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Health Care Reform
Health Care Reform for Employers
Health Care Reform for Employers
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You can also view Health Care Reform updates for: Individuals & Families | Brokers | Providers

How Health Reform will Impact Businesses

The Patient Protection and Affordable Care Act (PPACA) impacts businesses in several ways from the types of benefits offered under insurance plans, to the ways employers conduct their businesses. Some provisions are already in effect and more will be implemented over the next several years.

To help employers understand the law, the most important provisions and dates are outlined in a brochure, How are YOU Impacted? An Employer's Guide to Health Care Reform (PDF)

Impacts on Employer-Provided Coverage

General Impacts on Employer-Provided Coverage

There are several mandates from the Patient Protection and Affordable Care Act (PPACA) already in effect. View our Timeline for more information on timing of provisions.

Some of the key mandates are below. For a full list and a definition of each, please refer to the Resources tab.

Impacts on Small Businesses

How Does Health Care Reform Affect Small Businesses?

In addition to the key provisions outlined, its important to know that small businesses already have an opportunity to qualify for:

Impacts on Large Businesses

How Does Health Care Reform Affect Large Businesses?

We are here to guide you through the impacts of the PPACA on your business. We will continue to update you as we are made aware of future impacts to large and self-funded businesses.

Health Care Reform Provisions At-a-Glance

Some aspects of the law are already effective and others will be phased in over the next few years. Regulations will continue to be issued as implementation of the health care reform law is not yet complete. To help you understand the law, the most important provisions and dates are outlined here.

You can also download a printable version of this timeline (PDF).

2013 2014 2015+

January 1, 2013

Summary of Benefits and Coverage: Must be offered to employees on renewal of the health plan, effective 9/23/12.

Flexible Spending Account (FSA): Contribution limited to $2,500.

Medicare Withholding Tax Increase: Withholding increases from 1.45% to 2.35% for individuals making $200,000+/families making $250,000+.

January 31, 2013

New W-2 Reporting Requirements: Employers filing more than 250 W-2s must report the cost of health coverage on employees' W-2 form in January 2013 for calendar year 2012. Those who file fewer than 250 W-2s are exempt until 2014.

July 1, 2013

Patient Centered Outcome Research Tax (PCORI Tax): First PCORI Tax due for reporting period of 10/1/2011- 10/1/2012. Fee for the first year is $1.00 per covered life per reporting period. Self-insured plans required to remit payment. Insured plans covered by health insurers.

October 1, 2013

Exchanges Open: Enrollment in individual and small group exchanges begins October 2013 for coverage effective January 2014.

Employer Notification of Exchanges: Employers subject to FLSA must notify employees of Exchanges. Template letters are available at DOL.gov.

January 1, 2014

Individual Provision: Most U.S. citizens and legal residents will be required to have health insurance or pay a penalty.

Premium Tax Credits: These credits are available to eligible individuals to help pay for insurance coverage on the individual Exchange.

Coverage and Benefit Provisions

Small Businesses: Small group tax credit expanded up to 50%, if coverage purchased through small employer exchange and qualifying requirements met.

Large Businesses: Must offer coverage that meets affordability and coverage requirements or pay a penalty.

2016

Businesses with 51-100 employees shift to community rating.

2017

States can open exchanges to large groups.

2018

Cadillac tax imposed on plans with excessive premiums.

Topic Brief Description Tools/Resources
Annual Limits
see also Lifetime Limits
The ACA prohibits imposing annual limits on Essential Health Benefits and any lifetime dollar limits.  N/A
Dependent Coverage to Age 26 By allowing children to stay on their parents plan, the Affordable Care Act (ACA) makes it easier and more affordable for young adults to get health insurance coverage.

Dependent coverage overview (PDF)

Sample letter explaining a special enrollment period for dependents to age 26 (PDF)

Employer Checklists The following checklists are meant as a general guideline for actions that may be required of employer groups or Excellus BlueCross BlueShield. For more information, please contact your Sales Consultant.

Small Group Checklist (PDF)

Large Group Checklist (PDF)

Employer Mandate
see also Pay or Play
Requires employers with 50 or more full-time equivalent employees to pay a penalty if they don’t provide minimum, affordable health insurance to their full-time employees and dependent children in 2015.

Full-Time Equivalent Employees (PDF)

Employer Responsibility Penalties (PDF)

Seasonal/Variable Hour Employees (PDF)

Essential health benefits Non-grandfathered plans in the individual and small group markets both inside and outside of the Exchanges must cover essential health benefits (EHB) beginning in 2014. EHB include items and services within the following 10 benefit categories: (1) ambulatory patient services, (2) emergency services (3) hospitalization, (4) maternity and newborn care, (5) mental health and substance use disorder services, including behavioral health treatment, (6) prescription drugs, (7) rehabilitative and habilitative services and devices, (8) laboratory services, (9) preventive and wellness services and chronic disease management, and (10) pediatric services, including oral and vision care. Each state will define the EHB benchmark plan for 2014 and 2015. HHS intends to evaluate the benchmark process for 2016 and beyond based on evaluation and feedback.

