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Hot Topics in Health Care Reform (California)

Hot Topics in Health Care Reform (California)
August 2, 2013 at 1:00 - 2:00 PM ET
Jennifer Graff Lunski, Esq., Vice President-Compliance Officer(Woodruff-Sawyer & Co.)
Evaluate the impact of health care reform on your organization and ensure your employee benefit plans remain in compliance.

Health care reform and its major provisions take effect in 2014 and will have a major impact on employers’ benefits strategies. Employers must address compliance issues including recent San Francisco Health Care Ordinance revisions, Health Insurance Portability and Accountability Act audits, and the possible release of final Section 125 cafeteria plan regulations. Gain insight and practical information to successfully address the benefits and compliance issues resulting from health care reform over the next 12 months. Areas of discussion include:

The effective dates of the following provisions are uncertain as of 1/1/2013. Final effective dates will be determined by regulatory guidance yet to be issued.
IRS Nondiscrimination Rules Applicable to Fully-Insured Health Plans
• Employers with fully-insured plans are prohibited from providing benefits which discriminate in favor of highly compensated employees, similar to Section §105(h) rules which already apply to self-insured health plans.
• Effective date delayed - The IRS delayed the enforcement of these rules until plan years beginning sometime after the release of regulatory guidance. It is expected that the most likely effective date will be for plan years beginning 1/1/2014.
Automatic Enrollment
• Employers with more than 200 full-time employees must automatically enroll full-time employees in health coverage. Employees will have the option to opt out of automatic enrollment. DOL has stated rules will likely not be effective before 2015.
2012 - 2013
Summary of Benefits and Coverage
• Plans required to provide a Summary of Benefits and Coverage (SBC) to all applicants and participants.
– Requirements that apply to communications to participants during an annual enrollment period are effective for open enrollment periods that begin on or after September 23, 2012.
– Requirements that apply to new enrollees other than during an open enrollment period are effective beginning on the first day of the first plan year that begins on or after September 23, 2012.
Clinical Effectiveness Research Fee
• All health plans will pay a fee to fund clinical effectiveness research effective for plan years beginning 11/1/2011. The fee will equal $1 per year per participant for the first year, and $2 per year after that until it sunsets in 2018.
– Health insurance companies will pay fee on behalf of fully-insured plans.
– Plan sponsors of self-funded plans must pay fee by July 31 of the year following the end of the plan year.
Report Plan Cost on W-2
• Employers must report the value of employees’ health coverage on their W-2. Reporting does not result in value of health insurance being treated as taxable income.
• Large employer reporting is mandatory for tax year 2012 (W-2s released January 2013).
• Smaller employers who filed fewer than 250 W-2s in the prior year are not required to report.
Medicare Hospital Insurance (HI) Tax
• An additional Medicare tax of 0.9% applies to taxpayers with earned income above $200,000 (single return) or
$250,000 (joint return). Employers are not required to match the increase.
• Employers must only withhold additional tax if employee’s compensation from that employer exceeds $200,000.
Limit on Health FSA
• Employee annual pre-tax reductions for contribution to a Section 125 health FSA capped at $2,500 per year (then
indexed annually to inflation) beginning with plan years starting on or after 1/1/2013.
Employee Notice Requirement
• Employers will be required to provide employees with a notice by 3/1/2013 which includes; information on health
insurance exchanges, premium subsidies and if the employer’s plan meets minimum coverage requirements.
• HHS to release model notice for employer use.
Reinsurance Fees
• Intended to help stabilize premiums in the individual market during the first three years the state based exchange is in
existence. Estimated costs are $60 to $90 per member per year in 2014, $40 to $60 per member per year in 2015 and
$25 to $35 per member per year in 2016. Fees are tax deductible.
Health Benefit Exchanges
• States will establish an insurance Exchange to facilitate the offering of approved, qualified health plans. Exchange
coverage initially offered only to individuals and small employers (50-100 employees, depending on the state).
• Federal government will establish an Exchange in states that choose not to implement a state run Exchange.
