January 2014

Even though the employer shared responsibility provisions of the Patient Protection and Affordable Care Act (PPACA) were delayed and will not take effect until January 1, 2015, employers should have prepared for their compliance strategies in 2013. However, if you were a procrastinator now is the time to review.

Business owners and payroll personnel will want to determine if the employer mandate will apply to their company. If PPACA’s ‘shared responsibility’ provisions do apply, employers need to prepare in 2014 to ensure a smooth transition in 2015. Several issues need to be addressed to mitigate any potential challenges, covering issues such as how the baseline measurement period is calculated and the adequacy of coverage requirements are met.

Here are some of the most common questions employers have:

• Will my company have to comply with employer-shared responsibility provisions?
• What kind of insurance will my company have to provide?
• To whom will I have to provide insurance?
• What about seasonal, per diem, or part-time employees?

Employee Benefit Advisors has a FTE Worksheet to help companies determine these answers. Contact us if you’re interested in using it to help evaluate your course of action.

• Health Benefit Exchanges – state exchanges move from enrollment to covered phase
• Individual Mandate – requires each person to have minimum essential coverage
• Essential Health Benefits – requires new plans to cover 10 essential health benefits
• No Pre-Existing Conditions – prevents plans from limiting benefits on pre-existing conditions
• Clinical Trials – plans cannot limit routine costs for those in clinical trials
• Dollar Limits on Essential Health Benefits – PPACA ends annual limits on essential health benefits
• Guaranteed Availability/Renewability – carriers must accept all groups or individuals that apply for coverage
• Waiting Periods –reform requires waiting periods to be no more than 90 days
• Auto Enrollment – large employers enroll full-time employees in a health plan
• Health Care Excise Taxes – new taxes for health insurance and pharmaceutical companies, plus medical devices

Health Care Reform Updates – Hear are a few of the changes announced in the last weeks starting with Transition Policy.

Transitional Policy provides the Option to Keep Existing Coverage in 2014 – State agencies responsible are encouraged (but not required) to adopt the transitional policy. If the state allows, health insurers have the option of continuing small group coverage that would otherwise be terminated or cancelled.

Online Enrollment Delayed One Year for Federally-Facilitated SHOP (Small Business Health Options Program) Marketplace Further – Small Employers Must Continue to Apply Offline Until November 2014.

Enrollment Deadline Extended for Individual & SHOP Marketplace – Individuals and Small Businesses have until December 23rd to sign up. Coverage would begin January 1, 2014.

Temporary Hardship Exemption from Individual Mandate for Individuals with Cancelled Plans – The Hardship Exemption allows individuals to purchase catastrophic plans. One such exemption is for individuals with cancelled plans who have difficulty paying for coverage in the individual marketplace. (How ironic – exemption granted to those who cannot afford insurance under the Affordable Care Act.)