • Offering Coverage that is Unaffordable or Below Minimum Value  If one or more full-time employees receive a premium subsidy through an exchange and the employer offers coverage but that coverage is either unaffordable or does not provide minimum value, the employer is subject to a monthly penalty equal to the number of full-time employees receiving a subsidy multiplied by 1/12 of $3,000 or $250 for each applicable month.  This penalty is subject to cap equal to the penalty the employer would have been assessed if no coverage offered.  No penalty if employer provides a free choice voucher to employees for whom coverage is unaffordable 63 January 14, 2014
  64. 64. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Considerations in Deciding to Play or Pay Penalties for Not Playing • Employees who are offered employer coverage but who do not enroll may be eligible to receive a premium subsidy if either:  Their employer coverage is unaffordable, or  Their employer coverage does not provide minimum value 64 January 14, 2014
  65. 65. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Considerations in Deciding to Play or Pay Penalties for Not Playing • • Employer provided coverage is unaffordable if the employee’s cost of self-only coverage exceeds 9.5% of their household income – employee’s W2 under IRS safe harbor. Employer provided coverage does not provide minimum value if it pays for less than 60%, on average, of covered health care expenses. 65 January 14, 2014
  66. 66. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Penalties for Not Playing Examples • Large employer with 50 full-time employees unchanged throughout the plan year:  Employer does not offer health coverage to its employees.  No employee obtains a premium credit for exchange coverage.  Penalty Amount = $0 66 January 14, 2014
  67. 67. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Penalties for Not Playing Examples • Large employer with 50 full-time employees unchanged throughout the plan year:  Employer does not offer minimum essential health coverage to its employees.  Three full-time employees obtain coverage through the exchange and a premium credit.  Penalty Amount = $40,000 for the plan year (50 full-time employees minus 30) * $2,000 67 January 14, 2014
  68. 68. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Penalties for Not Playing Examples • Large employer with 50 full-time employees unchanged throughout the plan year:  Employer offers coverage to its employees.  Three full-time employees receive a premium credit for exchange coverage.  Penalty Amount = $9,000 o Lesser of: − 3 * $3,000 = $9,000; or − (50-30) * $2,000 = $40,000 68 January 14, 2014
  69. 69. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Employer Shared Responsibility Considerations in Deciding to Play or Pay Other than the Penalties • • • • • Employees have come to expect certain benefits  Recruiting, retention, motivation Gross up wages to combat loss of coverage  May need to gross up more to cover tax for employee Penalties will go up and are not tax deductible Law is new, complex and still changing Employee Distractions 69 January 14, 2014
  70. 70. SEGMENT 2: Patricia L. Beaty Partner Krieg DeVault LLP Disclaimer • These slides and the accompanying presentation are for educational purposes only and are not intended, and should not be relied upon, as legal advice. Patricia L. Beaty, Esq. Krieg DeVault, LLP One Indiana Square, Suite 2700 Indianapolis, IN 46204 pbeaty@kdlegal.com (317)238-6278 KD5929832v1pbeaty@kdlegal.com 70 January 14, 2014
  71. 71. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Introduction Michael W. Sheridan is a partner in the Nashville, Tennessee office of Butler, Snow, O'Mara, Stevens & Cannada, PLLC. He is a frequent speaker on employer decision-making in implementation of the Patient Protection and Affordable Care Act ("ACA"). In addition to working with employers with respect to the ACA, Sheridan's corporate and business practice has an emphasis on financial services and payments companies, including payment systems and information protection and privacy issues. Prior to joining Butler|Snow, Michael served as Executive Vice President, General Counsel and Secretary of Minneapolis-based Ceridian Corporation, an international human resources, payroll, benefits administration and payments company. From 1996 to 2007, he was General Counsel for Ceridian's subsidiaries, Comdata Network, Inc. and Ceridian Stored Value Solutions, Inc., leading providers of payment, stored value and gift card products to the transportation, retail and other industries. Michael holds a bachelor of arts degree, cum laude, from Vanderbilt University and received his doctor of jurisprudence with honors from the University of Tennessee College of Law where he served as managing editor of the Tennessee Law Review. 71 January 14, 2014
