MACPA PPACA Health Care Act - 2014 Business impact - Town Hall

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The Affordable Care Act: 2014 Business Impact

A special town hall for members

Presented by: Tom Hood, CPA, CITP, CGMA CEO Maryland Association of CPAs Business Learning institute

Thanks to our sponsors:

335 Clubhouse Road • Hunt Valley, MD www.rjpassociates.com 800.618.2600

THE AFFORDABLE CARE ACT

BUSINESS IMPACT – 2014

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Discussion Topic

Affordable Care Act Provisions –

Current, Ongoing, and Delayed


ACA Provisions applicable to EmployersMany of the provisions required to be implemented by 2014 already in effect or remain scheduled for implementation, including:� Exchange Notices

� Individual Mandate

� Implementation of Insurance Exchanges

� Employees’ access to premium subsidies

� Reporting minimum waiting period and essential coverage (including minimum value and affordability on SBC)

� Insurance Mandates (e.g., no pre-existing condition exclusion, premium rating, minimum essential benefits, medical loss ratio)

� Payment of reinsurance and PCORI fees


2014 ACA Provisions - Delayed

IRS Notice 2013-45 issued July 9, ,2013 provided a one-year enforcement delay for:� The information reporting requirements applicable to insurers

and self-insured plans who provide minimum essential coverage under IRC § 6055

� The information reporting requirements for large employers under IRC § 6056

� The Employer Shared Responsibilities under IRS § 4980H (“Play or Pay”)


Certain enforcement provisions previously delayed pending further guidance continue to be delayed, including:

� W-2 reporting of employer-provided health coverage cost for small employers (<250 W-2s) issued in prior calendar year

� Automatic enrollment of employees in employer-provided health coverage – 200+ FTE Employers

� Application of Code § 105(h) nondiscrimination rules to non-grandfathered fully insured health plans


InsuranceExchanges


� State Exchanges:California, Colorado, Connecticut, District of Columbia, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Rhode Island, Utah, Vermont and Washington

� State Partnership Exchanges:Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire and West Virginia

� Remaining states to default to Federally Facilitated Exchanges

More info at CMS.gov: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/state-marketplaces.html


Maryland Health Benefit Exchange and SHOP Discussion

Michele EberleExecutive Director

Maryland Health Insurance Plan

http://marylandhbe.com/wp-content/uploads/2013/05/mhc_h.jpg

A service of Maryland Health Benefit Exchange

Maryland Health Benefit

Exchange

The Affordable Care Act: 2014 Business Impact

Michele Eberle

Executive Director, MHIP

August 27, 2013

The Patient Protection and Affordable Care Act of 2010 (ACA)

Why It’s Important to Maryland

Expands access to health insurance for 730,000 Marylanders (13% of Maryland) currently without health insurance – Gives individuals access to primary care physicians, preventive services

Lowers uncompensated care costs in the healthcare system – lower insurance premiums across the state

Provides federal subsidies for individuals up to 400% of FPL to pay for health insurance premiums – Infuses $600 million in federal subsidies into the State of Maryland by 2015 NEW funds in health care system

Requires each state to establish a “health insurance exchange” by 2014

A marketplace where individuals and small businesses explore, compare and enroll in private health insurance and public assistance programs, as well as access federal tax credits and cost-sharing subsidies

States had a choice to establish a state-based exchange, join a partnership or the federally-facilitated exchange; Maryland opted to establish a state-based health insurance exchange

What it is NOT:

The state-based health insurance exchange is NOT an insurer or issuer of health insurance plans.

What is a State-Based Health Insurance Exchange?

4

Maryland ACA Related Legislation

Establishment of Maryland’s State-Based Health Insurance Exchange

Health Benefit Exchange Act of 2011 – April 12, 2011: Establish Maryland’s state-based exchange as a

public corporate and independent unit of state government – June 3, 2011: Nine-member Board of Trustees held its first

meeting – September 2011: Exchange appointed Executive Director (first

Executive Director appointment in the U.S.)

