Every business owner, regardless of their size needs to understand the affordable health care laws (Obama Care). This presentation was presented by Todd Gordon to customers of The Virtual HR Director in May 2013. New presentations will be delivered as the law becomes clear.

1. T O D D E . G O R D O N , R H U
P R E S I D E N T , T H E B E N E F I T S G R O U P , I N C .
N A H U C E R T I F I E D P A T I E N T P R O T E C T I O N
A N D A F F O R D A B L E C A R E A C T
( P P A C A ) P R O F E S S I O N A L
Health Care Reform: Impact
on You & Your Business

2. The Individual Mandate
 What are my options?
1. Employer-sponsored coverage
2. Individual coverage
 Individual market exchange
 „Off „ exchange
3. No coverage – pay the penalty

3. The Public Exchange/Marketplace
 Individuals who buy a policy from the public exchange may
be eligible for credits and subsidies
 Income range from 133% to 400% Federal Poverty Level (FPL)
 Individual: $14,856 to $44,680
 Family of four: $30,6565 to $92,200
 Not have access to minimum essential coverage through their employer
or have access to coverage, but it is not affordable
 Premium Credits – for any level plan
 Cost-Sharing Subsidies – Silver Plan only
 Public exchange open enrollment begins 10/1/13

4. No Coverage – Penalties for Individuals
 2014
 Greater of $95 or 1% of taxable income
 2015
 Greater of $325 or 2% of taxable income
 2016
 Greater of $695 or 2.5% of taxable income
 2017 and beyond
 Annual adjustments

5. Essential Health Benefits
 Applies to:
 Individual & Small Group plans
 Non-grandfathered plans: On and off exchange
 Does not apply to:
 Large Group and ASO plans
 Grandfathered plans
 Benchmark plan:
 Each state will select for the purposes of defining EHBs

6. Essential Health Benefits
 Ambulatory patient services
 Emergency services
 Hospitalization
 Laboratory services
 Maternity & newborn care
 Mental health & substance abuse disorder services
 Pediatric services, including oral & vision care
 Prescription drugs
 Preventive & wellness services and chronic disease management
 Rehabilitative and habilitative services and devices

7. Reform Related Taxes & Fees
What When Who Pays How Much
Comparative
Effectiveness
Research Fee
Plan/policy years ending
10/1/2012
Insurers of fully insured plans;
sponsors/administrators of
self-insured plans
$1 per person per year;
adjusted for subsequent years
Reinsurance
Assessment
1/1/2014 Issuers of fully insured plans Estimated at $5.25 per person
per month
Tax on high
earners
Tax year beginning 1/1/2013 Individuals .9% increase on Medicare, in
excess of $200k single/$250k
married
Tax on unearned
income
Tax year beginning 1/1/2013 Individuals 3.8% on unearned income in
excess of $200k single/$250k
married
Insurer Fees Tax year beginning 1/1/2014 Issuers of fully insured plans Estimated at 2.46% of
premium, plus state fee
High-cost
insurance tax
Tax year beginning 1/1/2018 Insurers of fully insured plans;
sponsors/administrators of
self-insured plan
40% on plan costs exceeding
“Cadillac” thresholds

8. What About Rates in 2014?
 Most significant changes will be in markets for
individuals and small employers
 Rating constraints
 Product constraints
 Benefit mandates
 New taxes
 Studies & Carrier Reports
 Forecasting a wide range of impact

9. Options for Small Businesses
Employers who have less than 50 employees:
 Offer a fully insured plan through either:
 SHOP Exchange (full implementation has been delayed)
 The off-exchange market
 Offer an ASO (administrative services only)
 Self-funded
 Stop offering coverage
 Employees go to exchange
 Offer “non-affordable” coverage
 Employees go to exchange

10. Options for Large Employer
 Employer Shared Responsibility Penalty
 If a “large” employer does not offer “minimum essential”
health benefits to their full-time employees, they may be
required to pay a penalty
 If a plan is offered, but it does not meet the coverage levels
required, they may be required to pay a penalty
 If a plan is offered, but “unaffordable”, they may be required to
pay a penalty

11. Employer “Play or Pay” Mandate
 Employers with 50+ employees who DO NOT offer
coverage:
 At least 1 employee obtains subsidized coverage from health
insurance exchange
 Fee equal to $2,000 X the number of full-time employees minus
the first 30 employee
 Employers with 50+ employees who DO offer
coverage, but coverage is not “affordable”
 Assessment of $3,000 X the number of employees receiving
subsidized coverage
 “Affordable” defined as employee‟s share of the premium is
greater than 9.5% of income for employee only coverage

12. Large Employer Considerations
 Calculating the number of full-time and full-time
equivalent employees (FTEs)
 Aggregation of common ownership
 Automatic Enrollment for employers with 200+ FTEs –
delayed for 2014
 Minimum essential coverage
 Plan coverage must provide minimum value at least 60% of the total
allowed cost of benefits that are expected to be incurred under the
plan
 HHS/IRS will provide a calculator to determine minimum value

13. Questions
Todd E. Gordon, RHU
President, The Benefits Group, Inc.
NAHU Certified Patient Protection and Affordable Care Act
(PPACA) Professional
todd@tbgatlanta.com
(770) 455-3446 ext. 207
www. tbgatlanta.com