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Patient Protection and Affordable Care Act (PPACA)

Patient Protection and Affordable Care Act (PPACA). A T imeline of PPACA P rovisions That Could Affect You. 2010 . 2010 Cont’d. 2011. Over-the-counter drugs not prescribed by a doctor may not be reimbursed through an FSA or HRA nor on a tax free basis through an Archer MSA or HSA.

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Patient Protection and Affordable Care Act (PPACA)

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  1. Patient Protection and Affordable Care Act (PPACA)

  2. A Timeline of PPACA Provisions That Could Affect You

  3. 2010

  4. 2010 Cont’d

  5. 2011 • Over-the-counter drugs not prescribed by a doctor may not be reimbursed through an FSA or HRA nor on a tax free basis through an Archer MSA or HSA.

  6. Closer Look at Medical Loss Ratios “Other non-claims costs,” such as administrative costs, cannot be more than 15% of the premium in the large group market or 20% in the small group/individual markets. In January 2011, HHS deemed that agent commissions must fit within that 15%/20%, leading to a squeeze on agent compensation. The Big “I” is focused on congressional legislation that would statutorily exclude agent compensation from the MLR formula. In the 112thCongress, Reps. Mike Rogers (R-MI) and John Barrow (D-GA) introduced H.R. 1206, which garnered 221 bipartisan cosponsors. Also in the 112th, Senators Mary Landrieu (D-LA) and Johnny Isakson (R-GA) introduced S.2288, the “Access to Professional Health Insurance Advisors Act of 2012”, which gained 10 bipartisan cosponsors.

  7. 2012

  8. 2013 (Repealed by the American Taxpayer Relief Act in Jan. 2013) CLASS Act:A national long term care assistance/disability insurance plan is established. The benefit is tied to one’s inability to perform two or three Activities of Daily Living (ADLs) and the benefit amount is varied based on the “scale of functional ability” with a $50-7/day cash benefit. All working adults will be automatically enrolled in the program unless they choose to opt-out.

  9. 2013 Cont’d • On October 1, 2013, health insurance exchanges must be ready to begin open enrollment. (Delayed– likely until Fall 2013) Beginning March 1, 2013, employers must provide a written notice to all employees with information on the following: (1) the existence of exchanges and contact information for assistance, (2) the availability of premium subsidies through exchanges and (3) that if the employee purchases health insurance through an exchange, they will lose any employer contribution and that all or a portion of any contribution may be excludable from income for tax purposes.

  10. 2014

  11. 2014 Cont’d New tax is levied on insurance companies based on net premiums written. This tax will raise an estimated $8 billion in 2014, reaching $14.3 billion by 2018. The tax does not sunset and is indexed to inflation thereafter.

  12. 2014 Cont’d

  13. Closer Look at Individual Mandate Beginning in 2014, virtually every U.S. citizen and legal resident will be required to purchase health insurance or face a tax penalty. There are certain exemptions from the individual mandate including: those who choose not to buy a policy for religious reasons, undocumented immigrants, incarcerated citizens, members of Native American tribes, those with family income below the threshold requiring a tax return. To satisfy the mandate, individuals must obtain health insurance for the entire year through one of the following sources: Medicare, Medicaid, CHIP, veteran’s health programs, a plan offered by an employer, insurance purchased on your own that is at least at the Bronze level (60% actuarial value). The penalty for non-compliance will be phased-in according to the following schedule: $95 (or 1% of income, whichever is higher) in 2014, $325 (or 2% of income) in 2015, and $695 (or 2.5% of income) in 2016. After 2016, the penalty will be increased annually by the cost-of-living adjustment.

  14. Closer Look at Employer Mandate Beginning in 2014, employers with 50 or more full-time employees that do not offer coverage to at least 95% of full time employees and have at least one employee who receives a premium tax credit will be assessed a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment. Employers with 50 or more full-time employees that offer coverage to at least 95% of employees but have at least one employee receiving a premium tax credit, will pay the lesser of $3,000 for each employee receiving a premium tax credit or $2,000 for each full-time employee, excluding the first 30 employees from the assessment. (Effective January 1, 2014). Employers with 200-plus full-time employees must automatically enroll their employees into health insurance plans.

  15. 2016

  16. 2017

  17. 2018

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