Stakeholder Engagement

Policy decisions were made through an open, public and transparent process with over 60 stakeholders representing Maryland’s diversity from across the state (Fall 2011)

Four Advisory Committees studied six topics: – Navigator and Consumer Assistance / Advertising – Market Rules and Risk Selection / Operating Model – SHOP Exchange – Financing the Exchange

Executive Director and Board Liaisons attended all 22 meetings

Stakeholder representation included: health insurance industry, providers and associations, community members, advocates, community-based organizations, academia, business owners and leaders, local chamber officials, consumers, consultants Continued through 2012 – Tenet of the Exchange

Health Benefit Exchange Act of 2012

Options laid out in the stakeholder advisory committee process provided recommendations from the Exchange Board to the General Assembly

“Recommendations for a Successful Maryland Health Benefit Exchange” Legislation Report (December 23, 2011) provided recommendations for SB238/HB443 Maryland Health Benefit Exchange Act of 2012 signed by Governor O’Malley (May 2, 2012) outlines the implementation policies for operating the state-based exchange

Guiding Principles of Policy Decisions

Informed by public input seven principles guide the policy decisions of MHBE to ensure that the state-based health insurance exchange serves the health care needs of Maryland individuals, families, employers and employees:

Accessibility: reduce the number of Marylanders without health insurance and improve access for all Marylanders. Affordability: the affordability of coverage, within the Exchange and within the state, is essential to improving Maryland’s health care system and economy. Sustainability: The Exchange will need to be sustainable in order to succeed in the long run. Stability: promote solutions that respect existing strengths of our state’s health care system and promote stability Health Equity: The Exchange should work to address longstanding, unjust disparities in health access and health outcomes in Maryland. Flexibility: be nimble and flexible in responding to the quickly changing insurance market, health care delivery system, and general economic conditions in Maryland, while being sensitive and responsive to consumer demands. Transparency: MHBE is accountable to the public, and its activities should be transparent, its services easily available, and its information easily understandable by the populations it assists

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Maryland Health Progress Act of 2013

Dedicated funding stream to finance the MHBE Gradual transition of MHIP enrollees into Exchange Flexibility for State reinsurance wrap-around program SHOP Exchange rules for employer premium contributions Continuity of care for Marylanders Consolidated Services Center employee function Plan certification appeals process MCO/carriers permitted to offer plans in Exchange only Creation of application counselors and captive producers Medicaid expansion

10

Small Business Health Insurance Options Program (SHOP)

The Small Business Health Options Program (SHOP) is a competitive private health insurance marketplace where small businesses and their employees will have access to affordable coverage and a choice of insurance plans Employer Benefits – Employers can offer employees choice of insurer and qualified health plan – Employers can continue to use their brokers – Online tools available to employers and their brokers will help employers predict costs – Many small employers will qualify for tax credits – Simple, online administration

• Online Adds & Drops • Online Billing & Payment • Phone & Online Support

Employee Benefits – Employees have a choice of plans that suit their individual needs – Standardized plans and online tools help employers make meaningful comparisons

between health plans – Employees can enroll online – Employees can manage their accounts online – Other benefits due to small group market reforms

SHOP Overview

Maryland Health Connection will have a Small Business Health Options Program (SHOP) dedicated portal for small businesses and their employees Small businesses (including non-profits) with up to 50 employees may participate In 2016, the ACA modifies the definition of small group to 100 employees SHOP supports the existing market (does not replace it), small employers will still be able to purchase insurance outside of the SHOP Carriers above a minimum threshold must offer products in the SHOP; all catastrophic plans be offered in the SHOP

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SHOP in Maryland

Meets the requirements of the Affordable Care Act (ACA) as it pertains to SHOP set-up and management; Encourages small business to purchase coverage on the SHOP Exchange; Provides minimum disruption to the existing small group health insurance market in Maryland while promoting innovation; Leverages the knowledge and expertise of current market players (e.g. carriers, benefit administrators, etc.) for key technical and business functions; Minimizes duplicative development effort among Maryland stakeholder through the development of common service components that can be leveraged equitably by the broadest number of market players; Provides a SHOP solution that satisfies the needs of employers, employees, and health plans in an efficient and consumer-friendly manner; Ensures that operations are transparent and managed with effective oversight whereby the Exchange and the State of Maryland meet all their management oversight and fiduciary responsibilities to the state’s small employer community.

SHOP Guiding Principles

SHOP Plan Set-Up & Enrollment

Employer Plan Set-up

Estimated Quote

Employee Enrollment

Eligibility Determination

Validate Group

Notify Carriers

Employer is evaluated for eligibility to purchase QHP based on demographic information

Employer selects a metal level (Employee Choice) or a carrier (Employer Choice) and sets defined contribution amount

SHOP provides an estimated quote based on employer choices and employee census (age, income, etc.)

Employees make plan selections with information on employer contribution and their expected cost

Validate that all requirements for the employer (e.g. minimum participation) have been met

Notify carriers to contract with employer and start coverage for employees

SHOP Administration • Premium aggregation and billing • Carrier payment • On-going eligibility / enrollment management

(employee adds, deletes, life changes, etc.) • Enrollment and funds flow reconciliation

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Two Options for Small Employers: Employer v Employee Choice

Gold

Bronze

Platinum

Carrier A

Carrier C

Carrier D

Carrier E

Carrier F

Employee Choice

Employer C

hoice

Carrier B

Silver

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Employee Counting Methodology

The employee counting methodology impacts whether a group will be eligible to purchase on the SHOP – Maryland Exchange Board approved the FTE aggregation method consistent with federal rules for tax subsidies Employers can decide whether to offer coverage to full time employees or all employees

Seasonal employees can be excluded from the employer count under certain conditions (e.g. the employer only exceeded the 50 employee count for four or less months in the year).

Tax Credits for Health Insurance will only be available through MarylandHealthConnection.gov beginning October 1, 2013

The SHOP will provide employers: – Innovative plan options that are easy to administer – Access to tax credits to cover employee premiums – Employee choice model

Streamlined application, and customer service through statewide Call Center Ability to continue to work with brokers and third party administrators

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Why Consider the SHOP?

Employee Choice Features: – Employer selects a metal level with multiple

carriers offering different plans – Employees are free to choose between plans

that best meet individual needs – Broader selection – Ability to stay with carrier and providers as

jobs change portability – Allows employers to recruit and retain in

competitive environment In 2014, small employers will have the same purchasing power with health insurance as large employers Small employers can continue to work with their brokers in the SHOP Aggregated billing (single list bill) will be available

Employee Choice Model

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2010-2013: Maximum tax credit for small employers is 35% of the qualified premium for health insurance for employees – Maximum tax credit for small tax-exempt

employers (charities) is 25%

January 1, 2014, rate increases to: – 50% tax credit for small employers – 35% for small tax-exempt employers

(charities)

Can be carried back and forward to other tax years

Tax Credit Eligibility

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Fewer than 25 full-time equivalents, with average wages of less than $50,000 per year

Provide 50% of single (not family) coverage for each employee

Calculations are made on a sliding scale

Tool available on IRS website

Tax Credit Eligibility Examples

21 * Source: Internal Revenue Service

Small Business Tax Scenarios

Example*: Auto Repair Shop with 10 Full-Time Employees – Wages: $250,000 total, or $25,000 per worker – Employee Health Care Costs: $70,000 – 2010 Tax Credit: $24,500 (35% credit) – 2014 Tax Credit: $35,000 (50% credit)

Scenario #2: Restaurant with 40 Part-Time Employees (the equivalent of 20 full-time workers) – Wages: $500,000 total, or $25,000 per full-time equivalent

worker – Employee Health Care Costs: $240,000 – 2010 Tax Credit: $28,000 (35% credit with phase-out) – 2014 Tax Credit: $40,000 (50% credit with phase-out)

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Online Resources

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Sign Up for Email Updates Sign Up for Text Updates: Text “Connected” to 69302 Get information on resources available to help now Link to details on meetings and reports

MarylandHealthConnection.gov

MarylandHBE.com

Questions?


