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PPACA IMPACT ON MEMBER INSTITUTIONS. Why would you be Confused?. Health Care Reform Timeline. Insurance Market Post 2014. Most individuals in the U.S. are required to have health Insurance that qualifies as minimum essential coverage or be subject to a penalty.
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Insurance Market Post 2014 Most individuals in the U.S. are required to have health Insurance that qualifies as minimum essential coverage or be subject to a penalty. 2014 penalty: greater of 1% taxable gross household income or $95, increases in future years.
Insurance Market Post 2014 In 2014, Insurance for Healthcare will have four primary delivery markets Employer Provided Coverage. Marketplace (i.e. Exchange). Medicaid (for States with expansion). Medicare.
Employer Mandate Flowchart (Applies to employers with > 50 full-time employees delayed until January 1, 2015) (Individual mandate requires all individuals to have coverage as of January 1, 2014) Does employer offer a health plan? PENALTY $2000 X # FTE Employees > 30 No Yes Is the health plan both “qualified” and “affordable”? No employer penalty. Yes No If any employee opts out of the employer plan and receives a subsidy in an Exchange, the employer pays the Exchange $3,000 for every employee that receives a subsidy. The total potential payment is capped at $2,000 multiplied by the total number of FT employees minus 30. Employee is not eligible for subsidy within Exchange. No employer penalty. Does employee’s household income exceed 400% of Federal Poverty Level? A plan is considered “qualified” when it is expected to pay at least 60% of allowed charges and “affordable” when the employee contribution does not exceed 9.5% of Adjusted Household Income. Yes No
Insurance Market Post 2014:Employer Coverage Employers with over 50 employees are required to provide coverage or subject to penalties (delayed until 2015). Employer coverage must meet minimum standards and be affordable to avoid penalties (delayed until 2015).
The 30-Hour Dilemma • defined under ACA as an average of 30 hours per week, or at least 130 hours in a month to be tracked and reported by employer. • American Council on Education letter of March 18, 2013 to IRS requesting clarification on: • Student employees • Adjunct Faculty • http://www.cupahr.org/advocacy/positions/ACE-Employer-Shared-Responsibility-Proposed-Regulations-03182013.pdf
Why should you be concerned? Assuming your organization is dealing with finite resources UBA benchmark – annual medical plan cost $10,521 pepyof which employer pays $7,684 pepy.
Introduction to the Marketplace Marketplace, Exchange, “Obamacare”
Insurance Market Post 2014:Marketplace for Individuals • Envision Travelocity or Expedia etc. • Plan types Platinum, Gold, Silver, Bronze • Different Insurance Companies • Cost will depend on plan type, carrier and • Your Household income could qualify for a subsidy • Are you offered a qualified affordable plan by your employer
Insurance Market Post 2014:Marketplace for Individuals Eligible for subsidy if you are not offered a qualified affordable plan by your employer and your household income is below 400% of Federal Poverty Level.
Insurance Market Post 2014:Marketplace for Individuals Sample chart of Premium Subsidy
What next? May need to help your institutions “manage” eligibility for part time or adjunct staff (or understand the impact on institutional budgets). Define institutionally who owns this responsibility – limited H.R. staffs looking for help. Some institutions defining policies and procedures.