N/A

Exchanges Shopping marketplace that allows consumers to research, compare, and purchase health insurance. Consumers can shop online or file their application in person, by phone, or by mail. Employer Requirement to Notify Employees about Exchange (PDF)
FSA Contribution Limit For plan years beginning on or after January 1, 2013, the maximum allowable salary reduction contribution to a cafeteria plan (Section 125 plan) Health Flexible Spending Account will be $2,500. FSA Contribution Limit FAQ (PDF)
Full-Time Employee Under the ACA, “full-time” is defined as anyone working an average of 30 or more hours per week.  N/A
Grandfathering "Grandfathering" allowed some plans to be exempt from some ACA provisions.

Grandfathering Advantages and Disadvantages(PDF)

Grandfathered Plans - List of Requirements (PDF)

Grandfather Status Application for Fully-Insured Groups (PDF)

Grandfather Status Recertification Form for Fully-Insured Groups (PDF)

Certification Form for Grandfather Status for Self-Insured Groups (PDF)

Individual Mandate The requirement that most individuals have health insurance or pay a penalty beginning in 2014. Learn about other changes for Individuals & Families
Lifetime Limits
see also Annual Limits
The ACA prohibits imposing annual limits on Essential Health Benefits and any lifetime dollar limits.  N/A
Medical Loss Ratio (MLR) Reporting A Medical Loss Ratio or MLR is the percentage of premium dollars insurers spend to provide covered medical services and improve the quality of health care for their members. Frequently Asked Questions (FAQ) (PDF)
Minimum Essential Coverage Individuals who don’t maintain minimum essential coverage may be subject to the Individual Mandate penalty. Minimum essential coverage includes individual & family plans, employer-sponsored health plans and government-sponsored health plans like Medicare, Medicaid and Child Health Plus. N/A 

Part-Time Employee

Under the ACA, “part-time” is defined as anyone working less than 30 hours per week on average.  N/A
Patient-centered Outcomes Research Fee The Patient-Centered Outcomes Research Tax, also known as the Comparative Effectiveness Research Fee, is a fee paid to the government to fund Patient-Centered Outcomes Research Institute (PCORI) research. Frequently Asked Questions (PDF)

Pay or Play
see also Employer Mandate

Requires employers with 50 or more full-time equivalent employees to pay a penalty if they don’t provide minimum, affordable health insurance to their full-time employees and dependent children in 2015.

Full-Time Equivalent Employees (PDF)

Employer Responsibility Penalties (PDF)

Seasonal/Variable Hour Employees (PDF)

Pre-Existing Conditions Exclusions As of September 2010 there are no pre-existing exclusions for children under age 19. Beginning in 2014, this provision applies to everyone, including adults. N/A

Premium Tax Credit
see also Subsidy

Financial assistance available for qualified individuals and families with income between 133 percent and 400 percent of the federal poverty level to help pay for premiums. Learn about other changes for Individuals & Families
Preventive Services
see also Women's Preventive Services
The ACA requires health plans to cover designated preventive services without any member cost sharing.

Preventive services overview (PDF)

List of preventive services (PDF)

Retiree only certification Employers should complete this form if they think that one or more of their plan options qualifies for an exemption from the market reform provisions of the Affordable Care Act because the plan(s) provides coverage for fewer than two active employees, often known as a retiree only plan. Certification form (PDF)
Small Business Health Options Program (SHOP) SHOP is a competitive health insurance marketplace where small businesses and their employees will be able to purchase coverage. N/A
Small business tax credits The Affordable Care Act includes a tax credit equal to 50 percent (35 percent in the case of tax-exempt eligible small employers) for qualified small employers that provide health coverage to their employees. The tax credit is available to employers with 25 or fewer employees with average annual wages of less than $50,000.

How to Get Small Business Tax Credits

Fact sheet (PDF)

Subsidy
see also Premium Tax Credit

Financial assistance available for qualified individuals and families with income between 133 percent and 400 percent of the federal poverty level to help pay for premiums. Learn about other changes for Individuals & Families
Summary of Benefits and Coverage The Departments of Health and Human Services, Labor and Treasury recently issued final regulations requiring health plans to provide a SBC and Uniform Glossary that clearly explain benefits and coverage within a standardized template with uniform language. Learn more or request a Summary of Benefits and Coverage (SBC)
W-2 reporting The ACA contains a requirement for employers to report the cost of health coverage under an employer sponsored group health plan on an employees W-2 form. The cost includes both the cost paid by the employer and contributions from the employee.

W-2 Fact Sheet for employers (PDF)

Women's Preventive Services
see also Preventive Services
The ACA requires health plans to cover designated womens preventive services without cost sharing for the member. Cost-sharing includes deductibles, copayments and coinsurance. Some of the benefits and services outlined in the women's preventive guidelines are already included within the existing ACA preventive services requirements.

Women's Preventive Services FAQ (PDF)

List of Women's Preventive Services (PDF)

Exempt Religious Employers Form (PDF)

The information provided here is not intended to advise you on how to comply with any provisions of the referenced legislation or related legislation or regulations, nor is it otherwise intended to impart any legal advice.

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