2014 Small Group and Individual Insurance Premium Rate Setting

Richard J. PrincinskyPresident

Richard J. Princinsky & Associates, Inc.


Current Rating Structure for Small Groups (2 – 50 Employees)

� Based on average age of all employees enrolled in the health insurance plan

� Rates are established for each tier level of coverage (individual, individual plus spouse, family )

� All employees pay the same tier rate, regardless of their age

Get ready This is about to change


New Member Level Rating Structureeffective January 1, 2014 (PHSA § 2701)

New rating structure will be based on the state-specified geographic rating area and on the age of each individual employee and dependents being enrolled.

� Every employee and their dependents with different ages will have a unique rate

� Employee + Spouse = sum of the two individual rates based on their ages

� Family plan = sum of each member’s rate based on their age- Age of the employee, the spouse and the oldest three children

under the age of 21 and all adult children between the ages of 21 and 26


Rate Structure Ratios

� Will move from 5:1 to 3:1

� 5:1 implies if individual group rate was $100/month for the lowest average age group in the state, then the group with the highest average age could not be charged more than $500/month for the individual rate

� The compression of a 3:1 ratio creates less of a gap in cost between the younger person and older person

– The change from the current rates may be greater for the younger person than the older


Individual

Mandate


Individual Shared ResponsibilityAnnual penalty assessment against any individual that does not have monthly minimum essential health coverage – specific exceptions apply.� Individual is taxpayer (or spouse/dependent).� Minimum Essential Coverage is health coverage under a:

– Government plan; e.g., Medicare Part A, Medicaid, CHIP, Tri-Care– Eligible employer-sponsored plan– Individual market plan– HHS recognized plan; i.e., State health benefits risk pool

� Exceptions:- Cannot afford coverage (premium share >8% of household income)- No federal income tax return filing requirement based on income threshold- Hardship exemption deemed by HHS- Members of certain Indian tribes- Gap in coverage for less than a continuous three-month period – one time per year


� Annual Penalty Amount is the greater of:– Flat dollar amount per individual

• 2014 - $95/individual; $47.50 for individual 18 years or younger

• 2015 - $325/individual; $162.50 for ��DJH��\HDUV

• 2016 - $695/individual; $327.50 for ��DJH��\HDUV

Annual cap amount = 3 x individual rate

– Percentage of income amount

• 2014 – 1% of combined household income (after exemptions and standard deductions)

• 2015 – 2% of combined household income

• 2016 – 2.5% of combined household income

Penalty capped at the national average of the annual cost of a bronze level health insurance plan, for the applicable family size, offered through the state health care exchanges.


Individual Tax Credit/Premium SubsidyAvailable to individuals and families who do not qualify for Medicare or Medicaid and are not offered health insurance through an employer.� Taxpayers with household income between 100% and 400% of

federal poverty line (FPL) who purchase insurance through an Exchange

– Based on modified adjusted gross household income – includes social security benefits that are not included in taxable year gross income

– Some individual may additionally qualify for cost-sharing reduction subsidy to help with deductibles and co-payments

– Exchanges to determine eligibility for premium tax credit and cost-sharing reductions


Premium Cost Share Assistance Illustration% of Fed Poverty Level (FPL)

Annual Income1

(Individual)

Premium (% of Income)

Monthly PremiumShare

Reduction in Max OOP Limit

Reduced Cost-Sharing Limit

Required Actuarial Value of Plan

138% $15,856 Financial eligibility for Medicaid enrollment in Maryland

150% $17,430 4.0% $58 66.7% $2,250 87%

200% $23,240 6.3% $122 20% $5,200 73%

250% $29,050 8.05% $195 N/A $6,400 70%

300% $34,860 9.5% $276 N/A $6,400 70%

400% $46,480 9.5% $368 N/A $6.400 70%

1Based on 2012 individual FPL ($11,170) trended two years at 2% annual trend (rounded).


