This document summarizes key provisions of the recently passed US healthcare reform legislation. It outlines major changes occurring between 2010-2014, such as dependent coverage until age 26, elimination of lifetime limits, creation of health insurance exchanges in 2014, and employer penalties for not providing coverage. Administrative impacts are also discussed, such as increased workload from additional required notices and forms. Specific provisions like tax changes, Medicare discounts, and essential health benefits are reviewed.
Learn how you can successfully navigate the Affordable Care Act, "Obama Care".
This easy to read outline will benefit your family and business.
Call (816-224-9466) for more information today.
Health Reform Bulletin 133 | Executive Order Directing Modifications to the A...CBIZ, Inc.
An Executive Order, signed on October 12, 2017, promotes modifications of certain aspects of the Affordable Care Act (ACA) (also see press statement). In a nutshell, this Executive Order directs the ACA’s governing agencies (Health and Human Services/Labor/Treasury) to address three
elements: formation of association health plans, expansion of short-term, limited-duration insurance, and expanding the rules to allow individual premium to be reimbursed through health reimbursement arrangements (HRAs). Briefly, this Executive Order directs the governing agencies to
Learn how you can successfully navigate the Affordable Care Act, "Obama Care".
This easy to read outline will benefit your family and business.
Call (816-224-9466) for more information today.
Health Reform Bulletin 133 | Executive Order Directing Modifications to the A...CBIZ, Inc.
An Executive Order, signed on October 12, 2017, promotes modifications of certain aspects of the Affordable Care Act (ACA) (also see press statement). In a nutshell, this Executive Order directs the ACA’s governing agencies (Health and Human Services/Labor/Treasury) to address three
elements: formation of association health plans, expansion of short-term, limited-duration insurance, and expanding the rules to allow individual premium to be reimbursed through health reimbursement arrangements (HRAs). Briefly, this Executive Order directs the governing agencies to
The Health Care and Education Affordability Reconciliation Act of 2010 was recently passed by the House and will be signed into law 03/30/2010. NAHU (National Association for Health Underwriters) published a comprehensive timeline of the changes coming over the next few years. Please contact me with any questions.
Check this out! My friends at Greener Accounting and Tax Services put this presentation together to show some of the changes that will be made with two health care legislations passed this term. Very informative and somewhat disturbing.
How Does Obamacare Impact Your Business Planning?Tilson
The Supreme Court has upheld the PPACA and its implementation is full steam ahead. Now is the time to begin preparing for the impact on your business and your employees. Many have forgotten the complexity, decisions, and regulatory requirements of this legislation. As we all know, the devil is in the details.
The recently enacted federal healthcare legislation will affect virtually everyone and will mean significant changes for patients, insurers, employers, hospitals and physicians. This is one of the largest changes to the tax laws in the past 30 years. Are you interested in finding out how the Reform will affect you or your business? We want to help. We are offering presentations to businesses and groups to provide information on how the Reform may impact you.
For more information visit our website at www.kl-cpa.com.
Are you ready for the upcoming 2014 provisions of the new healthcare reform act? Do you know what the implications are to you as a small or midsize company?
Our webinar will help you become familiar with upcoming requirements under the Patient Protection and Affordable Care Act.
Expect to learn the following and more:
What is the Patient Protection and Affordable Care Act
How does an organization determine their 2014 cost to comply?
What should organizations be doing now to prepare?
The Health Care and Education Affordability Reconciliation Act of 2010 was recently passed by the House and will be signed into law 03/30/2010. NAHU (National Association for Health Underwriters) published a comprehensive timeline of the changes coming over the next few years. Please contact me with any questions.
Check this out! My friends at Greener Accounting and Tax Services put this presentation together to show some of the changes that will be made with two health care legislations passed this term. Very informative and somewhat disturbing.
How Does Obamacare Impact Your Business Planning?Tilson
The Supreme Court has upheld the PPACA and its implementation is full steam ahead. Now is the time to begin preparing for the impact on your business and your employees. Many have forgotten the complexity, decisions, and regulatory requirements of this legislation. As we all know, the devil is in the details.