  72. 72. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Treasury Department’s July 2, 2013 Delay of Employer Shared Responsibility Provision • • Delay did NOT postpone:  Other ACA provisions:  The individual mandate – still effective January 1, 2014  Roll-out of federal and state insurance marketplaces or exchanges  Potential tax subsidies for individuals  New fees and taxes (i.e., PCORI, reinsurance fee, health insurer tax, Medicare tax, etc. BUT – marketplaces limited in ability to verify an applicant’s:  Income  Insurance coverage offered through employer 72 January 14, 2014
  73. 73. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Individual mandate 73 January 14, 2014
  74. 74. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP The Individual Mandate • • • • Supreme Court upheld on June 28, 2012 (National Federation of Independent Business v. Sebelius) Effective January 1, 2014, individuals must have minimal health coverage or pay an annual penalty Penalty: Greater of $ amount or specified % of income Question: Is penalty substantial enough to encourage healthy and/or younger persons to obtain health coverage? 74 January 14, 2014
  75. 75. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP The Individual Mandate • • • §5000A of the Internal Revenue Code (§1501(a) of the Affordable Care Act) Final Rule issued August 27, 2013 General Rule: Individuals must pay a “shared responsibility payment” for each month a person (or a person’s dependent) does not have “minimum essential coverage” (MEC) 75 January 14, 2014
  76. 76. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP The Individual Mandate Exempt Individuals •Individuals who lack access to “affordable” coverage are exempt  For year 2014: coverage costing taxpayer 8% or less of household income is considered affordable •Short coverage gap exemption  <3 full calendar months •Retirees and COBRA eligible persons •Hardship Exemptions  Persons whose policies were cancelled in 2013 •Native American Tribes 76 January 14, 2014
  77. 77. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP The Individual Mandate Penalty Amounts  (a) 1% of household income in excess of applicable filing threshold, increasing to 2.5% in 2016;  (b) $95 per uninsured adult, increasing to $695 in 2016 •Under (a), liability could not exceed national average premium for bronze coverage •Under (b), liability for uninsured minor dependents is ½ that of adults, though penalties would not exceed 300% of penalty for a single adult •No Escape for Liability for Dependents: Even if a taxpayer does not claim the dependent or the other parent has a legal obligation to provide health coverage (e.g., pursuant to terms of divorce) 77 January 14, 2014
  78. 78. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Exchanges or marketplaces 78 January 14, 2014
  79. 79. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Exchanges or Marketplaces • • Insurance marketplace where individuals and small businesses may purchase health insurance which meets the minimum ACA requirements Purpose: to assist individuals with the purchase of qualified health coverage  Subsidies will be available for individuals to purchase insurance: Household Size 79 January 14, 2014
  80. 80. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Exchanges or Marketplaces • • • • Employers must have provided notice of Marketplace by Oct. 1, 2013 (Dept. of Labor Tech. Release 2013-02) Administered by the government  States or Federal Government Health Plans provided by private insurers and non-profit organizations Enrollment began October 2013 80 January 14, 2014
  81. 81. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Exchanges or Marketplaces *Source: New York Times, October 27, 2013, §1 at 16. Updated December 11, 2013. Data based on Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation Issue Brief: Health Insurance Marketplace December 2013 Enrollment Report 81 January 14, 2014
  82. 82. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Small Business Health Options Program (SHOP) Marketplace 82 January 14, 2014
  83. 83. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Small Business Health Options Program (SHOP) Marketplace • • • Available now to employers with 50 or fewer Full-time Equivalent Employees (FTEs)  January 1, 2016 : available for businesses with 100 or fewer FTEs Generally required participation rate of SHOP plan: 70%, but varies  6 states require 75% participation rate; Tennessee requires 50% Online SHOP enrollment delayed until November 2015  Direct enrollment process in effect for 2014 plan year through an agent or broker 83 January 14, 2014
  84. 84. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Small Business Health Options Program (SHOP) Marketplace • • • In 2014: Employee choice model delayed in federally-operated SHOP states  Multiple plan offerings for SHOP enrollees optional in 2014, although most state-run models offer multiple plan offerings In 2015 and following years:  SHOP must offer employee choice of all plans in a metal level  Additional options may be made available to employers by entity operating SHOP exchange Employers choose among metal levels of premium contribution:  Bronze (60%)  Silver (70%)  Gold (80%)  Platinum (90%) 84 January 14, 2014
