Health Care Reform: Tools, Techniques and Alternatives Cammie Scott MSIE, LUTCF, RHU, REBC, CLTC, ChHC, SPHR CK Harp & Associates

The things kids say

Employer Requirements 50 or more FTEs must offer coverage or pay a penalty –This is not full time employees, but Full Time Equivalents –Must meet minimum value – 60% - an actuarial value –Must meet affordability guidelines – 9.5% of box 1 W-2

Your Friends at the IRS IRS 4980h Regulations – E-2011-title26/pdf/USCODE title26-subtitleD-chap43- sec4980H.pdfhttp:// E-2011-title26/pdf/USCODE title26-subtitleD-chap43- sec4980H.pdf –Shared Responsibility for Employers Regarding Health Coverage Full time employee 30 hours/week Hours of service

Who gets benefits? Variable hour employees –Seasonal workers – retail, golf courses, landscaping companies, snow removal, PRN employees in medical or banking Notice –Safe harbor methods 12 month look back period

Who is a variable hour employee? An employee is a variable hour employee if, based on the facts and circumstances at the date the employee begins providing services to the employer (the start date), it cannot be determined that the employee is reasonably expected to work on average at least 30 hours per week.

New Terms Initial Measurement Period –For new variable hour employees –At least 3 months not more than 12 months Initial Stability Period –For new employees who have completed their measurement period –At least 6 months, but not less than the measurement period Ongoing Measurement Period –Completed at least one “Standard Measurement Period”

Take Aways Evaluate your workforce –Safe Harbor - Offer coverage to 95% of eligible employees or pay a penalty Who is full time Who is part time Who is benefit eligible –Evaluate your systems – what about time and attendance software –Document decisions Prepare as if you are preparing for an audit

Marketplace Supposed start enrolling people October 1, 2013 Lots of problems President had no idea Sebelius called to Congress Lots of confusion Improving HealthCare.gov The Health Insurance Marketplace online application isn't available from approximately 1 a.m. to 5 a.m. EST daily while we make improvements. Additional down times may be possible as we work to make things better. The rest of the site and the Marketplace call center remain available during these hours.

Notices Employers subject to FLSA Model Exchange Notice to all existing employees by October 1, 2013 All new employees at the time of hiring Must tell the following: –Description of the Exchange, the services they provide and who to contact for additional information –If the plan offered meets the minimum value requirements –Model notices posted with this material

Confusion Affordability – based on employee’s box 1 W-2 income for the lowest cost plan for individual coverage –If the employer offers affordable coverage that meets the minimum value then neither they nor their family are eligible for a subsidy UNLESS –Medicaid – based on family income, not just employee income

Quick Check Chart Do I qualify to save on health insurance coverage?

How do I apply? 1.Online 2.Paper 3.Phone 4.In Person

Online Process Online – Set up an account Fill out the online application Compare your options Enroll after you choose your plan.

Process Paper – Fill out a paper application and mail it in. Get a determination letter/notice Go online to compare, choose and enroll in a plan or contact the call center and a customer service representative will help you. If you or someone on your application are eligible for Medicaid or CHIP, a representative will contact you to enroll. Get the paper application on line at healthcare.gov or call and have one mailed to you articles/marketplace-application-for-family-instructions.pdf

Phone Process , 24 hours a day, 7 days a week (TTY: ). –A customer representative will work with you to complete the application and enrollment process. –Many of them are using the same on line system and you must wait for your eligibility determination.

Process In Person – Most common request has been Medicaid eligible individuals – go to DHS office Others who can help –Navigators –Application Assisters –Agents –Certified application counselors –Government agencies such as State Medicaid –Children’s Health Insurance Program (CHIP) offices

The Moose Hunt

Contact Information Cammie Scott CK Harp & Associates Consultants