Health Care Reform Bootcamp
An Overview of the Affordable Care Act (ACA) for
Park City Businesses
The Online Alternative to Group Health Insurance
(like 401k for Health Benefits)
The ZaneHRA Software provides a 100% pape...
Additional FREE Resources: Health Care Reform & Defined Contribution
View all of our free eBooks, Whitepapers and On-Deman...
Agenda
1. Why did ACA (or "ObamaCare") get passed?
2. What you need to know about "ObamaCare"
3. What is the "Individual H...
Why did ACA (or "ObamaCare") Get Passed?
The Current (Employer-Based) System is NOT Sustainable
U.S. is shifting to Individual
Health Insurance
What you need to know about "ObamaCare"
What are Your Options?
As a business, you have three primary choices regarding health benefits:
1. Play (I.e. Offer Group ...
Here's What You Need to Know!
In order to evaluate your options, you must understand the following key
"ObamaCare" provisi...
The Major Changes to the Individual Health Insurance Market
The "major" provisions primarily affect the individual market....
What is the "Individual Health Insurance Marketplace"?
What is the Individual Health Insurance Marketplace?
Earlier this year, the government re-branded health insurance exchang...
Understanding How the Health Insurance Marketplace Works
Step 1: Individual goes to his or her state's Individual Health I...
Advantages of the Individual Health Insurance Marketplace
The Individual Health Insurance Marketplace will
have the follow...
#1 Choice
Individuals will be able to choose the health insurance plan that best fits their families'
needs based on stand...
#2 Portability
Individual health insurance is not tied to employment, meaning they will be able to take
their health insur...
#3 One Stop Shop / Convenience
One Website and One Application gets individual access to:
● All available plan options
● P...
#4 Tax Subsidies
SPECIAL INCENTIVE:
Massive tax subsidies* will be available for
households earning up to 400% of the FPL ...
Household Income & Size are Key Variables for Individuals
Tax subsidy calculator at
http://navigator.zanebenefits.com
Hous...
Individual Marketplace Notice Requirement
Employers* must provide written notice to all current employees (regardless of
f...
What is the "Employer Mandate"?
What is the "Employer Mandate"?
Starting January 1st, 2014 2015*, the "Employer Mandate" (aka
"Play or Pay") requires cert...
How to Calculate Full-Time Equivalent Employees (FTEs)
How to Calculate Full-Time Equivalent Employees (FTEs)
● FTEs = Ful...
An Overview of Tax Penalty
Employers with less than 50 FTEs are NOT subject to this requirement.
If you have >50 FTEs, you...
Two Potential
Employer Tax Penalties
Now Starting in 2015
1. Penalty for Not Offering
Insurance
2. Penalty if Insurance is...
How to evaluate your "ObamaCare" options
How to Decide Your Health Care Reform Strategy?
1. Determine if you are subject to the "Employer Mandate" (starting in 201...
Summary/Next Steps
Summary/Next Steps
Summary (cont.)
● The Core Problem is that Employer Health Insurance Costs Too Much.
● Starting in 2014...
Additional FREE Resources: Health Care Reform & Defined Contribution
View all of our free eBooks, Whitepapers and
On-Deman...
The ZaneHRA Software provides a 100% paperless administration experience to employers and insurance
professionals that wan...
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Zane Benefits & Park City Chamber Webinar: Health Care Reform Bootcamp

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The key health care reform laws that impact your business and what you can do about it: http://www.zanebenefits.com/health-care-reform-park-city-chamber-webinar

Health care reform is changing the landscape of employee benefits. There are new ways for businesses and employees to save a combined 50% on health insurance through the new individual health insurance marketplaces and tax subsidies. Are you ready to reshape your employee health benefits?

Park City businesses and nonprofits should attend this webinar to learn how to take advantage of these new health care reform savings.

During this 45-minute webinar you will learn:

- Key health care reform laws that impact your business

- How the new health insurance marketplaces benefit employees

- How defined contribution will save your business, and employees, on the cost of health insurance

- Tools to start planning now

View on-demand video at: http://www.zanebenefits.com/health-care-reform-park-city-chamber-webinar

Note: Slides updated July 8, 2013 to reflect delay in employer mandate from 2014 to 2015.

