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Published byTerence Conley Modified over 9 years ago
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PATIENT PROTECTION AND AFFORDABLE CARE ACT (AKA HEALTH CARE REFORM)
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WHAT IS IT Law enacted in March 2010 Purpose: ensure that almost everyone living in the United States has comprehensive medical coverage
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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
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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)
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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)
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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
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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
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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
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BCC Action Steps Taken Identified 28 hours/week for part time employees Identified maximum loads for adjunct faculty Established Measurement periods for compliance purposes
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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)
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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
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For Further Information More information about Health Care Reform: www.healthcare.gov
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