  85. 85. SEGMENT 3: Michael W. Sheridan Partner Butler|Snow LLP Small Business Health Options Program (SHOP) Marketplace • Tax Credit: For Tax Year 2014, small business tax credit available only for plans purchased in SHOP Marketplace  Fewer than 25 FTE’s  This credit will only be available for a 2-year consecutive period  Maximum Tax Credit rate for years 2014 and beyond: 50% of cost to employer (35% for taxexempt employers)  Credits decrease as groups size and employee wages increase 85 January 14, 2014
  86. 86. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP Introduction David Wasserstrum possesses over 35 years of experience in public accounting. He specializes in providing consulting, technical and compliance services in the areas of deferred compensation, employee benefits, and executive compensation. David's work includes assisting clients with all pension, compensation, and employee benefit issues, such as qualified retirement plan self-audits, nonqualified deferred compensation plan issues, equity based compensation including stock options and restricted stock, separation pay plans, health and welfare plan issues, merger and acquisition due diligence, services for not-for-profit organizations, IRS examinations, compliance programs, and DOL compliance programs. David also has extensive teaching experience. For over 20 years, David has served as an Associate and/or an Adjunct Professor for New York University, C.W. Post University, and The Stan Ross School of Accountancy at Baruch College, all at the graduate school level. 86 January 14, 2014
  87. 87. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP Special Considerations under the ACA • Minimum Essential Coverage defined • Controlled Groups • Employees inside and outside the United States • Variable and seasonal employees • Multi-employer plans • PCORI Fees • STRATEGIES to REDUCE COST of EMPLOYER PROVIDED BENEFIT PLANS 87 January 14, 2014
  88. 88. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP Minimum essential coverage • Beginning in 2014, all US citizens and legal residents will be required to have “minimum essential coverage“ (“MEC”) for themselves and dependents or face a “shared responsibility payment” (“SRP”)”  AKA the Mandate  The Congressional Budget Office estimates that below 2% of Americans will owe a SRP • MEC means the coverage is “affordable” and provides “minimum value” • Individuals have MEC if they are covered by a(n):  Government sponsored plan  Medicare Part A  Medicaid  CHIP  TRICARE (for uniformed services personnel) 88 January 14, 2014
  89. 89. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP Minimum essential coverage “Minimum Essential Coverage” (cont’d from prior slide) • Employer sponsored plan, including COBRA Coverage • Individual plan from an insurance exchange when individual may be eligible for premium assistance if his/her income is between 100% and 400% of the Federal Poverty Level (FPL) • Insurance plan purchased directly from insurance company agents • MEC excludes:  Dental care  Vision Care  Worker’s compensation 89 January 14, 2014
  90. 90. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP APPLICABLE LARGE EMPLOYER: Controlled groups • Controlled Group Rules  An employers that is not an Applicable Large Employer also may be subject to the employer mandate if it is a member of a commonly controlled group of trades or businesses, known a “controlled group".  A controlled group is considered a single employer for purposes of determining whether the 50-employee threshold is met.  The requirements then apply to each individual employer in the group, regardless of whether the employer itself has 50 employees.  The 30-employee exclusion is allocated pro rata among the members of a controlled group based on the number of full-time employees of each.  Where the combined total of full-time or full-time equivalent employees in a controlled group is at least 50, each individual employer is subject to the employer mandate, even if such employer itself does not employ enough employees to meet the threshold.  The rules for combining related employers do not apply for purposes of determining whether an employer owes an Employer Shared Responsibility payment or the amount of any payment 90 January 14, 2014