The recently enacted federal healthcare legislation will affect virtually everyone and will mean significant changes for patients, insurers, employers, hospitals and physicians. This is one of the largest changes to the tax laws in the past 30 years. Are you interested in finding out how the Reform will affect you or your business? We want to help. We are offering presentations to businesses and groups to provide information on how the Reform may impact you.
For more information visit our website at www.kl-cpa.com.
Are you ready for the upcoming 2014 provisions of the new healthcare reform act? Do you know what the implications are to you as a small or midsize company?
Our webinar will help you become familiar with upcoming requirements under the Patient Protection and Affordable Care Act.
Expect to learn the following and more:
What is the Patient Protection and Affordable Care Act
How does an organization determine their 2014 cost to comply?
What should organizations be doing now to prepare?
With the landmark healthcare reform legislation now in place, we're sure that you have questions about how it impacts your organization and your employees. At a Pearson Partners International HR Roundtable presentation, Buck Consultants helped decipher the legislation—so you understand, in practical terms, what it means and what you need to do. Presentation includes:
Market Reform:
timeline and play-or-pay penalties
Individual Responsibility:
deadlines, definitions and numbers
Insurance Exchanges:
explanation and eligibility
Financing:
funding, taxes and surcharges
Employer Responsibility:
compliance, reporting and communication
How to Avoid a Head-on Collision with The Cadillac TaxBill Conlan
The Webinar addressed what state and local governments need to know about how other provisions of reform that take effect beginning in 2010 will complicate the challenge of meeting the thresholds – and that the time to begin planning for the Cadillac tax is now.
The presenters provided details on the Cadillac tax and factors that complicate compliance with premium thresholds such as the removal of traditional coverage limits, the increase in the dependent eligibility age, additional fees, mental health parity and the estimated 16 million more Americans who will receive Medicaid.
What Changes to Expect from the new Healthcare Law, presented by The National Federation of Independent Business, the leading small business association.
HEALTH CARE REFORM 2010: Top Ten Things Every Employer Should Know about the 2010 health care laws: The Patient Protection & Affordable Care Act and the Health Care
& Education Affordability Reconciliation Act of 2010
Staffscapes, Inc. is a Human Resources Outsourcing firm that specializes in HR, Payroll & Benefits. We recently presented this slide show to a group of Colorado Small Business Owners and Managers and are sharing it with the general public today.
ReadingsHealth Care Reform and Future PossibilitiesIntroduct.docxsodhi3
Readings
Health Care Reform and Future Possibilities
Introduction
Health care has undergone episodes of major change since the introduction of Medicare in the 1960s. All of these have resulted in fundamental changes in how health care providers were paid for services to Medicare patients and were swiftly followed by matching changes from independent insurance companies. The latest, and some might say the biggest, change since diagnosis-related groups (DRGs) were introduced in 1983 is the signing into law of the Patient Protection and Affordable Care Act (PPACA), on March 23, 2010. This law proposes to change the delivery of health care services by changing how providers are paid and what they are paid for. This module explores some of the key elements of PPACA and how health care providers are planning their changes in delivery processes and systems in response.
Major Elements of PPACA
The most significant elements of the PPACA legislation are scheduled to take place over several years. Congress still has the ability to modify some of these elements, so we will examine them with that in mind.
June 2010
Adults with pre-existing conditions were eligible to join a temporary high-risk insurance pool run by the federal government. This will be replaced by a health care exchange in 2014, which will provide access to insurance at affordable rates. Applicants must have a pre-existing health care condition and have been uninsured in the six months prior to application. Premiums will be set at rates for the general population rather than the high-risk premiums charged by insurance companies. Out-of-pocket costs will be limited to $5,950 for individuals and $11,900 for families.
July 2010
The government established the National Prevention, Health Promotion, and Public Health Council, with the Surgeon General to act as chair of the council. This council will oversee the implementation of many of the PPACA elements and will disseminate recommendations to the health care community at large in regard to best practices in prevention and health promotion. As of fall 2010, little had yet been heard from this entity. However, the National Committee on Quality Assurance, which is a private entity dedicated to improving the quality of health care services, is providing best practices and quality measures for health care providers, especially hospitals.
