I had a client that sent me this article and then asked if it was true, that if someone makes $1 more that the family would be paying $9,355 more annually.
I know there are a lot of confusing articles out there right now and this was written with a shock factor to get you to read the article, and for my client….it worked! He read it, and he contacted me to be his “BS Meter” as he put it.
Here is an example to further explain why this article is saying what it is say:
Ok, so let’s say it is a family of 4.
400% of the federal poverty level is around $95,000 for a family of four in 2014. If they are making $95,000, then with their subsidy aka discount they will get in the Exchange / Marketplace they cannot spend more than 9.5% of $95,000 on healthcare. Which translates to $9025 annually = $752 per month (just as a barometer, most family coverage in NY starts at around $1200 per month for a very watered down plan).
If the person makes $95,001, then they won’t get that discount and they’d be paying the full premium, so in my example $1200 x 12 = $14,400 annually, which translates into $5375 more annually if you make $1 more.
I’m not sure where they came up with that magic number of $9035 but it’s really not that far off if you start looking at richer benefit plans!
Filed under: Health Insurance, National Healthcare, Reform | Tags: Individual Health Insurance, National Healthcare, NY Healthcare Costs
We have been getting numerous emails with this article being referenced by our clients along with excitement that when they wake up on January 1st, 2014 that their insurance bills will now be cut in half. I would like to draw your attention to a few items in this article and give you a bit of a reality check.
Point 1: “Individuals buying on their own will see their premiums tumble next year in New York State as changes under the take effect, Gov. Andrew M. Cuomo announced on Wednesday.” The first thing that Groups need to look at is the first word….”Individuals”, this is not talking about Group Insurance, this is talking about the Individual Market in New York State that has been extremely expensive in the past. For example, one carrier that currently has an Individual Plan, the rates are coming in around $2000 per month for an Individual. Even with a 50% reduction, that is a $1000 premium for an Individual, which is still well over the average rate under Group Coverage in the State of New York.
Point 2: “Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly.” I believe that this is very misleading, this is giving you the lowest price that is going to be in the Exchange aka Marketplace without a Subsidy (tax credit for being under 400% of the Federal Poverty Level). This price references what is being called “Young Invincible” Plan meaning, that to get this plan, you must be under 30 years old and you are looking at having more of a catastrophic plan which would cover Preventative Care and then you would have a minimum of a $6000 Deductible before anything else would be covered. Currently, New York does not offer any plans with this type of watered down coverage.
Point 3: “With federal subsidies, the cost will be even lower. (than $308 monthly)”. This will be ONLY if you as an Individual qualify for a Subsidy. This means that as a single person, to get ANY type of price break in the Exchange / Marketplace you must make under 400% of the Federal Poverty Level, which translates into making under $45,960 annually. If you do not make under that, then the plans you can get in the Exchange / Marketplace are going to be the exact same costs that you can get outside the Exchange / Marketplace
Things we are excited about in this article:
1. That for Individuals that have struggled with the high cost of health insurance will get to see some relief.
2. Department of Financial Services say they have approved 17 insurers to sell individual coverage through the New York exchange, including eight that are just entering the state’s commercial market. Currently there are only a handful, so more choices will be better for everyone! Keep in mind some of these may just be Medicare networks that only the lower income individuals will qualify to be a part of.
What else to keep in mind:
1. Be looking for “Borough-centric” plans, meaning that carriers are going to come out with plans that limit the network dramatically in order to get the cost down. A great example of this has been with Aetna’s NYC Community Plan, these plans have typically been under $400 a month in premium but they are an HMO plan where you must get a referral and they only have doctors in the 5 Boroughs. The smaller NYC Community Network they are utilizing is about 40% of the size of the normal Aetna Network. So be looking for these type of plans to be coming out In and Out of the Exchange / Marketplace.
