TODD E. GORDON, RHU ®

PRESIDENT, THE BENEFITS GROUP, INC.NAHU CERTIFIED PATIENT PROTECTION

AND AFFORDABLE CARE ACT (PPACA) PROFESSIONAL

Health Care Reform: Impact on You & Your Business

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

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

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

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

Essential Health Benefits

Ambulatory patient servicesEmergency servicesHospitalizationLaboratory servicesMaternity & newborn careMental health & substance abuse disorder servicesPediatric services, including oral & vision carePrescription drugsPreventive & wellness services and chronic disease

managementRehabilitative and habilitative services and devices

Reform Related Taxes & Fees

What When Who Pays How MuchComparative 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

ReinsuranceAssessment

1/1/2014 Issuers of fully insured plans

Estimated at $5.25 per person per month

Tax on highearners

Tax year beginning 1/1/2013

Individuals .9% increase on Medicare, in excess of $200k single/$250k married

Tax on unearnedincome

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-costinsurance 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

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

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

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

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

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 2014Minimum 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

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