September 2010
Insurance companies can no longer apply lifetime dollar limits on essential benefits for patients. In addition, children may be covered under their parents' insurance plan until they turn 26 years of age. This includes children not living at home, not listed as dependents on their parents' tax returns, not students, and children who are married. Further, no patients under 19 years of age with pre-existing conditions can be excluded from health care benefits based on the pre-existing conditions, and there can be no deductibles or copayments required for provision of preventive care measures and medic ...
11. Dedicated Benefits Administration team with 20+ years experienceOur Mission: To help employers control and drive down the cost of delivering Human Resources & Employee Benefit Services.
12. About Secova Workshop Agenda Presenter Bruce Borgos Mr. Borgos is the Director of Healthcare audit services at Secova. With over 20 years of experience in risk management and benefits management for public sector employers, Mr. Borgos has developed and managed innovative solutions designed to reduce health care costs and improve employee health and productivity. Before joining Secova, Mr. Borgos served as Director of Sales and Marketing for a division of Sierra Health Services, Product Manager for GatesMcDonald, and Vice President of Operations for W.R. Gibbens. Karen Kerns Karen Kerns is the Internal Compliance Director at Secova. Miss Kerns has advised the public and private sector on all aspects of benefit administration including optimal operational and administrative design, as well as advising companies of the due diligence necessary for employee benefit issues. Karen has presented at the National Retail Federation’s Human Resources Executives Summit helping employers understand how to implement new administrative procedures to meet the new requirements from recently passed legislative measures for COBRA. With a focus on process improvements, her experience provides insight to enhancing current processes to accommodate future business needs while ensuring client needs and requirements are represented.
14. 2010 Impact 2011 Impact Overview Senate Passed Patient Protection & Affordable Care Act (PPACA) December 24, 2009 House Passed the Health Care and Education Reconciliation Act (HCERA) March 21, 2010 Senate Enacted Changes & Passed the HCERA March 25, 2010 Passage of Healthcare Reform PPACA Signed Into Law By President Obama March 23, 2010 HCERA Signed Into Lay by President Obama March 30, 2010
19. Comprehensive nature of this recently passed reform includes benefit re-design, increased administrative and compliance costs, eligibility rules restructuring, increased taxes and health insurance exchanges.
20. All provisions should be carefully reviewed with legal council, actuaries and plan design consultants.
21.
22. Next plan year after enactment, waiting period or effective date
39. 2011 - Automatic Enrollment: 1st national long-term care insurance program for U.S. workers. Few employers will enroll their employees when it officially launches.
42. 2014 - Automatic Enrollment: Employers with more than 200 employees are required to automatically enroll new-full time employees in their healthcare plans
43. 2014 - Expansion of eligibility for Medicaid and subsidized care
44. 2014 - Insurance Exchanges: Created to assist individuals and small businesses with fewer than 100 employees to purchase medical insurance
45. 2014 - Individual Coverage Mandate: Requires all individuals to qualify to receive affordable health insurance or pay a penalty
46. 2014 - Employer Pay or Play Mandate: Employers must offer affordable coverage to full time employees (30 hours a week), or pay a penalty
61. Grandfathered plans will be subject to the following insurance reforms. Expansion of child coverage for children until age 26. Prohibition of waiting periods for over 90 days. Prohibition of lifetime limits. Restrictions on annual limits from 2010 through 2013 and prohibit annual limits 2014 onward. Standard uniform explanation of coverage. Prohibition of pre-existing conditions on dependents under age 19 (2011 through 2013) and prohibition of pre-existing condition limitations entirely by 2014.
62.
63. Applies to married children. Excluded from this provision are married children’s spouse and their children.
64.
65.
66. The coverage gap falls between the $2,830 and $6,440 in total drug spending.
68. Program to Reduce the Cost of Covering Early Retirees - A program will be implemented to temporarily support employer retiree plans until the exchange is fully running.