2. Brokers will be allowed to sell inside and outside of the exchange and there will be no difference in cost. Be weary of signing up through a Navigator because as it stands right now, they are going to be glorified Enrollers that since they are not licensed, they cannot advise on Insurance, they can only present to you the plans and have you draw your own conclusions. Also, 6 months down the road if you have a question about the benefits you bought or you are having a claims issue, you cannot go back to the Navigator, you’ll be dealing with the carrier directly and not have someone as your advocate as you would if you had got your plan through a Licensed Broker that is more qualified to help assist you with your needs.
3. Be on the look out as groups to be getting hit with more taxes on your group plans, this is going to help to pay for the cost reduction for the Individual Plans.
The Treasury Department announced on July 2, 2013 that the Obama Administration will provide an additional year before the mandatory employer and insurer reporting requirements under the Affordable Care Act begin. This delay is intended to allow the Administration to look into ways to simplify the new reporting requirements and to provide time to adapt health coverage and reporting systems while employers move towards making health coverage affordable and accessible for their employees.
The Administration has promised formal guidance on this transition in the very near future. We also expect proposed rules this summer implementing information reporting. Once those rules are published, the Administration will encourage employers, insurers and other reporting entities to voluntarily implement this information reporting in 2014. Since this transition relief will make it difficult to determine which employers owe employer penalties, the Administration is extending this transition
relief to the employer penalties – the penalties will not apply until 2015.
The transition relief does not affect the opening of the Exchange, scheduled for October 1, nor the individual mandate.
Filed under: 90 day waiting period, HR, National Healthcare, Reform | Tags: 90 day waiting period, Reform, Waiting period
On March 18, 2013, the Departments of Labor, Treasury, and Health and Human Services issued proposed guidance regarding eliminating waiting periods in excess of 90 days for employees who are eligible for their company’s health insurance plan. A waiting period is defined as the time that must pass before an employee can be covered under a plan. This guidance is effective January 1, 2014, and remains in effect at least through December 31, 2014.
For plan years beginning on or after January 1, 2014, a waiting period for employees and dependents who are otherwise eligible for coverage under an employer’s group health plan cannot be longer than 90 calendar days, including weekends and holidays. Plans will no longer be able to use a “three month” waiting period as it might exceed 90 calendar days. This also means that employers can no longer use a waiting period in which coverage begins the first of the month following 90 days of service.
The proposed regulations also clarify how this provision applies to variable-hour employees where plan eligibility is based upon a specified number of hours worked. A plan is considered in compliance with the waiting period requirement if the hours of service required for eligibility for coverage under the plan do not exceed 1,200 hours. Note: This requirement cannot be re-applied to the same individual each year.
Some of you wondering if you are going to get hit with a penalty come 2014, the above picture is the best want to have a “quick check” on if you will or not. For more details, keep reading….
For the purposes of this provision fulltime is defined as an average of 30 or more hours per week.
Solely for the purposes of determining group size, the employer must calculate the number of FTEs or fulltime equivalent employees by including the employees working less than 30 hours into the equation.
For months beginning after December 31, 2013 an employer with an average of at least 50 FTE (full time equivalent employees) on business days in the preceding calendar year who fails to offer coverage to fulltime employees and their dependents (nothing is said about employer contribution) will pay an assessment of $168/month or $2,000/year for each fulltime employee who is able to obtain a premium tax credit or subsidy through an exchange (minus the first 30 employees).
Example: 60 fulltime employees- 30= 30 full time x $2,000 = $60,000 assessment.
Employers who do offer coverage but that is not minimally essential or unaffordable (meaning the employee contribution exceeds 9.5% of W-2 income for the lowest tier single premium) will pay $3k per FT employee who is able to obtain a premium tax credit or subsidy through the exchange. The assessment is limited to a maximum of $2k per FT employee minus the first 30.
Note subsidies are only available through a state or federally run exchange and are only available to individuals who are not eligible for Medicaid and who earn less than 400% of the FPL.
