UpdateOctober 2011

PPACA

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PPACA

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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

What’s Next!Supreme Court – Individual Mandate Challenge

June 2012?CLASS Act – (Voluntary Long Term Care)

Originally estimated 86 Billion of total 210 Billion in savings from Health Care Reform

Participants premiums for 5 years were factored in, but no accounting for payments.

PPACA Update