1. June 2013 Employee Benefits Manager A&M System Office Ellen Gerescher The Affordable Care Act (ACA) / The System Wellness Initiative An HR Liaison Presentation

2. Important Highlights of ACA Employer Fees –Transitional Reinsurance Fee –Patient-Centered Outcomes Research Institute Fee Eligibility Changes –30 hours/week = full-time employee Benefit Changes –90-days = maximum waiting period –All inclusive out-of-pocket maximum 2

3. More Highlights Employer Penalties related to: –Minimum Essential Coverage –Minimum Value –Affordable Coverage Exchange Notices to Employees (Oct‘13) Exchanges Begin 3

4. Employer Fees Employer fee (per covered life, per year) 2014 Fee: $63 $2.8 Million 2015 Fee: $42 $1.9 Million 2016 Fee: $26 $1.1 Million 4

5. Eligibility Changes Current benefit-eligible employee: – Works at least 20 hours/week for at least 4.5 continuous months New definition: –Works 30 hours or more/week Problem areas: –Adjunct faculty, student workers, employees with multiple positions, seasonal/ temporary employees 5

6. Required Benefit Changes Full-time employees must be enrolled in health coverage no later than the 90 th day of employment. Cap on out-of-pocket annual expenses - $6,400 per individual/$12,800 per family 6

7. “Shared Responsibility” TAMUS must offer the following or be subject to a tax penalty: –Offer “minimum essential coverage” to all or “substantially all” of its “full-time employees” and their “dependents”. –Offer self-only coverage to its full-time employees that has “minimum value” (is adequate) and is “affordable”. 7

8. Definitions Minimum Essential Coverage - basically all employer health plans. Minimum value - is an actuarial value calculated using the coinsurance percentage, copays, premiums and out-of-pocket maximums. Thus far, our plans are above minimum value. An “affordable” plan is one that does not exceed 9.5% of the employee’s hourly wage or monthly salary. 8

9. Exchange Notice Must go to new employees by October 13th, and new employees within 14 days of hire date Notice must include information about: –Health Exchange Insurance Marketplace –Contact information for Marketplace –Availability of premium tax credits –Loss of employer contribution 9

10. System Wellness Initiative Objective: Invest in wellness initiatives coordinated by System members Process: Grants awarded covering cost of classes, webinars, and program materials over the coming 2 years Grants: To be eligible, each member will be required to conduct a minimum of 4 webinars and a wellness fair 10

11. System Wellness Initiative Objective: Ensure employees are active in their personal health through annual exams Process: Employees/Spouses will be asked to have annual exams at least every 18 months; no cost to employees for services Premium Differential: Those who elect not to have annual exams will have premiums $30/month higher than those who do 11

12. Thank You 12