Example: -Income is $50k -Single annual premium is $600×12=$7,200 -9.5% of $50k = $4,750 (max to avoid penalty) -Employer must pay $7200-$4750 or pay the assessment
DETERMINING LARGE EMPLOYER STATUS:
The proposed regulations provide some transition relief for the determination of large employer status in 2014 that is aimed primarily at employers near the 50 full-time equivalent employee threshold. The transition relief allows employers to determine whether they are large employers based on a period of six consecutive calendar months as chosen by the employer in the 2013 calendar year, rather than based on the entire 2013 calendar year.
NON CALENDAR PLANS:
Relief was afforded to large employers who maintain a non-calendar year plan. If the employee is offered coverage that meets the law’s affordability and minimum value standards no later than the first day of the 2014 plan year, then no IRC §4980H penalty will be assessed with respect to that employee for the period prior to the first day of the 2014 plan year.
Note: Affiliated company rules changed with the proposed IRS rules of 12-28-2012.
AFFILIATED COMPANIES:
Example
Facts: Corporation A owns 100% of Corporation B. Corporation A employs 40 full-time employees in each calendar month of 2015. Corporation B employs 35 full-time employees in each calendar month of 2015. For 2015, the IRC §4980H(a) excise tax for a calendar month is $2,000 divided by 12. Corporation A does not sponsor an employer-sponsored plan for any calendar month of 2015, and receives a certification that at least one of its full-time employees has acquired health care coverage on an Exchange with the benefit of a premium tax credit. Corporation B sponsors an eligible employer-sponsored plan under which all full-time employees are eligible for minimum essential coverage that is affordable and meets the minimum value standard.
BIG change here. Standards will be applied separately to each entity that is a member of the controlled group comprising the employer (referred to in the rule as a “large employer member”) in determining the liability for and assessment of any tax penalties under IRC §4980H. (In this document, reference to “large employer member” means a member of a controlled group and also an employer that is a single entity and not part of a controlled group of corporations. If one entity of a controlled group is assessed, only the FT employees of the ONE entity is assessed, not the entire group.
Penalties and deduction of the first 30 employees therefore will be allocated to each separate entity based on its share of the total.
Conclusion: Corporation A and Corporation B are members of a controlled group that employs 50 or more full-time employees and, therefore, are large employers subject to IRC §4980H; however, the excise tax liability is applied separately. Under these facts, Corporation A is subject to an assessable excise tax under IRC §4980H for 2015 equal to $48,000, which is equal to 24 x $2,000 (40 full-time employees reduced by 16 (its allocable share of the 30-employee offset ((40/75 x 30 = 16)) and then multiplied by $2,000. Corporation B is not subject to any assessable excise tax under IRC §4980H for 2015
– an offer of coverage must be made to full-time employees and their dependents. Dependents, for purposes of IRC §4980H, is defined as children under age 26. Large employers will not face tax penalties for not offering coverage to spouses,
DEFINITION OF DEPENDENT :
The proposed regulations define “dependents” for purposes of IRC §4980H as an employee’s child under age 26. Employers will not face tax penalties for not offering coverage to spouses, who will be able to seek a federal premium tax credit to purchase health insurance in an Exchange if other minimum essential coverage is not available. This definition of dependents does not apply for purposes of any other section of the Code.
Note: FTE means fulltime equivalents, NOT fulltime employees.
Filed under: Health Insurance | Tags: Copay, Deductible, Health Insurance 101, How does a deductible work, Insurance Glossary, Insurance Terms, Out of Network, Summary of Benefits & Coverage
So many times we are asked to explain health insurance terms to our clients and their employees. Thought we would share the most commonly used terms and explain how it works!
Health Insurance Glossary
Prescription Drugs:
Drugs come in 3 tiers, below are the details:
A tiered formulary offers its lowest copay for generic drugs (Tier 1), charges you a little more for brand-name drugs (Tier 2) still under patent (that is, you have no option but to take them if you need them) and a lot more for what formularies call “non-preferred” drugs or non-formulary brand named drugs (Tier 3) most often, they are brand-name drugs you choose to purchase in spite of available generics), and new drugs whose cost is higher than alternative therapies (though these may eventually become tier two drugs).
Deductible: The deductible is the amount an individual must pay for health care expenses before insurance (or a self-insured company) covers the costs. Often, insurance plans are based on yearly deductible amounts. For Prescription Drugs, you have a one-time annual Deductible that has to be satisfied for Tier 2 and Tier 3 Drugs only.
Major Medical In Network:
Deductible: The deductible is the amount an individual must pay for health care expenses before insurance (or a self-insured company) covers the costs. Often, insurance plans are based on yearly deductible amounts.
Coinsurance: refers to money that an individual is required to pay for services, after a deductible has been paid. By definition it is the split between the Insurance Company and the Insured. Coinsurance is always specified by a percentage. For example, the employee pays 20 percent toward the charges for a service and the insurance company pays 80 percent.
Out-of-Pocket Maximum: The dollar amount of claims filed for eligible expenses at which point you’ve paid 100 percent of your out-of-pocket and the insurance begins to pay at 100 percent. Stop-loss is reached when an insured individual has paid the deductible and reached the out-of-pocket maximum amount of co-insurance.
Copayment: is a predetermined (flat) fee that an individual pays for health care services, in addition to what the insurance covers. For example, some plans require a $30 copayment for each office visit, regardless of the type or level of services provided during the visit.
DXL: Stands for – Diagnostic X-ray and Lab, when you see this, it will give you the amount of the copayment associated with these services.
Lab Fees: The copayment associated with lab fees.
Hospital Benefits In Network:
Hospital In-Patient: Copay associated with hospitalizations where you are admitted for overnight stays.
Hospital Out-Patient: Copay associated with hospitalizations where you are admitted, but you do not have an overnight stay.
Emergency Room: Copay associated with Emergency Room visit, this is waived if you end up being admitted.
Surgical Benefits In Network:
Surgical In-Patient: Copay associated with an in hospital surgical procedure where you are going to be admitted for an overnight stay.
Surgical Out-Patient: Copay associated with an in hospital surgical procedure where you are admitted, but you do not have an overnight stay.
Mental Health & Substance Abuse In Network:
Mental Nervous In-Patient: Copay associated when admitted to a facility for overnight stays.
Substance Abuse In-Patient: Copay associated when admitted to a facility for overnight stays, aka rehab.
Mental Nervous Out-Patient: Copay associated with visit aka therapist visit
Substance Abuse Out-Patient: Copay associated with visit aka Out Patient Program
Out of Network Services:
All Out of Network are treated the same, the deductible has to be satisfied first, then a percentage of the Allowable Charges are covered until an Out of Pocket Maximum is reached, then 100% of the Allowable Charges are covered. Keep in mind, if you go to an Out of Network Doctor that charges over the Allowable Charge Amount, then you will be balance billed.
Filed under: Medicaid Expansion, National Healthcare | Tags: Medicaid Expansion, National Healthcare, What does Medicaid Expansion mean for employers
Medicaid Expansion
Medicaid is a partnership between the federal government and the states. States are able to design their own programs within the boundaries set by federal regulations and the federal government ponies up a large share of the money. The current Medicaid program requires states to cover only certain categories of needy individuals: pregnant women, children, needy families, the blind, the elderly and the disabled. Today, approximately 60 million people are enrolled in the program; expansion would add another 17 million. The ACA’s Medicaid expansion provisions require states to expand their Medicaid programs by 2014 to cover all individuals under the age of 65 with incomes below 133% of the federal poverty level (roughly $31,000 for a family of four). The ACA offered expansion of Medicaid on very generous terms – the law calls for the federal government to pick up all costs of the Medicaid expansion from 2014 through 2016. Subsequently, the federal payment level gradually decreases, to a minimum of 90%.
