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Implementation Issues for Employer Plans Steve Wojcik Vice President, Public Policy National Business Group on Health wojcik@businessgrouphealth.org Washington, DC September 8, 2010. Patient Protection and Affordable Care Act of 2010.
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Implementation Issues for Employer Plans • Steve Wojcik • Vice President, Public Policy • National Business Group on Health • wojcik@businessgrouphealth.org • Washington, DC • September 8, 2010
Patient Protection and Affordable Care Act of 2010 • Employer Plans Must Make Decisions in Face of Regulatory Uncertainty • Law Will Raise Employer Plan Administration Costs • Plans Expect Overall Health Care Costs to Continue to Outpace Economic Growth
Estimated Cost Increase Due to PPACA-related Plan Changes 3 Source: Mercer, Health Care Reform – Sizing up the Challenge, 2010.
Key Employer Provisions that Affect All Plans in 2011 • New Plan Requirements (2011) • Cover Dependents Up to Age 26 • No Lifetime Dollar Limits on Overall Benefits • Restrictions on Annual Dollar Limits on Overall Benefits • No Pre-Existing Condition Exclusions for Children under 19 • No Use of FSA, HSA, or HRA for OTC Medicines (2011) • Increase Penalty for Use of HSA for Non-Medical Expenses (2011) • Decide When to Relinquish Grandfathered Plan Status (2011)
Additional Requirements for Non-Grandfathered Plans • 100% Coverage of Preventive Health Services (2011) • USPSTF Recommended Services, A or B • CDC-Recommended Immunizations • HRSA Guidelines for Preventive Care and Screenings for Infants, Children and Women • HHS-Approved Internal Appeals and External Review Processes (2011) • Nondiscrimination Rules (Insured Plans Only) (2011) • Eliminate Prior Authorization or Higher Out-of-Network Cost-Sharing for Emergency, Ob/Gyn, and Pediatric Services (2011) • File Plan Financial Reports with HHS/State Insurance Depts. (2011) • File Quality of Care Reports with HHS (2012) • Cover Routine Care Costs for People in Clinical Trials (2014) • Cost-Sharing Limits not to Exceed HSA Maximums (Currently $5950 Individual, $11,900 Family) (2014)
Key Employer Provisions that Take Effect in 2012-2013 • Report Value of Health Benefits on W-2s (2012) • Provide Summary of Benefits and Coverage, Material Modifications in Terms and Coverage of Plans that Meets HHS Standards to Plan Enrollees No Later than March 23, 2012 • Plans Have 60 Days to Notify Enrollees of Plan Changes • Auto-Enroll New Hires in Health Plan (Likely Effective in 2013) • Limit Maximum FSA Amount to $2,500 (2013) • Notify Employees of Availability of and Potential Eligibility for Health Insurance Exchanges/Tax Credits (March 1, 2013) • Begin Medicare Surtax for High Income Earners (2013)
Key Employer Provisions that Take Effect in 2014 and Beyond • Employer Penalties for not Offering Coverage or for Coverage That Is Not Deemed Comprehensive or Affordable (2014) • Employer Subsidy Vouchers for Certain Employees Whose Coverage Approaches Unaffordability (2014) • Additional Employer Plan Requirements (2014) • No Annual or Lifetime Limits on Essential Benefits • Bans Waiting Periods Longer than 90 Days • Bans Pre-Existing Conditions Exclusion Clauses for Adults • HIPAA-Allowed Wellness Incentives Increase to 30% of Total Plan Costs (2014) • Medicaid Assistance to Medicaid-Eligible People in Employer Plans (2014) • Begin 40% Excise Tax on Higher Cost Plans (2018)
