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Health Reform Discussion

Health Reform Discussion. Lisa Evans Director of Healthcare June 20, 2013. Agenda. Health Reform Provisions Employer Health Plan Standards Public Health Exchanges Employer Purchase Options Pay or Play Cadillac Tax. 2014 Health Reform Provisions.

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Health Reform Discussion

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  1. Health Reform Discussion Lisa Evans Director of Healthcare June 20, 2013

  2. Agenda • Health Reform Provisions • Employer Health Plan Standards • Public Health Exchanges • Employer Purchase Options • Pay or Play • Cadillac Tax

  3. 2014 Health Reform Provisions • No one can be turned down for coverage for health reasons • Everyone must buy health insurance coverage or pay a tax 2014: Greater of 1% of AGI or $ 95 per person 2015: Greater of 2% of AGI or $325 per person 2016: Greater of 2.5% of AGI or $696 per person Family maximum is capped at 300% of individual tax. • Access will be provided through Health Exchanges in each state.

  4. Health Reform Provisions 2011 Cover up to age 26 for dependents 2012 Unlimited dollar coverage Preventative Services at 100% Must report health costs on W-2s 2013 Female Contraceptives covered at 100% 2014 No one can be turned down for coverage No pre-existing limits are allowed Reinsurance Fee (2014-2016) 30 hour rule (monitoring starts in 2013) 2018 “Cadillac” tax

  5. Employer Health Plan Standards • Coverage must be adequate • Plan coverage value of at least 60% or more • Coverage must be affordable • Employee-only premium must not exceed 9.5% of employee’s AGI • Offer coverage to at least 95% of full-time employees

  6. Public Health Exchanges • Every state will have option by 2014 or federal government will step in and establish. • Minimum coverage is required. • Subsidies/credits will be available based on income. • Premiums will vary based on age, people covered and zip code within set limits (3:1) • Standardized options will be available: Bronze Silver Gold Platinum 60% 70% 80% 90%

  7. Health Care Employer Purchase Options Public Health Exchanges Cost Employers Private Health Exchanges Subsidies only available in Public Exchanges Exchange = Marketplace 2014 Time

  8. Employer Considerations Pay orPlay

  9. Pay Option Fail to offer Minimum essential coverage 95% full-time employees/dependents* Penalty = $2,000 per each full-time employee (-30) annually • *and one of those employees receives subsidy in Health Exchange.

  10. PLAY Options Offered minimum coverage to at least 95% full-time employees & dependents but not adequate/affordable* Penalty - $3,000 per exchange enrolled employee (up to maximum of $2,000 per full time employees) -No Penalty – offer coverage 100% of employees who work >30 hours AND Adequate (> 60% value) AND Affordable (single premium cannot exceed 9.5% of employee’s AGI

  11. How will person get coverage in 2014? *Using dollar estimates of 2014 Federal Poverty Level (FPL)

  12. Spectrum of Opportunity

  13. “Cadillac” Tax Effective 2018 and will be indexed by CPI+1%. “40% tax on value of employer sponsored coverage over a given dollar threshold” $ 10,200 Employee Only $ 27,500 Family Separate High Risk or Retiree Single coverage rate: $ 11,850 Single Coverage $ 30,950 Family

  14. Thank you.

  15. Questions? To sign up for ELM information contact: Don Betts betts@gatech.edu 912.381.9003

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