PPACA Update
Provisions Effective
2010Appeals and External
ReviewDependent Coverage
to age 26Doctor ChoiceAnnual and Lifetime
Maximum $ Limits
Emergency CarePreventive Services
without Cost Share
Provisions Effective 2011Carrier Medical Loss Ratio
85% Large Groups 80% Small Groups
Over the Counter Drugs FSA, HSA No longer reimbursed unless Rx
HSA Distribution Tax Penalty
PPACA Update
Provisions Effective 2012W-2 Reporting 2012 Tax Year
Report in January 2013 Small Employers with less than 250 W-2’s are exempt
60 Day Plan Change Notification RequiredStandardization of Coverage Documents
Page Limits Lay Person Language Uniform Definition of Standard Terms Description of Coverage Include Limitations, Reductions, Cost Sharing Provisions,
Web Links for actual Contract download $1,000 per Enrollee Penalty Carrier Requirement
PPACA Update
Provisions Effective 2013FSA Limits
$2,500 Maximum on Health FSA $5,000 Dependant Care Limit
PPACA Update
Provisions Effective 2014American Health Benefit Exchange
Option for Individuals and “Small Employers”. Main objective is to make Health Insurance more
affordable, accessible , and easy to purchase. Four Main Coverage Levels:
PPACA Update
Coverage Level Benefit Equivalent
Platinum 90%
Gold 80%
Silver 70%
Bronze 60%
Provisions Effective 2014Essential Health Benefit
Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental Health & substance abuse disorder services
(including behavioral health treatment) Prescription drugs Rehabilitative & habilitative services and devices Laboratory services Preventive & wellness services & chronic disease
management Pediatric services, including oral and vision care
PPACA Update
Provisions Effective 2014Individual Mandate
US Citizens required to have “Minimum Essential” Coverage.
Subject to Tax Penalty Calculated Monthly Paid Annually
$95 - 2014 $325 – 2015 $695 - 2016
PPACA Update
Provisions Effective 2014Employer Mandates 50+
If no Coverage offered to any Full-Time Employee receiving Premium Assistance. $2,000 Annual Fee for each Full-Time Employee
(minus 30) If Coverage offered but Full-Time Employee
receives Premium Assistance. lesser of $3,000 per employee receiving assistance
or $2,000 per employee (minus 30) Full-Time Employees defined as 30+ Hours.
PPACA Update
Provisions Effective 2014Financial Assistance
Premium Tax Credit Cost Sharing Subsidies
Auto-Enrollment Requires Employer with 200 Full-Time Employees
to enroll Employees into the Health Plan.PA – Status
Hearings being held Decision on whether to offer State or Federal
Program
PPACA Update