1. Health Care Reform Discussion Lisa J. Duquette Program Administrator lduquette@schoolcare.org August 17, 2010

2. Health Care Reform Senate Bill HR 3590: Patient Protection and Affordable Care Act + Reconciliation Bill HR 4872: The House Reconciliation Act = Final Health Reform Law Signed March 23, 2010

3. Today’s Focus Near term effect on NH schools Insight into future issues

4. Provisions Effective First plan year starting on or after September 23, 2010 (6 months) July 1, 2011 – NH school group health plans subject to insurance reforms

5. 2010 3/30/2010 Elimination of Imputed Income §IRC 105(b) amended to exclude taxability of medical benefits for adult dependents children 6/1/2010 Early Retiree Reinsurance Program reimbursement for 80% of cost for retirees age 55 - 64 who have claims in excess of $15,000 and below $90,000. (Program ends in 2014 or when the $5B funding is exhausted)

6. 2011 1/1/2011 OTC medications – unless prescribed by a doctor over-the counter medications are no longer eligible for reimbursed pre tax reimbursement from FSA, HSA, or HRA

7. 2011 – July 1 st ! Increase age limit to age 26 for uninsured dependents – No tax dependent requirement – Married/unmarried – NOT child or spouse of dependent – Up to 1/1/2014 grandfathered plans may exclude dependents if eligible for employment based coverage Be sure payroll system is updated Ensure FSA administration includes expense reimbursement for a dependent child until the year in which the child attains age 27

8. 2011 – July 1 st ! Lifetime on essential benefits prohibited Annual dollar limits on essential benefits prohibited (presumption that # of visits, # of procedures, and limits on cost are permissible) Cost sharing on preventive care prohibited (grandfathered plans exempt) Increased premium cost of 1-4% for improved plan provisions

9. 2011 – July 1 st ! Automatic Enrollment Requirements for employers with 200 or more FT employees – No regulations have been issued by DOL yet – Some interpret that this provision will be effective 1/1/2014 CLASS Act – national voluntary long term care program… need more HHS guidance – employers required to automatically enroll employees and facilitate payroll deductions – employees must opt-out of program if not wishing to participate – pays cash benefits averaging $50 per day – five year (5) vesting period

10. 2011 – December 31 st W-2 reporting of the value of employer provided coverage (issue in January 2012) Information only Need to accumulate information required for reporting.

11. 2012 9/30/2012 Tax Assessments on group health plans of $2 per participant for “comparative effectiveness research” – Applies to self-funded and insured plans – Reduced to $1 per participant 9/30/2013 – Scheduled to “sunset” for plan years ending after 9/30/2019 Increased cost from assessments passed along to employers/employees

12. 2013 – 2014 1/1/2013 FSA max limits reduced – may not exceed $2,500 2014 - prohibits waiting periods greater than 90 days Consider current collective bargaining agreement terms