The challenge to the ACA was that it unconstitutionally coerced states to expand Medicaid by threatening to withhold all federal Medicaid grants for non-compliance. Instead of just refusing to grant new funds to states that did not comply with the new conditions, it would withhold those states’ existing Medicaid funds. The counter argument was that the Medicaid expansion provisions were simply modifications of the existing program that offered financial inducements to comply with the new law. The Supreme Court held that, while states could be required to comply with certain conditions in order to receive funds, they could not be penalized if they chose not.to participate in the new program by taking away their existing Medicaid funding. Simply put, the Court found that the ACA provisions were unconstitutional because the government cannot coerce states to expand Medicaid by threatening to withhold existing federal Medicaid funds. Additionally, the Court further found that the unconstitutional provisions could be severed and remedied, leaving the rest of the statute intact. The end result is that states may decide to opt out of the Medicaid expansion.
States that choose not to participate in the expansion will be faced with questions about how Medicaid programs will function and how it will affect the population that would have been Medicaid eligible through the expanded coverage. Opting out of the expansion would save the states some money in the long run. Within hours of the Supreme Court’s decision, Republican officials in several states said they were likely to oppose expanding the program.
What does this mean for employers?
For employers with above 50 lives, this could mean additional penalties under the ACA. If a state doesn’t expand Medicaid coverage, employers with over 50 lives may be subject to more plan affordability penalties than they would be were the state to expand. Under the employer mandate, employers are subject to penalties if they fail to offer group health plan coverage or they offer coverage that fails to meet certain quality and affordability standards (generally if premium for single coverage exceeds 9.5% of employee’s household income or if the plan fails to provide at least a 60% “actuarial value” and the individual enrolls in the Exchange). If Medicaid coverage is not expanded, individuals who would have been eligible for Medicaid under the expanded conditions will now likely find coverage under an Exchange and be eligible for federal subsidies. This could increase an employer’s exposure to shared responsibility under the employer mandate.
Employers with less than 50 lives and not subject to the employer mandate will also be affected. States that choose not to expand Medicaid will force more people to be dependent upon their employers or an Exchange for health insurance. Coverage under the Exchange will be challenging to navigate at the onset, will vary state by state, and may or may not be a viable option for many employees, effectively forcing the employer to step in. When employees cannot afford their insurance, it tends to leave employers in a sticky situation.
No matter what the size of an employer, allowing states to opt out of the Medicaid expansion provisions will likely result in more people (who typically were not insured in the past) seeking coverage on an Exchange. This certainly does not bode well for the overall experience of the Exchange-based plans, ultimately affecting rates and affordability for employees.
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This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely on any information contained herein without seeking the advice of an attorney or tax professional. ©2012 Emerson Reid, LLC. All Rights Reserved.
Filed under: National Healthcare | Tags: ACA, Healthcare Ruling, National Healthcare, supreme court, Supreme Court Decision
US Supreme Court Upholds Affordable Care Act
The US Supreme Court today (June 28, 2012) upheld the Affordable Care Act (ACA), ruling that the law’s individual mandate is a constitutional exercise of Congress’s power to impose taxes. With the Court’s decision, compliance efforts likely will move ahead at full speed with major provisions of the ACA becoming effective in 2013 and 2014.
In a 5-4 decision, Chief Justice Roberts, joined by Justices Ginsberg, Breyer, Sotomayor and Kagan, concluded, “The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”
In the Court’s analysis of the ACA’s Medicaid provisions, it held that it would be unconstitutional for the federal government to withhold all Medicaid funding in order to force states to comply with the Medicaid expansion. Chief Justice Roberts wrote, “Nothing … precludes Congress from offering funds under the ACA to expand the availability of health care, and requiring that states accepting such funds comply with the conditions on their use. What Congress is not free to do is to penalize States that choose not to participate in that new program by taking away their existing Medicaid funding.”
The Court ruled that the Anti-Injunction Act, which limits lawsuits challenging a tax before it is assessed, does not apply because Congress specifically provided that the penalty payment enforcing the individual mandate would not be treated as a “tax.” Notwithstanding acceptance of Congress’s penalty label for purposes of application of the Anti-Injunction Act, the Court ruled that for purposes of determining whether the individual mandate is constitutional, the penalty payment falls within Congress’s general power to tax and, therefore, is upheld.
