PATIENT PROTECTION AND AFFORDABLE CARE ACT (AKA HEALTH CARE REFORM)

WHAT IS IT  Law enacted in March 2010  Purpose: ensure that almost everyone living in the United States has comprehensive medical coverage

PROVISIONS  Coverage for adult children to age 26  Prohibition on lifetime dollar limits on essential benefits  Restriction on annual dollar limits on essential benefits  No pre-existing condition exclusions on children under 19  No cost sharing on certain preventive care  Contraceptive coverage required

Provisions (cont’d)  Patient-Centered Outcomes Research Fee (CER Fee)  MLR rebates  Summary of Benefits and Coverage Must be provided to all New Hires and current employees (and in a specific format)

FOR EMPLOYERS  If provide health insurance to employees:  Must provide to full time employees (defined as working 30 or more hours a week)  Must be affordable  3 safe harbors (W-2 wages, Rate of Pay or Federal Poverty level)  Must provide minimum essential coverage  Plan’s share of total allowed costs of benefits provided under the plan must be at least 60% of such costs (a measure of benefits, not premium amounts)

FOR EMPLOYEES  Individual Mandate (all individuals must have health insurance coverage as of January 1, 2014)  Health insurance coverage can be obtained through:  Employer  Federal or State Exchanges  Kansas – no state exchange, defer to Federal  Approved providers are Coventry and Blue Cross/Blue Shield  Private insurance company

Penalties for Non-Compliance  Employer  If coverage is not affordable or doesn’t meet Minimum value  Lesser of $3000 per full time employee receiving the tax credit or $2000 per full time employee (minus first 30)  Employee  2014: $95/person up to $285 per family or 1.0% of adjusted gross income  2015: $325/person up to $975 per family or 2.0% of adjusted gross income  2016: $$695/person up to $2085 per family (indexed) or 2.5% of adjusted gross income  Full responsibility for all medical costs incurred

Cadillac Tax  2018: Tax levied if premium levels exceed $10,200 for single and $27,500 for employee+1/family  40% tax will be levied  Tax paid by insurance provider but probable impact on premiums

BCC Action Steps Taken  Identified 28 hours/week for part time employees  Identified maximum loads for adjunct faculty  Established Measurement periods for compliance purposes

Measurement Periods  Initial Measurement period  12 month period beginning with the 1 st of month following first day of hire  Standard Measurement period  November 1 – October 31  Administrative Period (2 months after the end of each measurement period)

Analysis of Hours Worked  Analysis completed for each employee for each measurement period  If employee averages 30 hours or more per week then must offer health insurance for the following 12 months

For Further Information  More information about Health Care Reform: