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June 2013

The Affordable Care Act (ACA) / The System Wellness Initiative An HR Liaison Presentation. June 2013. Ellen Gerescher. Employee Benefits Manager A&M System Office. Important Highlights of ACA. Employer Fees Transitional Reinsurance Fee Patient-Centered Outcomes Research Institute Fee

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June 2013

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  1. The Affordable Care Act (ACA) / The System Wellness Initiative An HR Liaison Presentation • June 2013 Ellen Gerescher Employee Benefits Manager A&M System Office

  2. Important Highlights of ACA • Employer Fees • Transitional Reinsurance Fee • Patient-Centered Outcomes Research Institute Fee • Eligibility Changes • 30 hours/week = full-time employee • Benefit Changes • 90-days = maximum waiting period • All inclusive out-of-pocket maximum

  3. More Highlights • Employer Penalties related to: • Minimum Essential Coverage • Minimum Value • Affordable Coverage • Exchange Notices to Employees (Oct‘13) • Exchanges Begin

  4. Employer Fees • Employer fee (per covered life, per year) 2014 Fee: $63 $2.8 Million 2015 Fee: $42 $1.9 Million 2016 Fee: $26 $1.1 Million

  5. Eligibility Changes • Current benefit-eligible employee: • Works at least 20 hours/week for at least 4.5 continuous months • New definition: • Works 30 hours or more/week • Problem areas: • Adjunct faculty, student workers, employees with multiple positions, seasonal/ temporary employees

  6. Required Benefit Changes • Full-time employees must be enrolled in health coverage no later than the 90th day of employment. • Cap on out-of-pocket annual expenses - $6,400 per individual/$12,800 per family

  7. “Shared Responsibility” • TAMUS must offer the following or be subject to a tax penalty: • Offer “minimum essential coverage” to all or “substantially all” of its “full-time employees” and their “dependents”. • Offer self-only coverage to its full-time employees that has “minimum value” (is adequate) and is “affordable”.

  8. Definitions Minimum Essential Coverage - basically all employer health plans. Minimum value - is an actuarial value calculated using the coinsurance percentage, copays, premiums and out-of-pocket maximums. Thus far, our plans are above minimum value. An “affordable” plan is one that does not exceed 9.5% of the employee’s hourly wage or monthly salary.

  9. Exchange Notice • Must go to new employees by October 13th, and new employees within 14 days of hire date • Notice must include information about: • Health Exchange Insurance Marketplace • Contact information for Marketplace • Availability of premium tax credits • Loss of employer contribution

  10. System Wellness Initiative Objective: Invest in wellness initiatives coordinated by System members Process: Grants awarded covering cost of classes, webinars, and program materials over the coming 2 years Grants: To be eligible, each member will be required to conduct a minimum of 4 webinars and a wellness fair

  11. System Wellness Initiative Objective: Ensure employees are active in their personal health through annual exams Process: Employees/Spouses will be asked to have annual exams at least every 18 months; no cost to employees for services Premium Differential: Those who elect not to have annual exams will have premiums $30/month higher than those who do

  12. Thank You

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