  91. 91. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP APPLICABLE LARGE EMPLOYER: Controlled Groups • Under §§414(b), (c), and (o), of the Internal Revenue Code (the "Code"), a controlled group exists when any two or more entities are connected through ownership in a parent-subsidiary controlled group, a brother-sister controlled group, or a combination of the foregoing. Any type of business entity can be a member of a controlled group for benefit plan purposes, for example, a corporation, partnership, sole proprietorship or limited liability company. There generally are three types of controlled groups:  A "parent-subsidiary" controlled group exists when a parent company directly or indirectly owns 80% of a subsidiary organization;  A "brother-sister" controlled group exists where the same five or fewer persons own more than 80% of two or more other entities and own more than 50% when taking into account the ownership of each person only to the extent that it is identical with respect to each such entity; and  A "combined" controlled group exists where a group includes both parent-subsidiary and brother-sister members. 91 January 14, 2014
  92. 92. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP APPLICABLE LARGE EMPLOYER: Controlled Groups • The controlled group rules apply for purposes of determining whether an employer meets the 50 fulltime employee threshold, regardless of whether the parent or owner is located in the United States.  For example, a foreign-based company with several subsidiaries in the United States must aggregate the employees of the parent and all subsidiaries who work in the United States for purposes of complying with the ACA. This requirement may be problematic for foreign-owned subsidiaries operating in separate lines of business that may or may not know of the existence of the other related companies because of the pro rata allocation of the 30-employee exclusion and required coverage of all but 5% of employees, or five full-time employees, if greater. 92 January 14, 2014
  93. 93. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP APPLICABLE LARGE EMPLOYER: Work outside the united states Companies with Employees Working outside the United States • For purposes of determining whether an employer meets the 50 FT or FT plus FTEs threshold, an employer generally will take into account only work performed in the United States. • For example, if a foreign employer has a large workforce worldwide, but fewer than 50 FT or FTEs in the United States, the foreign employer generally would not be subject to the Employer Shared Responsibility provisions. • If a company employs U.S. citizens working abroad, the company is subject to the employer mandate only if it had at least 50 FTs or a combination of FTs and FTEs, determined by taking into account only work performed in the United States.  The Individual Mandate applies to the U.S. citizens • Employees working only abroad, whether or not U.S. citizens, generally will not be taken into account for this purpose. 93 January 14, 2014
  94. 94. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP Identifying full-time employees • Full-time Employee: All employees who work on average at least 30 hours of service per week (or 130 hours of service per month) • Full-time Equivalent Employee: Any employee who was not a FT for any month in the preceding calendar year is included in the calculation by:  Step 1: Calculate aggregate hours of service per month for non-full time employees (up to 120 hours per employee)  Step 2: Divide total aggregate hours by 120 • For hourly employees, Hours of Service include  Paid performance: Each hour for which an employee is paid, or entitled to payment, for performance of duties for the employer  Paid leave: Each hour for which employee is paid, or entitled to payment, but no duties are performed (e.g. vacation, holiday, illness, disability, layoff, jury duty, military leave) • Three methods for measuring hours of service for non-hourly employees:  Actual hours worked  Daily Equivalency- credit 8 hours of service per day that 1 hour is performed  Weekly Equivalency- credit 40 hours of service per week that 1 hour is performed  94 January 14, 2014
  95. 95. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP Variable hour or seasonal employees • Variable Hour or Seasonal Employees: if the employer uses the look-back measurement method for its ongoing employees, the employer may use the same method for new variable hour and seasonal employees  Variable hour employee: based on the facts and circumstances at the start date, it cannot be determined that the employee is reasonably expected to work an average of 30 hours of service per week  Initial measurement period: must be at least 3 but not more than 12 months and begin on any date between the employee’s start date and the first day of the first calendar month following the employee’s start date  Initial stability period: must be the same as the stability period for ongoing employees and begins immediately after the initial measurement period and any applicable initial administrative period 95 January 14, 2014
