Affordable Health Care Act Affordable Health Care Act

Individuals –U.S. Citizens and legal residents are required to have “minimum essential coverage” for themselves and their dependents beginning on 1/1/2014 OR be subject to a tax penalty (date may change)

• Employer sponsored plans • Individual market insurance policies• Government programs such as

Medicare, Medicaid, CHIP, TRICARE

AHC Act –Three tests: AHC Act –Three tests: Acceptable Coverage = Minimum Essential

Coverage and at least 60% Actuarial Value

Fair Access = All Employees working 30 hours weekly or more (several tests; 90 day look back rules apply)

Affordable Coverage = Employee only cost of coverage may not exceed 9.5% of household income for individuals making < 400% of Federal Poverty line

AffordableAffordable Health Care Act Health Care Act Significance of Full time (>30 hours) -employee who IS offered insurance but earns low pay determines which employers are subject to Penalty $3,000/annually per person: coverage costs must be LESS than 9.5% MAGI

SINGLE Employee annual Cost $ 6930.00Divide by 9.5%

Earnings must be greater $7,295.00

Employee Notices Required

•Annual Summary of Benefits and Coverage (SBC) –explaining coverage plans, deductibles, co-pays, and giving specific examples of out-of-pocket expenses to employees

•At date of hire – ALL new employees are required to receive Marketplace notification notices that explain the exchanges and the benefits to employees

“Marketplace” used to be called “Exchange”

Fees to be paid by employers:

•Patient-centered Outcomes Research Institute Fee (PCORI) $1/covered life first year; $2/covered life second year; adjusts annually Cost YR1 $ 2,736

•Transitional Reinsurance Fee (TRF):$63/per year/per covered life due January 2015 Cost YR1 $172,368

Administration work so far…Administration work so far…Strategic staffing across employee groups to provide oversight at each level to ensure that part time employees do not consistently work greater than 30 hours/weekly

Employee groups have been accessed and adjustments made so that Health Insurance is offered to employees who are contracted for >30 hours/week.

•Summary of Benefits and Coverage (SBC) is being incorporated into the Employee handbook

•90 day review period has been selected (November 1 to January 31); payroll records will be pulled to perform review

•Administrative review of hours each payroll to make adjustments where needed

•Changes will be made during Open Enrollment to capture signatures of employees who refuse Health Care with SPS