The decision arises from cases brought by the state of Florida (and joined by 25 other states), the National Federation of Independent Business, and several individuals challenging the constitutionality of the individual mandate and the Medicaid expansion. The cases were later consolidated.
In their dissent, Justices Kennedy, Scalia, Thomas and Alito wrote that the law should have been struck down in its entirety.
With the exception of the limitation on the federal government’s authority to withhold Medicaid funding, all provisions of the ACA stand and compliance efforts likely will move ahead at full speed. In preparation for the major coverage expansion to occur under the ACA in 2014, the Administration is expected to release a host of regulations dealing with the definition of minimum essential coverage, employer coverage and reporting requirements, and an array of new taxes and fees. Clients should be aware of provisions of the law set to take effect in 2013 and 2014, including those listed in the table below.
Provisions of the Affordable Care Act That Take Effect in 2012, 2013 and 2014
2012
• Medicare hospital value-based purchasing program
• Increase in physician quality reporting requirements in Medicare
• Additional Medicare pilot programs on alternative payment methodologies, e.g., accountable care organizations
• Increased requirements for hospitals to maintain not-for-profit status
• Fees from insured (including self-insured) plans transferred to the Patient-Centered Outcomes Research Trust Fund
2013
• Increase Medicare payroll tax by 0.9% on high-income earners
• Impose a 3.8% tax on net investment income of high-income individuals
• $500,000 cap on health insurers’ deduction for executive compensation
• Eliminate employer deduction for Medicare Part D subsidy
• FSA limitations
• Excise tax on medical device manufacturers and importers
• Medical expense deduction floor increases to 10%
• Nationwide bundled payment pilot begins in Medicare
• Increased Medicaid reimbursement for primary care
• Medicare physician comparison data available to the public
• Reductions in Medicare payments for select hospital readmissions
• Expanded coverage of preventive services by Medicaid
2014
• Employer mandate and individual mandate
• Employer and insurer reporting requirements
• New health insurance market reforms take effect
• State health insurance Exchanges established
• Premium tax credits and cost-sharing subsidies available to certain individuals in Exchange insurance products
• Medicaid expansion to new populations (100% federal match to states for newly-eligible populations through 2016)
• Annual fee on health insurers
• Medicare/Medicaid DSH payment cuts begin
• Independent Payment Advisory Board (IPAB) issues first report to Congress if Medicare spending exceeds growth target
Post-2014
• Excise tax on high-cost employer-sponsored coverage (2018)
Political reactions
The Court’s ruling will not end the political debate over health care, which will remain a central issue in the 2012 elections and beyond. The law stands as the centerpiece of the domestic record of President Obama, who today said, “Whatever the politics, today’s decision was a victory for people all over this country whose lives will be more secure because of this law and the Supreme Court’s decision to uphold it.” The President added, “With today’s announcement it is time for us to move forward to implement and, where necessary, to improve this law.”
In comments in response to the ruling, presumed Republican presidential nominee Gov. Mitt Romney said, “What the Supreme Court did not do on its last day in session, I will do in my first day in office. I will act to repeal Obamacare.”
Following the release of the decision, House Majority Leader Eric Cantor (R-VA) announced that the House on July 11 will hold a vote on legislation to repeal the ACA in its entirety. The measure likely will pass the Republican-controlled House, but it is unlikely to advance in the Democratic-controlled Senate.
Repeal of the ACA has been a primary focus of congressional Republicans and remains a central objective of many Republicans’ campaigns in the November elections. Efforts to repeal all or part of the law will remain difficult unless Republicans maintain control of the House, win the presidency, and win at least a majority in the Senate in the November 2012 elections.
Republicans to date have not coalesced around a proposal to replace the ACA. Further efforts to control rising health care costs, including reforms to federal health entitlement programs and health-related tax expenditures, will be at the center of budget and deficit-reduction debates that are expected to dominate Washington after the November elections.