Individual Health Coverage Mandate
• Individuals who do not enroll in “minimum essential coverage” will pay a tax starting at $95 or 1% of income in 2014,
increasing to $695 or 2.5% of income per adult in 2017 (tax is half this amount for children).
Insurance Market Reforms
• Insurers in the individual and small-group markets subject to various rating and underwriting rules. Rules apply to
small group and individual health insurance plans sold both inside and outside an exchange.
– Guarantee issue and renewable basis, no health underwriting, no preexisting condition exclusions and limits on
permissible premium rating bands
– Premium rates can only vary premium according to specific criteria including individual or family coverage, rating
area and age.
Employer “Play or Pay” Penalties for not Providing Coverage to Full-Time Employees
• Applies to employers with 50 or more full-time employee equivalents (FTEs)
– Part-time employees are counted on a pro-rated basis to determine if employer is subject to the penalty but
employers are not required to cover part-time employees.
• Employers who offer health insurance to all full-time employees (30 hours per week) will pay $250 per month for
any full-time employee who opts out of the employer plans and purchases subsidized individual coverage through
the exchange.
• Employers who do not offer minimum essential health insurance to full-time employees would pay $2,000
annually multiplied by the total number of full-time employees (not counting first 30 employees).
No Lifetime Limits, Restricted Annual Limits
• Plans may not impose lifetime limits.
• Restrictions on annual limits begin in 2012, with no annual limits permitted beginning in 2014.
Cost-Sharing Limitations
• Fully insured small group health plans cannot impose deductibles that are higher than $2,000 for single coverage
and $4,000 for any other coverage.
– Carriers may offer deductibles higher than $2000 if necessary to meet bronze level coverage requirements.
• Out-of-pocket maximum limited to those applicable to HSA qualified high deductible health plans.
Limits on Waiting Periods
• Plan years beginning on or after January 1, 2014 - Plan cannot impose any waiting period that exceeds 90 days.
Fees on Certain Plans/Insurers
• Annual fee on health insurance “issuers” (health insurance companies). Does not apply to self-funded plans.
Comprehensive Health Insurance Coverage
• A health Insurance issuer offering coverage in the individual or small group market must offer those essential
benefits that are required to be offered on the state exchanges.
Wellness Incentives
• HIPAA limits on financial incentives for participation in wellness programs will increase to 30%.
Federal Premium Subsidies and Cost Sharing Reductions for Low and Middle-Income Individuals
• Premium subsidies & reduced cost sharing will be provided to individuals earning up to 400% of federal poverty
level who purchase individual health insurance through an Exchange. Individuals eligible for affordable employer
sponsored health insurance are not eligible.
Report to Government on Plan Coverage
• Employers offering minimum essential coverage must report to IRS about health coverage including the name of
each employee and dependent covered by plan, portion of premium paid by employer and other items.
• Summary of this information must be provided to each covered individual.
Coverage for Clinical Trials; No Discrimination
• Plan cannot deny participation in approved clinical trials or otherwise discriminate based on participating in trials.
Excise Tax on High-Cost Health Plans
• A 40% excise tax will apply to the cost of employee health coverage that exceeds $10,200 annually for single coverage
and $27,500 for family coverage.
Who Should Participate
You are an HR professional, CEO or CFO who wants to know how to stay in compliance with health care reform.
What You Will Learn
Take away key items that you need to do this year to avoid government penalties and litigation risk associated with benefits law. Evaluate the impact of health care reform on your organization and ensure your employee benefit plans remain in compliance.

Topics of discussion include pay or play penalties, disclosure requirements and future planning strategies.

Recommended Resources Click here
HR in California
Presented by
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Jennifer Graff Lunski, Esq.
Woodruff-Sawyer & Co.

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Event Sponsors
Woodruff-Sawyer & Co.
Woodruff-Sawyer & Co. is one of the largest privately held insurance firms and ranked among the top insurance brokers in the nation.
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