Less than 50 Employees – Does Health Care Reform apply to me??

(Most of these do not apply to grandfathered plans)

Text Highlighted in Red = Requires action by the employer

o Mandate to cover specific benefits in the small group market – preventive, no preexisting for children, no lifetime limit, limitedannual maximum, no rescission, dependent to age 26 – 2010

o Existing plans grandfathered as of date of enactment from some, but not all, of the new plan requirements – 2010

o Non-discrimination requirements for insured plans – 2010

o An internal and external appeals process – 2010

o No prior authorization for emergency services – 2010

o Plans must allow designation of a primary care provider – 2010

o Small employer tax credits (for those who qualify) – 2010

o FSA, HSA, HRA definition of medical expenses – 2011

o Increase to 20% penalty for non-health withdrawals from an HSA or Archer MSA – 2011

o Wellness grants ‐ 2011 through 2015

o Increase Medicare payroll tax by 0.9% on earned income in excess of $200,000/$250,000 (unindexed); wages received after December 31,   2012

o Impose fee on health insurance and fully self-funded employer plans to fund comparative effectiveness research – 2012

o 3.8% investment tax on unearned income for taxpayers with AGI in excess of $200,000/$250,000

(unindexed) – taxable years after December 31, 2012

o Uniform explanation of coverage – November 1, 2012 (Fully Insured Clients – Carrier

o Notice of material modifications – September 2010 

o Elimination of tax deduction for retiree drug subsidies to employers – 2013

o Employee Notification of the Exchange – March 1, 2013 (This regulation was delayed as of 1/23/13 – ETA late 2013)

o Limit salary deferrals to FSAs to $2,500 – 2013, then indexed to inflation

o Eliminate deduction for Medicare Part D employer subsidy – 2013

o Raise 7.5% adjusted gross income (AGI) floor on medical expense deduction to 10% – 2013

o No preexisting condition exclusions for all participants – 2014

o Guaranteed issue – 2014

o Guaranteed renewability – 2014

o Must cover minimum benefit package – 2014

o Allows HIPAA wellness discount up to 30%(50%at Secretaries’ discretion) – 2014

o Limits on out-of-pocket cost sharing, maximum deductibles – 2014

o Coverage of routine costs associated with clinical trials – 2014

o Prohibition on waiting periods more than 90 days – 2014

o Must provide a minimum actuarial value for benefits – 2014

o File an annual report with HHS on employer and plan information – 2014

o Eliminate annual limits on benefits – 2014

o Limits premium underwriting – 2014

o Plan disclosure of claims payment policies and rating practices – 2014

o New SHOP Exchange for small-group and individual markets – 2014

o Limits on underwriting – 2014

o W2 reporting – 2013 tracking to be reported 2014; > 250 W-2’s

o IRS reporting – 2014

o 40% excise tax on high-cost plans – 2018

As always, confused?  Have questions?  Not sure what applies? 

Call your Health Care Reform Experts at 916-932-2357.

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