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Affordable Health Care Act

Individuals –U.S. Citizens and legal residents are required to have “minimum essential coverage” for themselves and their dependents beginning on 1/1/2014 OR be subject to a tax penalty ( date may change ) Employer sponsored plans Individual market insurance policies

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Affordable Health Care Act

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  1. Individuals –U.S. Citizens and legal residents are required to have “minimum essential coverage” for themselves and their dependents beginning on 1/1/2014 OR be subject to a tax penalty (date may change) • Employer sponsored plans • Individual market insurance policies • Government programs such as Medicare, Medicaid, CHIP, TRICARE Affordable Health Care Act

  2. Acceptable Coverage = Minimum Essential Coverage and at least 60% Actuarial Value Fair Access = All Employees working 30 hours weekly or more (several tests; 90 day look back rules apply) Affordable Coverage = Employee only cost of coverage may not exceed 9.5% of household income for individuals making < 400% of Federal Poverty line AHC Act –Three tests:

  3. Significance of Full time (>30 hours) -employee who IS offered insurance but earns low pay determines which employers are subject to Penalty $3,000/annually per person: coverage costs must be LESS than 9.5% MAGI SINGLE EmployeeannualCost $ 6930.00 Divide by 9.5% Earnings must be greater $7,295.00 Affordable Health Care Act

  4. Employee Notices Required • Annual Summary of Benefits and Coverage (SBC)–explaining coverage plans, deductibles, co-pays, and giving specific examples of out-of-pocket expenses to employees • At date of hire – ALL new employees are required to receive Marketplacenotification notices that explain the exchanges and the benefits to employees • “Marketplace” used to be called “Exchange”

  5. Fees to be paid by employers: • Patient-centered Outcomes Research Institute Fee (PCORI) $1/covered life first year; $2/covered life second year; adjusts annually Cost YR1 $ 2,736 • Transitional Reinsurance Fee (TRF): • $63/per year/per covered life due January 2015 Cost YR1 $172,368

  6. Strategic staffing across employee groups to provide oversight at each level to ensure that part time employees do not consistently work greater than 30 hours/weekly Employee groups have been accessed and adjustments made so that Health Insurance is offered to employees who are contracted for >30 hours/week. Administration work so far…

  7. Summary of Benefits and Coverage (SBC) is being incorporated into the Employee handbook • 90 day review period has been selected (November 1 to January 31); payroll records will be pulled to perform review • Administrative review of hours each payroll to make adjustments where needed • Changes will be made during Open Enrollment to capture signatures of employees who refuse Health Care with SPS

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