69. Plan sponsors will be reimbursed for 80% of claims between $15,000 and $90,000 for pre-Medicare retirees age 55-64.
70. Program does not apply to retirees on Medicare and retirees that are not actively working for an employer.
82. Access to Insurance for Uninsured Individuals with Pre-Existing Conditions - Through a new program of high-risk insurance pools, people who have been denied coverage on the basis of pre-existing conditions and have been uninsured for at least six months will be extended subsidized coverage.
83. The program will end when the health insurance exchanges roll out in 2014.
86. Tax on Indoor Tanning Services -The act imposes a 10% tax on amounts paid for indoor tanning services (new IRC § 5000B).
87. Like a sales tax, the tax will be collected from the person tanning when payment for the tanning services is made. The provision applies to services performed on or after July 1, 2010.
88.
89. Medicare Part D Discounts - Seniors who have fallen into the "donut hole" of Medicare Part D prescription coverage in 2010 will receive a 50% discount on name brand drugs. Pharmaceutical manufacturers that don’t comply with the discount program will be subject to fines.
90. The legislation aims to close the donut hole by 2020 by offering a 75% discount on generic drugs.
91.
92.
93.
94. Under 2003 law, employers are eligible for tax-free government reimbursement of 28% of prescription drug expenses. With the elimination of this deduction some companies are reporting a $150 million dollar loss in earnings.
95.
96. There is no annual limit under current law. Currently employers impose limits between $4,000 and $5,000 a year.
97. Administrative Note: Employers that provide FSAs will need to amend their plan documentation and enrollment materials. Restrictions must be placed on automatic reimbursement procedures, such as the use of debit cards.
98. Required Employee Redesign of FSA’s - Employers will have to narrow allowed spending from flexible spending accounts to bar reimbursement for non-prescription and over-the-counter drugs. This is an FSA feature that the Internal Revenue Service sanctioned in 2003.
99.
100. Beginning 2013, individuals over 65 will be able to claim the itemized deduction for medical expenses at 7.5 percent of adjusted gross income through 2016.
101. Excise Tax on Medical Device - Medical device manufacturers will face a 2.9 percent national sales tax. Excepted are eyeglasses, contact lenses, hearing aids or other items for individuals.
104. Analysts and insurers are uncertain how state insurance exchanges will operate until after final regulations are issued.
105. In 2017 states may opt to allow businesses with more than 100 employees to participate in these exchanges.
106.
107. The first 30 employees are not counted in calculation of the penalty. Example: an employer with 75 employees would pay the penalty for 45 workers, or $90,000 (45* $2,000).
109. Employer Pay or Play Mandate for Employees Receiving Coverage through the Exchange - Employers who offer coverage, and has at least one employee that receives a tax credit, will be assessed a pay or play fine of $3,000 for each worker receiving the tax credit, up to an aggregate cap of $2,000 per full-time employee.
110. Employers are required to report to the federal government on health coverage they provide.
121. Premium tax credits will be available to individuals up to 400% of the Federal Poverty Level (FPL) through the “exchanges” for those not eligible/offered “affordable” employer coverage.
122. Employers are required to educate employees about their insurance options outside of employment
123.
124. Generous subsidies are offered to the low income. For this reason employers may not want to duplicate these offerings with salary-based cost sharing.
128. Contact Information 2015 - 2018 Questions Comprehensive nature of this recently passed reform includes benefit re-design, increased administrative and compliance costs, eligibility rules restructuring, increased taxes and health insurance exchanges. Note: All provisions should be carefully reviewed with legal council, actuaries and plan design consultants.
129.
130. Communicateto all HR ongoing processes which will be implemented to manage the healthcare reform provisions.
131. EducateHR about the healthcare reform legislation to reduce any mistakes that can lead to unwanted costs.
132. Provideongoing review and training to all HR for benefits improvements and the healthcare reform legislative updates.Whether you administer your benefits in house or utilize an outsourced vendor, here are suggestions regarding achieving success within your benefits department and administration:
134. Thank You Secova, Inc. 5000 Birch Street Suite 300, East Tower Newport Beach, CA 92660 1.800.257.0011 www.secova.com Sarah Soss 714-384-0590 Sarah.soss@secova.com 2009 Secova, Inc. All Rights Reserved.