practical employee benefits for erisa and non-erisa attorneys
TRANSCRIPT
TD&P Consulting, Inc.
Practical Employee Benefits for ERISA and NON-ERISA AttorneysSeptember 20, 2016
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Thomas (Tom) Dawson, Esq., MPH, MA
Founding Partner and CEO
TD&P Consulting, Inc.
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• Thomas (Tom) J. Dawson III, is the founder
and CEO of TD&P Consulting, Inc., a health
policy firm focused on health reform and its
impact on private and public health insurance
markets.
• With over 23 years in healthcare policy,
Dawson has served on Capitol Hill, at the
Department of Labor, with non-profits and in
the private sector.
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Thomas (Tom) Dawson, Esq., MPH, MA
Founding Partner and CEO
TD&P Consulting, Inc.
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• Dawson acted as the senior health care counsel to
the U.S. House of Representatives Committee on
Small Business.
• During his time on the Hill, Dawson also provided
healthcare policy guidance as an advisor to the
Congressional Hispanic Caucus (CHC) Health Care
Task Force and drafted legislation relevant to the
health science industry and small businesses.
• From 2001 to 2007, Dawson served as a Pension
Law Specialist with the U.S. Department of Labor’s
Employee Benefits Security Administration (EBSA).
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ACA Background
• Prior to ACA: a percentage of Americans were
uninsured.
• Purpose: intended to provide increased number
of Americans insurance and decrease cost of
healthcare.
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ACA – Important Features
• Individual Mandate
• Guaranteed Issue Requirement
• Medicaid Expansion
• Affordable Coverage
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Individual Mandate
The individual mandate requires that all individuals who are lawfully present in the United States obtain some form of minimum essential coverage, or pay a penalty.
There are only three exemptions to this requirement: (i) the religious exemption; (ii) individuals not lawfully present in the United States; and (iii) incarcerated individuals.
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Guaranteed Issue Requirement
The guaranteed issue requirement prohibits denial of
coverage due to preexisting health conditions.
This requirement guarantees access to minimum essential
coverage for all lawfully present individuals.
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Affordable Coverage
• Health coverage must be affordable, which is defined as
a percentage of an employee’s income.
• Minimum Essential Coverage (“MEC”).
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Examples of Minimum Essential Coverage
• Qualified Health Plans (QHPs) purchased in and outside the Exchange
• Medicaid / Traditional Medicare / Medicare Advantage (MA)
• Health plans for children (CHIP)
• VA benefits
• Union plans
• Plans offered by employers for their employees
• Plans offered to federal government employees
• Plans for retired persons
• Most health plans for active members of the United States military (TRICARE)
• Student health plans
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Case Challenge
• National Federation of Independent Business v.
Sebelius.
• Challenge to ACA individual mandate and Medicaid
expansion.
• Question: Does Congress have authority under the
consideration to enact legislation with the two provisions.
• Held: Yes, under the authority to “lay and collect Taxes.”
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ACA Update
• The Employer Play or Pay Mandate.
• Employers with greater than 50 full-time employees must offer at least 95% of full time employees insurance coverage to avoid penalty.
• Minimum Essential Coverage penalty increase.
• Dependent Coverage.
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ACA Update
• Reporting Requirements.
• Health Plan companies required to report Minimum Essential Coverage data to the IRS. See Section 6055 of ACA.
• Form 1095C – Statement of Employer Provided Health Insurance Offer and Coverage sent by large employer to all full-time employees.
• Form 1094C – Sent by large employers to the IRS.
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ACA Update
• Cadillac Tax
• Imposed on Coverage Providers
• 40% tax
• 2016 Consolidated Appropriations Act delays implementation until
2020
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ACA Update
• Menu Labeling Requirements
• Chain Restaurants
• Calorie Information on Menu
• Written Information Available Upon Request