  96. 96. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP Multiemployer plans • Employers that Contribute to Multiemployer Plans  Service at participating employers in a multiemployer health plan generally is aggregated to determine an employee's hours even though the participating employers generally are not related.  Employers contributing to a multiemployer health may not know how many hours any individual employee worked because collective bargaining agreements may provide that contributions are based on requirements other than hours worked, such as on a days worked, projects completed, or a percentage of earnings.  The proposed regulations provide a transition rule that will apply through 2014 for contributions made by large employers participating in a multiemployer health plan. The transition rule provides that a large employer will not owe the SRP for a full-time employee if the following three criteria are met:  The employer is required to contribute to a multiemployer plan with respect to that employee pursuant to a collective bargaining agreement or participation agreement,  Coverage is offered under the multiemployer plan to the full-time employee (and the employee’s dependent children), and  The coverage offered to the full-time employee is affordable and provides minimum 96 value. January 14, 2014
  97. 97. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP Patient-Centered Outcomes Research Institute • PCORI Fees  Funds Patient-Centered Outcomes Research Institute (“PCORI”)  The Institute will assist patients, clinicians, purchasers and policy-makers in making informed health decisions by advancing clinical effectiveness research • IRC §4376(a) imposes the PCORI fee on an applicable self-insured health plan for each plan year ending after September 30, 2012 and before September 30, 2019. An applicable self-insured health plan is a plan that provides for accident or health coverage where any portion of the plan’s coverage is not provided through an insurance policy and such plan is established or maintained:  by one or more employers for the benefit of their employees or former employees  by one or more employee organizations for the benefit of their members or former members  jointly by one or more employers and one or more employee organizations for the benefit of employees or former employees  by a voluntary employee’s beneficiary association  by other specified organizations including a multiple-employer welfare arrangement 97 January 14, 2014
  98. 98. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP Patient-Centered Outcomes Research Institute Calculation and payment of PCORI Fee for Self-Insured Health Plans • The PCORI fee is calculated as follows:  For plans ending after September 30, 2012 and before October 1, 2013 - $1 x the average number of lives covered during the policy period  For plans ending after September 30, 2013 and before October 1, 2014 - $2 x the average number of lives covered during the policy period  For plans beginning on or after October 1, 2014 the fee per life covered will be determined by the Secretary of Health and Human Services based on the inflation in national health expenditures • Self-insured plans may determine the “average number of covered lives” as follows:  Actual Count Method – Calculate the sum of lives covered for each day of the plan year and divide that sum by the number of days in the plan year  Snapshot Method – Calculate the total number of lives covered on a date in each quarter of the plan year (or more dates if an equal number of dates is used for each quarter) and divide that total by the number of dates on which a count was made  Form 5500 Method – Determine the number or reportable participants on the plan’s Form 5500. If the plan covers individuals other than the employee (spouses and dependents), calculate the sum of the total participants reported on Form 5500 at the beginning and at the end of the plan year. • The first annual fee payment for plan years ending after September 30, 2012 and before October 1, 2019 is due by July 31, 2013. The fees are due annually and reported on IRS Form 720 . Payment is made with Form 720-V. 98 January 14, 2014
  99. 99. SEGMENT 4: WeiserMazars LLP David Wasserstrum, CPA Partner WeiserMazars LLP Strategies to reduce cost of employer provided benefit plans • Health Savings Accounts (HSAs)- These accounts are tied to High Deductible Health Plans and shift to employees.  Also super-charged IRAs • Wellness programs that reward and incentivize employees go hand-in-hand with HSA and HRA plans. Biometric screenings, health fairs, weight loss, exercise and stop smoking programs ultimately will help lower healthcare costs through lower claims.  Empirical evidence- Americans do not take advantage of wellness programs • Conduct dependent audits • Small and mid-sized companies should consider self-insured plans.  Insurers are coming out with new products for this group who wants to control costs and plan design. • Negotiate commissions with brokers (generally groups 100 and above) • Reduce employer cost for ancillary plans such as long term disability and life insurance through use of voluntary (after-tax) employee paid plans 99 January 14, 2014
