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About HR Benefit Benefit Advisors, Ltd . PowerPoint Presentation
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About HR Benefit Benefit Advisors, Ltd .

About HR Benefit Benefit Advisors, Ltd .

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About HR Benefit Benefit Advisors, Ltd .

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  1. “Pay, Play, or Pray”Presented by:Rocco Lueck, MBA, GBDSManaging DirectorHR Benefit Advisors, Ltd.Buffalo, NY 14209

  2. About HR Benefit Benefit Advisors, Ltd. • Founded 18 years ago by Michael Colao and Gary Mink in Rochester, NY. Opened an office in Buffalo in 2007. • Invited to join the United Benefit Advisors (UBA) in 2005 • UBA is the 3rd largest employee benefit organization in the United States w/$16B in revenue

  3. Agenda Agenda • Understand the law • Review and Strategize • Develop your plan

  4. Einstein Riddle • A clerk at a butcher shop stands five feet ten inches tall and wears size 13 sneakers. What does he weigh?

  5. Einstein Riddle • Answer: Meat

  6. Understand the Law

  7. Employer Obligations • What Should I Do Now? • What Do I Need to Do in 2014? • To 2014, and Beyond!!

  8. Employer Obligations-Under 50 ee’s NOW: • Distribute medical loss ratio rebates • Begin issuing summary of benefits and coverage (SBC’s) starting with the first enrollment period beginning on or after 9/23/12 • Reduce employee FSA contribution to $2,500 • Withhold an extra .9 percent FICA on employees earning greater than $200,000 per year • Be prepared to file an application to participate in a SHOP exchange in summer or fall of 2013 • Provide notice of upcoming exchanges in March 2013 • Expand the definition of first dollar preventative care starting April 1st 2014

  9. Employer Obligations-Under 50ee’s What to do in 2014:Non-grandfathered plans • Work with exchanges to identify ee’s eligible for premium tax credits • Amend the plan to: • Remove all annual limits on essential health benefits • Provide coverage for those in clinical trials for services outside the trial • Limit cost sharing • Remove pre-existing condition limitations for adults • Limit eligibility waiting periods to 90 days • Begin reporting to IRS on coverage offered and available (first reports due actually in 2015)

  10. Employer Obligations-Under 50ee’s 2014 for grandfathered plans: • Work with exchanges to identify employees eligible for premium tax credits • Amend the plans to: • Remove all annual limits on essential health benefits • Remove pre-existing conditions for adults • Cover dependent children to age 26 even if they are eligible for coverage through their own employers plan • Limit eligibility waiting period to 90 days • Begin reporting to IRS on coverage offered and available (first reports due actually in 2015)

  11. Employer Obligations-Under 50ee’s • 2014 and beyond!! • Nondiscrimination rules will apply, no date set yet • 2018: 40% non-deductible excise tax will apply to high cost health coverage. • $10,200 for single coverage • $27,500 for family coverage • Employee and employer contributions will count towards threshold • Trigger amount will be increased annually

  12. Einstein Riddle • In British Columbia you cannot take a picture of a man with a wooden leg. Why not?

  13. Einstein Riddle • Answer: You can’t take a picture with a wooden leg. You need a camera (or iPad or cell phone) to take a picture.

  14. Employer Obligations-Over 50 Employees Between NOW and 2014: • Expand definition of first-dollar preventative care to include a number of women’s services on or after 8/1/12 • Does not apply to grandfathered plans • Does not apply to religious employers • Not-for-profit’s who have excluded contraception for religious reasons have a one year delay to comply. • Distribute medical loss ratio rebates • Begin issuing summary of benefits and coverage (SBC’s) starting with the first enrollment period beginning on or after 9/23/12 • Reduce employee FSA contribution to $2,500, on or after 1/1/2013 • Withhold an extra .9 percent FICA on employees earning greater than $200,000 per year • Calculate and pay the Patient Centered Outcomes Fee in July 2013 if plan is self-funded and its plan year ends between 10/1/2012 and 12/31/2012. • Insurers are responsible for paying the fee for insured plans but will likely pass it on

  15. Employer Obligations-Over 50 Employees What to do in 2014:Non-grandfathered plans • Provide affordable, min value to FT (30 hrs per week) or pay a penalty • Work with exchanges to identify those employees eligible for premium tax credits • Amend plan to: • Remove all annual limits on essential health benefits • Provide coverage for those in clinical trials for services outside the trial • Limit cost sharing • Remove pre-existing condition limitations for adults • Limit eligibility waiting periods to 90 days • Begin reporting to IRS on coverage offered and available(first reports are actually due in 2015)

  16. Employer Obligations-Over 50 Employees What to do in 2014: Grandfathered plans • Provide affordable, min value to FT (30 hrs per week) or pay a penalty • Work with exchanges to identify those employees eligible for premium tax credits • Amend plan to: • Remove all annual limits on essential health benefits • Remove pre-existing condition limitations for adults • Cover dependent children to age 26 even if they are eligible for coverage through their own employer • Limit eligibility waiting periods to 90 days • Begin reporting to IRS on coverage offered and available(first reports are actually due in 2015)

  17. Employer Obligations-Over 50 Employees • 2014 and beyond!! • 200 or more FT employees, must auto-enroll. Effective dat not set yet. • 2018: 40% non-deductible excise tax will apply to high cost health coverage. • $10,200 for single coverage • $27,500 for family coverage • Employee and employer contributions will count towards threshold • Trigger amount will be increased annually

  18. Pay • For employers with 50 or more full time employees: • You do not have to offer medical insurance, but, • If you don’t…… • Non-Tax deductible fine: $2,000 x number of full time employees, less the first 30. • Example: • 80 full time employees, no insurance offered. • 80 – 30 = 50 x $2,000 = $100,000 fine (non tax deductible)

  19. Pay • For employers that offer medical insurance; the insurance must be: • “Qualified” – Expected to pay at least 60% of allowed charges and have minimum benefit standards • AND • “Affordable” – Single coveragecan cost the employee no more than 9.5% of W-2 wages

  20. Pay • If plans are not “BOTH” qualified and affordable AND employee(s) • receives a subsidy via insurance purchase from“state exchange” • Then Non-Tax Deductible Fine: • The lesser of $3,000 per such employee or $2,000 x number of full time employees, less the 1st 30 employees. • Example: • 80 full time employees, 25 purchase coverage through the exchange & receive the subsidy: • Non-Tax Deductible Fine: • 25 x $3,000 = $75,000 (lesser of) • 80 – 30 = 50 x $2,000 = $100,000

  21. Pray • Why do it now, when I can wait?I'll get it done before it's late,I work much better under stress,(But that's not true, I must confess). • Poem by David Ronald Bruce Pekrul • “Procrastination”

  22. Summary • Thank you • For • Attending