the aca & your organization: what you need to know - BerryDunn

64 Pages·2013·0.4 MB·English

by  James Cannon

April 25, 2013

THE ACA & YOUR
ORGANIZATION: WHAT
YOU NEED TO KNOW
crossagency.com | berrydunn.com
ACA LIKELY HERE TO STAY
• Law passed on March 23, 2010

• Supreme Court – weighs in on June 28, 2012
Authority to extend individual mandate comes from Congress’s power
to tax

• Presidential Elections on November 6, 2012
President Obama Re-Elected

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PLANS SUBJECT TO HEALTH CARE REFORM
• Health plan rules generally apply to group health plan coverage
• Exceptions
• Excepted benefits
• Accident or disability income coverage
• Separate dental and vision plans
• Liability insurance
• Some FSAs
• Retiree-only health plans
• Group health plans covering fewer than 2 employees

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PROVISIONS ALREADY IN PLACE
• Small employer tax credit
• Dependent coverage to age 26
• No lifetime limits/restrictions on annual limits
• No rescissions
• No pre-existing condition exclusions for children
• No cost-sharing for preventive care services (non-GF plans)
• Appeals process changes (non-GF plans)
• No reimbursement for OTC medicine or drugs (without a prescription)
Exception is insulin

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TODAY’S TOPICS
Form W-2 Summary of
Medical Loss Limits on FSA
reporting of Benefits &
Ratio Rebates contributions
health insurance Coverage
(2012) (2013)
(2012 ) (2012)
Transitional
Health Insurance Small Business
PCOR fees Reinsurance
Provider Fee Heath Care Tax
(2012 – 2019) Fees
(2014 ) Credit (ongoing)
(2014 – 2016)
Exchange Individual Employer play
Notices Mandate and or pay rules
(2013 ) Credit (2014) (2014)
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FORM W-2 REPORTING FOR VALUE OF HEALTH CARE
Effective with 2012 tax year (Forms issued in January 2013)

• Reporting is for informational purposes only
Benefits continue to be tax-free

• Must report the value of “applicable employer sponsored coverage”

• Only applies to Large Employers for now

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ACA IMPACT IN 2012
Medical Loss Ratio (MLR) Rebates
• Applies to calendar years beginning on or after January 1, 2011
Applies to fully insured plans
• Based on insurer’s MLR – not plan specific
• MLR Threshold:
• Large Plans (>100 benefits eligible employees) = 85%
• Small Plans (100 or less benefits eligible employees) = 80%

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SUMMARY OF BENEFITS & COVERAGE (SBC)
• Simple and concise explanation of benefits
Applies to GF and non-GF plans

• Model template and guidance available

• Special rules specify when SBC must be provided

• Does not replace other required plan documents
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NEW MEDICAL FSA LIMIT FOR 2013
Annual limit on Cafeteria Plan Health FSA Contributions

Limit will be $2,500 per plan year (as indexed)
• A plan limit; not an individual limit
• For employee deferrals; not for employer contributions
Effective for Plan Years beginning on or after 1/01/2013

Don’t forget to amend plans on or before 12/31/2014!

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PATIENT CENTER OUTCOMES RESEARCH (PCOR) FEE –
IRC §4376
• Applies to insurers and sponsors of self-insured plans (including HRAs and
some Medical FSAs)
• The fee is:

2012 • $1 x Average # of covered lives

2013 • $2 x Average # of covered lives

2014 – 2019 • $2 (indexed)

• Applies to Plan Years ending after 10/01/2012
• Reportable and payable by means of IRS Form 720
• Filing due date is 7/31 for all Plan Years ending in preceding calendar year

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