  100. 100. Q&A: SEGMENT 1: SEGMENT 2: Thomas Halvorson Analytic Consulting Manager, Practice Leadership Truven Health Analytics Patricia L. Beaty Partner Krieg DeVault LLP SEGMENT 3: SEGMENT 4: Michael W. Sheridan Partner Butler|Snow LLP David Wasserstrum, CPA Partner WeiserMazars LLP WeiserMazars LLP ► You may ask a question at anytime throughout the presentation today. Simply click on the question mark icon located on the floating tool bar on the bottom right side of your screen. Type your question in the box that appears and click send. ► Questions will be answered in the order they are received. 100 January 14, 2014
  101. 101. Welcome to the Knowledge Group Unlimited Subscription Programs. 2 Options: FREE UNLIMITED: This program is free of charge with no further costs or obligations. It includes: Unlimited access to over 15,000 pages of course material from all Knowledge Group Webcasts1. Subscribers to this program can download any slides, white papers, or supplemental material covered during all live webcasts. 2 A special discount code which will give you 50% off the purchase of all Live webcast and downloaded recordings. Free Subscription! Cost $0.00 PAID UNLIMITED: Our most comprehensive and cost-effective plan, it includes: Free Access to all LIVE Webcasts (Normally $199 to $349 for each event without a subscription). Sign up for as many as you wish. Free Access to all of Recorded/Archived Events - 1500+ hours of audio material (Normally $299 for each event without a subscription). Free CLE/CPE/CE Processing3 (Normally $49 Per Course without a subscription). Access to over 15,000 pages of course material from Knowledge Group Webcasts.1 Ability to invite a guest of your choice to attend any live webcast Free of charge. (Exclusive benefit only available for PAID UNLIMITED subscribers.) 6 Month Subscription $299 with No Additional Fees. Other options are available. Special Offer: Sign up today and add 2 of your colleagues to your plan for free. Check the “Triple Play” box on the sign-up sheet contained in the link below. 1. As a Knowledge Group Subscriber you will have access to all available course materials with the exception of materials which have been omitted or redacted from the archives as per the request of the speakers or their firms. 2. Course material is generally available one week after the live event broadcast date. 3. CE credit is subject to the approval and issuance of the governing accrediting organization. 101 January 14, 2014
  102. 102. Knowledge Group Unlimited Subscription Programs. Pricing: Individual Subscription Fees: (3 Options) Semi-Annual: $299 one-time fee for a 6 month subscription with unlimited access to all webcasts, recordings, and materials. Annual (Recommended): $499 one-time fee for a 12 month unlimited subscription with unlimited access to all webcasts, recordings, and materials. Month-to-Month: Pay $49 monthly. Cancel anytime (no commitment). GROUP Options Are Available How to sign up (3 ways): Please click the Link Below: https://gkc.memberclicks.net/index.php?option=com_mc&view=mc&mcid=form_157964 Visit our website: http://new2.knowledgecongress.org and click “Subscribe” Send an email to: info@knowledgecongress.org with “Unlimited” in the Subject 102 January 14, 2014
  103. 103. ABOUT THE KNOWLEDGE GROUP : The Knowledge Group, LLC is an organization that produces live webcasts which examine regulatory changes and their impacts across a variety of industries. “We bring together the world's leading authorities and industry participants through informative two-hour webcasts to study the impact of changing regulations.” If you would like to be informed of other upcoming events, please click here. Disclaimer: The Knowledge Group, LLC is producing this event for information purposes only. We do not intend to provide or offer business advice. The contents of this event are based upon the opinions of our speakers. The Knowledge Congress does not warrant their accuracy and completeness. The statements made by them are based on their independent opinions and does not necessarily reflect that of The Knowledge Congress' views. In no event shall The Knowledge Congress be liable to any person or business entity for any special, direct, indirect, punitive, incidental or consequential damages as a result of any information gathered from this webcast. Certain images and/or photos on this page are the copyrighted property of 123RF Limited, their Contributors or Licensed Partners and are being used with permission under license. These images and/or photos may not be copied or downloaded without permission from 123RF Limited. 103 January 14, 2014
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×