Background on the law
The Affordable Care Act was enacted in March 2010; it comprises the Patient Protection and Affordable Care Act of 2010 (which President Obama signed on March 23, 2010) and the Health Care and Education Reconciliation Act of 2010 (which the President signed on March 30, 2010).
The primary goals of the ACA are to: (i) expand coverage to an estimated 32 million Americans without health insurance; (ii) reform the delivery system to improve quality and drive efficiency; and (iii) lower the overall costs of providing health care.
To accomplish the goal of expanding coverage, the ACA mandates that all Americans maintain a minimum level of health coverage (the so-called individual mandate) or face a tax penalty. The law expands Medicaid coverage and provides federal premium tax credits and cost-sharing subsidies to assist low and moderate income individuals without affordable employer-sponsored insurance in obtaining health insurance through state-based insurance Exchanges. The ACA mandates, for the first time, that employers with 50 or more full-time employees provide certain minimum benefits or pay penalty fees.
The law also implemented insurance market reforms, including a ban on exclusions for pre-existing conditions, premium rate restrictions, extension of dependent coverage through age 26, and mandatory coverage of preventive services.
A mix of Medicare and Medicaid reimbursement cuts; provisions to reduce fraud, waste, and abuse in those public programs; other delivery system reforms; and a series of tax increases on individuals, corporations and the health industry are used to offset the cost of the law.
For more information
A video highlighting key elements of the Supreme Court’s decision will be available on www.ey.com.
An Ernst & Young Thought Center webcast discussing the ruling’s implications for individuals, employers, and health care providers has been scheduled for July 17. Follow this link to register.
The Affordable Care Act (ACA or health care reform law) requires nongrandfathered health plans to cover evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) department of HHS.
In guidelines released August 1, 2011, HHS outlined required preventive care services for women. The guidelines require nongrandfathered individual and group health plans to include these services without cost sharing:
- Well-woman visits
- Screening for gestational diabetes
- Testing for human papillomavirus (HPV)
- Counseling for sexually transmitted infections
- Screening and counseling for human immunodeficiency virus (HIV)
- FDA-approved contraception methods and contraceptive counseling
- Breastfeeding support, supplies and counseling
- Screening and counseling for interpersonal and domestic violence
For group health plans (whether insured or ASO), these services must be provided at the first plan year on or after August 1, 2012. For individual plans, the services must be provided in new policies beginning on or after August 1, 2012, and existing policies beginning at the start of the next policy year following August 1, 2012 (generally January 1, 2013). System and market considerations may accelerate the effective date in the individual market in some states.
The guidelines require coverage of contraceptive methods “as prescribed.” This language appears to limit the coverage requirement to contraceptive methods that require a prescription; future guidance may clarify this issue. The guidelines allow plans to encourage lower-cost contraceptives by charging cost-sharing for brand-name contraceptives when a generic is available.
The initial guidance about these requirements allowed a narrowly defined group of religious employers (essentially just churches) to choose not to cover contraceptives and sterilizations as part of preventive care benefits. Many other religious groups, such as religiously affiliated hospitals and universities, will not qualify for this exemption. On February 10, 2012, the administration announced its intention to issue revised regulations. According to a White House Fact Sheet, the revised regulations will:
- Exempt churches, other houses of worship and similar organizations from covering contraception on the basis of their religious objections.
- Establish a one-year transition period for other religiously affiliated organizations while this policy is being implemented.
Filed under: National Healthcare
What’s new for 2013? HSA contribution limits, HDHP minimum deductibles and out-of-pocket maximums will increase.
HSA Contribution Limits:
- Individual (self-only HDHP): $3,250($150 increase from 2012)
- Family: $6,450 ($200 increase from 2012)
Limits for catch-up contributions (for persons over age 55): $1,000 (unchanged from 2012)
HDHP Minimum Required Deductibles:
- Self-only: $1,250
- Family: $2,500
HDHP Out-of-Pocket Maximum:
- Self-only: $6,250 (a $200 increase from 2012)
- Family: $12,500 (a $400 increase from 2012)
For more information view the IRS change
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