Published in: Business, Economy & Finance
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Zane Benefits & Park City Chamber Webinar: Health Care Reform Bootcamp

  1. 1. Health Care Reform Bootcamp An Overview of the Affordable Care Act (ACA) for Park City Businesses
  2. 2. The Online Alternative to Group Health Insurance (like 401k for Health Benefits) The ZaneHRA Software provides a 100% paperless administration experience to employers and insurance professionals that want to offer better health benefits without a traditional group health insurance plan at lower costs. For more information about ZaneHRA, check out our Software. Employers use ZaneHRA to open and manage their own stand-alone HRA or defined contribution health plan completely online, electronically enroll participants and print welcome kits, and monitor expenses and reimbursements in real-time. Employees obtain their own individual health policies from a designated health insurance broker (see below), submit premium and medical expenses online, via fax, or mail, and receive same-day reimbursement via check, payroll addition, or direct deposit. Zane Benefits does not sell health insurance. DISCLAIMER The information provided herein by Zane Benefits is general in nature and should not be relied on for commercial decisions without conducting independent review and analysis and discussing alternatives with legal, accounting, and insurance advisors. Furthermore, health insurance regulations differ in each state; information provided does not apply to any specific U.S. state except where noted. See a licensed agent for detailed information on your state. www.ZaneBenefits.com For additional resources on Health Care Reform, visit www.zanebenefits.com/blog
  3. 3. Additional FREE Resources: Health Care Reform & Defined Contribution View all of our free eBooks, Whitepapers and On-Demand Webinars at: zanebenefits.com/health-benefits-resources
  4. 4. Agenda 1. Why did ACA (or "ObamaCare") get passed? 2. What you need to know about "ObamaCare" 3. What is the "Individual Health Insurance Marketplace"? 4. What is the "Employer Mandate"? 5. How to evaluate your "ObamaCare" options 6. Summary/Next Steps
  5. 5. Why did ACA (or "ObamaCare") Get Passed?
  6. 6. The Current (Employer-Based) System is NOT Sustainable U.S. is shifting to Individual Health Insurance
  7. 7. What you need to know about "ObamaCare"
  8. 8. What are Your Options? As a business, you have three primary choices regarding health benefits: 1. Play (I.e. Offer Group Health Insurance) 2. Pay (I.e. Offer No Health Benefits) 3. Play Differently (I.e. Offer a Defined Contribution HRA) For most businesses, Option #3 will save you and your employees up to 50% on health insurance. ... 401K Analogy.
  9. 9. Here's What You Need to Know! In order to evaluate your options, you must understand the following key "ObamaCare" provisions: 1. The NEW Individual Health Insurance Marketplaces 2. The NEW "Individual Tax Credits" 3. The "Employer Mandate" - Now delayed to 2015 We will cover all 3 of these provisions today, in order. Note: There are additional impacts of health care reform on employers (e.g. W-2 Reporting), but they should not significantly impact your decision making progress.
  10. 10. The Major Changes to the Individual Health Insurance Market The "major" provisions primarily affect the individual market. Starting January 1st, 2014, the ACA: 1. Equalizes Individual and Employer Health Plans 2. Requires "Guaranteed Issue" 3. Creates a NEW State Individual Health Insurance Marketplace 4. Requires virtually all Americans to purchase coverage (i.e. the "Individual Mandate") "To understand your options, you must understand the NEW Individual Health Insurance Marketplace!"
  11. 11. What is the "Individual Health Insurance Marketplace"?
  12. 12. What is the Individual Health Insurance Marketplace? Earlier this year, the government re-branded health insurance exchanges as Health Insurance Marketplaces. The Individual Health Insurance Marketplace is the ACA's health insurance exchange ("AHBE") for individuals, which provides: 1. Individual Plan Standardization (standardizes individual health insurance products within specific metal tiers) 2. "Unbiased" Individual Plan Comparison (allows individuals to compare all plans in one "unbiased" place) 3. Tax Subsidy Administration (determines tax subsidy eligibility/amount and facilitates advanced payment) "Helping individuals compare standard individual health insurance options"
