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PATIENT PROTECTION AND AFFORDABLE CARE ACT (AKA HEALTH CARE REFORM)

PATIENT PROTECTION AND AFFORDABLE CARE ACT (AKA HEALTH CARE REFORM). WHAT IS IT . Law enacted in March 2010 Purpose: ensure that almost everyone living in the United States has comprehensive medical coverage. PROVISIONS. Coverage for adult children to age 26

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PATIENT PROTECTION AND AFFORDABLE CARE ACT (AKA HEALTH CARE REFORM)

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  1. PATIENT PROTECTION AND AFFORDABLE CARE ACT(AKA HEALTH CARE REFORM)

  2. WHAT IS IT • Law enacted in March 2010 • Purpose: ensure that almost everyone living in the United States has comprehensive medical coverage

  3. PROVISIONS • Coverage for adult children to age 26 • Prohibition on lifetime dollar limits on essential benefits • Restriction on annual dollar limits on essential benefits • No pre-existing condition exclusions on children under 19 • No cost sharing on certain preventive care • Contraceptive coverage required

  4. Provisions (cont’d) • Patient-Centered Outcomes Research Fee (CER Fee) • MLR rebates • Summary of Benefits and Coverage Must be provided to all New Hires and current employees (and in a specific format)

  5. FOR EMPLOYERS • If provide health insurance to employees: • Must provide to full time employees (defined as working 30 or more hours a week) • Must be affordable • 3 safe harbors (W-2 wages, Rate of Pay or Federal Poverty level) • Must provide minimum essential coverage • Plan’s share of total allowed costs of benefits provided under the plan must be at least 60% of such costs (a measure of benefits, not premium amounts)

  6. FOR EMPLOYEES • Individual Mandate (all individuals must have health insurance coverage as of January 1, 2014) • Health insurance coverage can be obtained through: • Employer • Federal or State Exchanges • Kansas – no state exchange, defer to Federal • Approved providers are Coventry and Blue Cross/Blue Shield • Private insurance company

  7. Penalties for Non-Compliance • Employer • If coverage is not affordable or doesn’t meet Minimum value • Lesser of $3000 per full time employee receiving the tax credit or $2000 per full time employee (minus first 30) • Employee • 2014: $95/person up to $285 per family or 1.0% of adjusted gross income • 2015: $325/person up to $975 per family or 2.0% of adjusted gross income • 2016: $$695/person up to $2085 per family (indexed) or 2.5% of adjusted gross income • Full responsibility for all medical costs incurred

  8. Cadillac Tax • 2018: Tax levied if premium levels exceed $10,200 for single and $27,500 for employee+1/family • 40% tax will be levied • Tax paid by insurance provider but probable impact on premiums

  9. BCC Action Steps Taken • Identified 28 hours/week for part time employees • Identified maximum loads for adjunct faculty • Established Measurement periods for compliance purposes

  10. Measurement Periods • Initial Measurement period • 12 month period beginning with the 1st of month following first day of hire • Standard Measurement period • November 1 – October 31 • Administrative Period (2 months after the end of each measurement period)

  11. Analysis of Hours Worked • Analysis completed for each employee for each measurement period • If employee averages 30 hours or more per week then must offer health insurance for the following 12 months

  12. For Further Information • More information about Health Care Reform: www.healthcare.gov

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