1. Benefits Group Manager
Implementing PPACA (Patient Protection and Affordable Care Act) Presented by
Thomas Goedde, CLU, ChFC
Benefits Group Manager

2. Where Are We Now? The House passed the Senate bill on March 21,2010
House and Senate passed “fixes”
Signed by President on March 23, 2010
September 23, 2010: Implementation begins
“We have to pass the bill so that you can find out what is in it” …. Speaker Nancy Pelosi 2

3. Confused – Implementation overload!!
DON’T
PANIC
YET!!
Don’t memorize this! We are at the
End of the beginning—7 to 10 years of rule making and changes.

7. How the Public Views PPACA
Rasmussen: 55% view PPACA as
“Unfavorable”
(5/6/2013)

8. How the Public Views PPACA (cont.)
Kaiser Family Foundation:
23% don’t know about PPACA
12% think Congress has repealed
7% believe it has been overturned by the Supreme Court
40% cite family and friends as primary
source of news
40% view as unfavorable
(5/9/2013)

9. The Sugar 2010 Small Business Tax Credit
Reinsurance for Employers who provide Early Retirement Coverage (Age 55-65)
High Risk Pool for Uninsured
Dependent to Age 26
Rescissions Prohibited
Lifetime / Annual Limits
No Pre-Ex for Children to Age 19
Coverage for Preventive Care

10. 2011 2012 Class Act (Suspended 10/14/2011) MLR – Medical Loss Ratio
80% for less than 100 employees
85% for 100+
2012
Expanded Preventive Care Services for Women
Uniform Summary of Benefits and Coverage (SBC)
60-Day Notice of Material Modifications
MLR Rebates

11. … and The Not So Sweet 2013 W-2 Reporting (250+) $2,500 Limit On FSAs
Increased Threshold for Medical Expense Deductions from 7.5% to 10%
Additional Medicare Tax for High Wage Workers
Medical Device Tax of 2.3%
SBC penalty up $100/day
60-Day Notice of Plan Changes

13. Shared Responsibility
Individual Mandate
Buy Minimum Essential Coverage,
or, Pay a Penalty
*Effective on Anniversary
Employer Mandate
Employer with 50+ Employees must offer coverage
Small Employers exempt, but still subject to
- Market Reforms
- Taxes
*Effective on Anniversary

14. Individual Mandate Every American must have Minimum Essential Coverage
Or, Pay a Penalty! (errr, Tax)
$95 or 1% of Earnings
$325 or 2% of Earnings
$695 or 2.5% of Earnings
Family – a limit of three

15. Individual Mandate (cont.)
Individuals can access:
Medicaid
Exchange

16. Individual Mandate (cont.)
Medicaid
available up to 138% of the poverty level (2013: $11,490)
to date only about half of States favor expansion
(only seven states have passed legislation as of
5/12/2013 –AR, CO, MD, MN, NC, NM & NY)

17. Individual Mandate (cont.)
Exchange (over 138% of FPL)
With subsidies up to 400% of
FPL, if not “affordable” at work
Employer Plan, if available

18. Individual Mandate (cont.)
Exchanges – State, Federal, or Partnerships
Buy through Exchanges with
No medical information
No exclusion for Pre-ex
Market Reforms
Compressed Age Rating
Buy with subsidy if not “affordable” at work

21. What is an Exchange?
A marketplace that provides individuals & small business comparable access to insurers plans:
Consists of a selection of private plans
Multi-state plans
Separate exchanges for individuals vs. small employer (SHOP) permitted
State Action
17 State-based Exchange
7 State-Federal Partnership Exchange
26 Default to Federal Exchange

24. Employer Shared Responsibility
Large Employers
Offer coverage or pay a big penalty
Offer affordable coverage, or pay a
fine if …
Small Employers
No requirement to provide benefits but rates will (probably) go up

25. Employer Mandates (cont.)
Small Employer (under 50)
No Requirement to provide coverage
But, Subject to
- Market Reforms
Taxes
Low Deductibles and Out-of-Pocket

26. Employer Mandates (cont.)
Large Employers
Must OFFER coverage with Essential Health Benefits to substantially all employees (or pay a fine of $2,000 x # of employees less 30)

27. Employer Mandates (cont.)
Large Employers
Must offer coverage that is:
Affordable – 9.5% of W-2 wages
Provides Minimum Value
or, pay a penalty of $3,000 for each
employee
- who get a subsidy from the exchange

28. Employer Mandate Calculator
htpp://
health-reform/calculator

30. Large Employer (cont.) No Maximum Deductible ($2,000)
Maximum Out of Pocket limited to HDHP OOP ($6,350 / $12,700)
Applies to Non-Grandfathered Plans only

34. Shared Responsibility
90 Day Waiting Period
30 hours per week or 120 per month
Maximum W.P. is 90 calendar days
(not first of the month following)
Must cover if reasonably expected to be a full-time employee (not seasonal)
What about - seasonal (120 days?)
variable hour
cumulative hours of service
(can’t exceed 1,200 hours, one time only)

38. What We Are Hearing As regulations are issued, new ideas
and strategies emerge:
Voluntary plans that meet minimum requirements for individuals combined with Employer plans that avoid large fines
PEO/Staffing Agencies – “common law standard” applies (Regs. not final)

39. 2013-14 Unfinished Business Notice to Employees of Exchanges
Originally due March 1st
Now, October 1st
Auto Enrollment
Companies with 200+ employees must auto enroll
Rules not yet released

43. Questions to Discuss with your Attorney
Should we offer coverage?
Should we just pay the penalty?
Do we provide Minimum Value?
Is coverage affordable?

44. Questions