  13. 13. Understanding How the Health Insurance Marketplace Works Step 1: Individual goes to his or her state's Individual Health Insurance Marketplace website (e.g. www.coveredca.com). Step 2: Individual completes 1 of 2 applications: i. Application for Insurance with Tax Credit (e.g. sample). ii. Application for Insurance without Tax Credit (e.g. sample). Step 3: Individual health insurance marketplace displays all available plan options within metallic tiers and displayed cost will factor in tax credit. Step 4: Individual selects plan. Step 5: Individual health insurance marketplace bills individual for his or her portion of premium (i.e. the total premium minus tax credit) and forwards payment to the carrier.
  14. 14. Advantages of the Individual Health Insurance Marketplace The Individual Health Insurance Marketplace will have the following 4 key advantages: 1. Choice 2. Portability 3. One Stop Shop / Convenience 4. Tax Credits
  15. 15. #1 Choice Individuals will be able to choose the health insurance plan that best fits their families' needs based on standard metallic levels: Within each metallic level, individuals will be able to choose different combinations of: ● co-pays ● deductibles ● co-insurance ● networks
  16. 16. #2 Portability Individual health insurance is not tied to employment, meaning they will be able to take their health insurance with them when they switch jobs. This is a major advantage over traditional employer-sponsored health insurance. Portable Memory Analogy
  17. 17. #3 One Stop Shop / Convenience One Website and One Application gets individual access to: ● All available plan options ● Premium tax subsidies
  18. 18. #4 Tax Subsidies SPECIAL INCENTIVE: Massive tax subsidies* will be available for households earning up to 400% of the FPL (majority of Americans). Individuals can only access the premium tax subsidies through the INDIVIDUAL health insurance marketplace. (*Requires Employer to Drop Group Coverage)
  19. 19. Household Income & Size are Key Variables for Individuals Tax subsidy calculator at http://navigator.zanebenefits.com Household Size 100% of FPL 400% of FPL Premium Cap Range 1 $11,490 $45,960 $0 - $363.85 / mo 2 $15,510 $62,040 $0 - $491.15 / mo 3 $19,530 $78,120 $0 - $618.45 / mo 4 $23,550 $94,200 $0 - $745.75 / mo 5 $27,570 $110,280 $0 - $873.05 / mo 6 $31,590 $126,360 $0 - $1,000.35 / mo 7 $35,610 $142,440 $0 - $1,127.65 / mo 8 $39,630 $158,520 $0 - $1,254.95 / mo 2013 FPL Guidelines Average Group Single Premium in 2012 was: $467.92 Average Group Family of 4 Premium in 2012 was: $1312.33
  20. 20. Individual Marketplace Notice Requirement Employers* must provide written notice to all current employees (regardless of full-time/part-time status) about coverage options through the Marketplaces. For details on the notice see: Employer ACA Marketplace Notice Requirements Notice must be provided to all employees by October 1, 2013, and to new employees at time of hire thereafter. The Department of Labor has provided two templates for employers to use: 1. Employers Offering a Group Health Plan 2. Employers Not Offering a Group Health Plan *The notice is required under FLSA.
  21. 21. What is the "Employer Mandate"?
  22. 22. What is the "Employer Mandate"? Starting January 1st, 2014 2015*, the "Employer Mandate" (aka "Play or Pay") requires certain LARGE employers to pay a tax penalty if health insurance is not offered to employees. ● SMALL BUSINESSES (< 50 EES) ARE NOT SUBJECT TO "EMPLOYER MANDATE" ● Only Applicable Large Employers (>50 FTEs) are subject to "Employer Mandate" ● FTE is the Key Variable for "Employer Mandate" * In July 2013, the employer mandate was delayed from 2014 to 2015.
  23. 23. How to Calculate Full-Time Equivalent Employees (FTEs) How to Calculate Full-Time Equivalent Employees (FTEs) ● FTEs = Full-time Employees* + Full-time Equivalent of Part-time Employees *Generally, a full-time employee is an employee who is employed on average at least 30 hours of service per week in a given month. ● Full-time Equivalent of Part-time Employees = Part-time Hours Worked / 120. If your FTE is < 50, you are not subject to "Employer Mandate". If your FTE is > 50, you are subject "Employer Mandate", but tax penalty may not apply.
  24. 24. An Overview of Tax Penalty Employers with less than 50 FTEs are NOT subject to this requirement. If you have >50 FTEs, your monthly penalty is capped by the following formula: Max Tax Penalty ~= (# of Full-Time - 30) * $166.67 Example: If you have 60 Full-Time Employees, your max monthly penalty is: ~ $5000 (or ~ $0.50 / hour) The actual penalty is based on whether employees receive Tax Credits on Individual Health Insurance Marketplace... So... TAX PENALTY IS REALLY AN EMPLOYER CONTRIBUTION
  25. 25. Two Potential Employer Tax Penalties Now Starting in 2015 1. Penalty for Not Offering Insurance 2. Penalty if Insurance is Not Affordable
  26. 26. How to evaluate your "ObamaCare" options
  27. 27. How to Decide Your Health Care Reform Strategy? 1. Determine if you are subject to the "Employer Mandate" (starting in 2015) 2. Complete cost analysis of your three options: ● Play (Offer a qualified, affordable group health insurance plan) ● Pay (Choose to not offer a group health insurance plan, and pay applicable penalties) ● Play Differently (Choose to not offer a group health insurance plan, pay penalties, and offer a defined contribution health plan) If you have < 50 FTEs, the tax penalties do not apply! If you have >= 50 FTEs, you must factor in the cost of the penalties. Tip: See Worksheets in Play or Pay Guide
  28. 28. Summary/Next Steps
  29. 29. Summary/Next Steps Summary (cont.) ● The Core Problem is that Employer Health Insurance Costs Too Much. ● Starting in 2014, the Individual Health Insurance Marketplace will allow individuals to compare/purchase standard individual plans. ● Employees are only eligible for the premium tax subsidies if employer drops coverage. ● In 2014, most businesses will switch to Defined Contribution due to tax subsidies & guaranteed issue. Next Steps: 1. Get educated on Defined Contribution and key health care reform tax issues. 2. Start preparing your employees for the transition.
  30. 30. Additional FREE Resources: Health Care Reform & Defined Contribution View all of our free eBooks, Whitepapers and On-Demand Webinars at: zanebenefits. com/health-benefits-resources
  31. 31. The ZaneHRA Software provides a 100% paperless administration experience to employers and insurance professionals that want to offer better health benefits without a traditional group health insurance plan at lower costs. For more information about ZaneHRA, check out our Software. Employers use ZaneHRA to open and manage their own stand-alone HRA or defined contribution health plan completely online, electronically enroll participants and print welcome kits, and monitor expenses and reimbursements in real-time. Employees obtain their own individual health policies from a designated health insurance broker (see below), submit premium and medical expenses online, via fax, or mail, and receive same-day reimbursement via check, payroll addition, or direct deposit. Zane Benefits does not sell health insurance. Insurance Professionals partner with Zane Benefits and use ZaneHRA to provide clients with a cost-saving health benefits option. Insurance brokers earn compensation on ZaneHRA referrals and retain 100% of the health insurance compensation from carriers. ZaneHRA is distributed by leading health insurance carriers, agencies, brokers, and accountants. DISCLAIMER The information provided herein by Zane Benefits is general in nature and should not be relied on for commercial decisions without conducting independent review and analysis and discussing alternatives with legal, accounting, and insurance advisors. Furthermore, health insurance regulations differ in each state; information provided does not apply to any specific U.S. state except where noted. See a licensed agent for detailed information on your state. www.ZaneBenefits.com For additional resources on Health Care Reform, visit www.zanebenefits.com/blog
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