Additional Healthcare Reform
Provisions and Programs
Following are additional provisions and programs specified in the Patient Protection and Affordable Care Act (ACA).
(2010 & 2011) Early Retiree Reinsurance Program
- Temporary program whereby employers can receive 80% subsidy rebates for retirees with claims between $15,000 and $90,000.
- The law has provided $5 billion in reimbursements on a first-come, first-served basis.
- Refer to previous LGC guidance provided via email notification on May 5, 2010 and June 18, 2010 regarding a detailed program overview and guidance on filing an application for these monies.
(2011) FSA/HRA/HSA
Beginning January 1, 2011, regardless of the plan year, for these types of accounts:
- Pre-tax reimbursements from FSA, HRA or HSA for over-the-counter (OTC) medications will not be considered an eligible expense unless prescribed by a physician; however, guidance is still pending.
- The excise tax for nonqualified HSA withdrawals will increase from 10 to 20 percent.
- (2013) FSA contributions will be capped at $2,500 annually, with the cap adjusted annually to the Consumer Price Index.
(2011) Voluntary Disability/Long-Term Care Benefit Program
- Employer may elect to allow employees to participate in this national program.
- Employer does not have to contribute.
- If employer does sponsor the program, all employees are automatically enrolled; employees may subsequently opt out.
- Employer needs to administer funds through a payroll deduction.
(2011 – 2014) Employer Notification Responsibilities
- (2011) Employers need to report the value of employer-sponsored coverage to employees on their 2011 W-2s.
- (2013) Large Group employers (those who issue more than 250 W-2s) need to report the value of employer-sponsored coverage to employees on their employees’ 2012 W-2s.
- (2013) Employee Notices
- Information about the new State Health Insurance Exchanges
- Whether employer plan share of costs is less than 60% of total costs
- Information about tax credits
- Information about free choice vouchers
- (2014) Comprehensive Report to U.S. Department of Health and Human Services
- Whether employees were offered coverage
- Length of waiting period
- Premiums for lowest cost options
- Employer’s share of total plan costs
- Number of full time employees
- Name, address and Tax Identification Number (TIN) of each full-time employee (FTE) and months of coverage for each FTE
- Written statement corresponding to each employee
(2014) Employer Coverage and Contribution Requirements for FTEs
- Employers with 50 or more employees will be required to offer their FTEs (employees employed for 30 or more hours per week) with “minimum essential coverage” (still to be defined) or pay a fine of up to $2,000/year for each FTE, in excess of 30 FTEs.
- Employers with more than 200 employees must automatically enroll each new FTE in their health plan.
- The employer must give affected employees notice of this automatic enrollment procedure and an opportunity to opt out.
- Employers with less than 100 employees may also offer coverage through the state-sponsored Exchange, which will be established by the New Hampshire Insurance Department for 2014.
- Employers will have to subsidize low income FTEs who cannot afford employer coverage with special subsidies and/or vouchers for participation in the federal Exchanges.
- Employers are not required to offer or pay for group health coverage for part-time employees (those working less than 30 hours a week).
- Individuals, such as part-timers who are not eligible for an employer’s coverage, are required to obtain minimum essential health coverage for themselves and their dependents through the state-sponsored Exchange or pay a monthly penalty tax for each month without coverage.
(2012 – 2018) Additional Taxes or Fees
- (2012) Employers will pay to the federal government a $1.00 annual assessment per each covered life beginning in 2012.
- (2014-2019) Employers will pay to the federal government a $2.00 annual assessment per each covered life in 2014 through 2019.
- (2018) 40 percent excise tax - “Cadillac Tax”
- The ACA includes a 40 percent excise tax on high-cost coverage.
- The tax applies to any health coverage plan that is above the threshold of $10,200 for single coverage and $27,500 for family coverage.
- The tax applies to the premium in excess of the threshold.
- An increase in the threshold amount of $1,650 for singles and $3,450 for families is available for retired individuals age 55 and older and for plans that cover employees engaged in high risk professions, such as police, EMT and fire personnel.
Approximately 15 percent of LGC plans currently exceed these amounts.
(2014) Waiting Periods
Employers cannot require new employees to wait more than 90 days before coverage begins.
Under current LGC guidelines, coverage begins on the first of the month following the employer defined probationary period. Members will be required to implement a probationary period of 60 days or less in order to comply with this provision.
(2014) Essential Health Benefits
- The legislation requires all health plans to cover an essential health benefits package as determined by the U.S. Department of Health and Human Services.
- Coverage must include, at a minimum:
- Ambulatory patient services; emergency services; hospitalizations; maternity and newborn care; mental health and substance use disorder services, including behavioral health; prescription drugs; rehabilitative services and devices; laboratory services; preventive services
- Services, yet to be determined, that are recommended by the Task Force on Clinical Preventive Services
- Vaccines, yet to be determined, that are recommended by the director of the Centers for Disease Control and Prevention
- Chronic disease management
- Pediatric services, including vision and dental care, which are not currently part of the health plans that LGC offers
- Alternative therapies such as acupuncture, chiropractic care, massage therapy, nutrition, biofeedback, naturopathy, homeopathy, acupressure and yoga and others are being considered
Small Business Tax Credit
Governmental entities are not eligible for this program.