Required

Employee

Disclosure


Notice of Exchange AvailabilityEmployers must provide written notice to employees of availability of health coverage through the 2014 Exchange

Notice deadline October 1, 2013

� Provide to all W-2 employees of the Employer– FT, PT, seasonal, on-call– Regardless of eligibility for Employer’s health plan– Provided free of charge

� New hires must receive notice within 14 days of hire

DOL model notice template available at: www.dol.gov/ebsa/healthreform/index.html


Employer offering Health Coverage Notice

� PDF fillable template to customize notice

� Part B (2nd page) –employer and group health plan info

� Part B (3rd page) –optional info

� Distribution to allcurrent W-2 employees by October 1st; new employees at time of hire (October 1st and forward)



Notice Template – Employer does not offer Health Coverage


� Non-calendar year plan Section 125 Plan nonqualified mid-year status change event – transition rule

– 2014 Exchange open enrollment is not a qualified status change event or special enrollment right for Section 125 Plans

– Employer is permitted to amend Plan to allow either one or both of the following salary reduction elections:

– Employees currently participating (and enrolled in Health plan option) to change current election to opt out

– Employees not currently enrolled in health plan through the Plan to elect to participate (and enroll in Employer health plan)


– Important Note: insurance carrier must also agree to allow health plan election change for this reason

– Plan amendment only applies to 2013 Plan year renewing on or after February 2014

– Transition rule allows retroactive Plan amendment until December 31, 2014

Recommendation: inform employees of ability/inability to change current election or newly enroll in employer plan


� Revised COBRA notice released – DOL Technical Release 2013-02 (http://www.dol.gov/ebsa/newsroom/tr13-02.html )– Revised model notice advises of alternative health coverage

availability through the Exchange

� HIPAA Certificate of Creditable Coverage – notice requirement eliminated effective 12/31/2014

� Summary of Benefits and Coverage (SBC)

� Grandfathered Plan assertion or Patient Protections notice

� W-2 reporting cost of employer provided health coverage –large employer (250 or more W-2s issued in prior year)– Small employer transition rule still applicable


� Rebate for failure to meet MLR standardsInsurers must meet medical loss ratio standards each year, report to HHS, and issue premium rebates to policy holder reflecting portion that did not meet applicable ratio.

– Large Group Market = 85%

– Small Group/Individual Market = 80%

– Not applicable to self-insured health plans

– Rebate issued in form of premium credit or lump sum payment to policy holder – employer for group plan

– Insurer must provide notice of rebate to employer and enrollees

– Employer responsibility to distribute any insurance rebate received according to pro-rata share of premiums paid by employer and plan participants


Group plans subject to Title I of ERISA must follow those requirements for distribution of the rebate; Non-ERISA plans (e.g., non-Federal government plans and Church plans) must follow CMS guidance.

� ERISA covered plans distribution guidelines – DOL guidance issued (Technical Release 2011-04)

• No requirement under ERISA to include or exclude prior plan participants

• “Ordinary notions of property rights” application to pro-rata distribution

• ERISA trust requirements for plan assets avoided if rebate distributed within 3 months

• May apply “de minimus” amount rebate to plan enhancement that benefits all plan participants


– ERISA group plan participant rebate distribution:• Lump sum cash

• Premium holiday/reduction

• Plan enhancement benefiting all participants

– Participant rebate distribution may be made to:• Participants of plan that rebate applies

• Current plan participants that were also plan participants in prior year

• Current plan participants only, regardless of prior year participation


� Non-Federal Government group plan (e.g., state/local government) participant rebate distribution may be made only to current plan participants.(HHS/CMS guidance – 76 Fed Reg. 76596 Dec. 7, 2011)

– Policy holder may apply participant rebate:• Reduce future premium contribution to all current plan

participants (covered under any option of the policy)

• Reduce future premium contribution to only current plan participants who were covered in prior plan year (year rebate applies)

• Cash rebate to current participants of plan that were covered under the plan option/policy rebate applies


– Policy holder may distribute rebate:• Divide participant rebate equally among all participants

• Divide it based on each participant’s actual contribution

• Apportion as reasonable reflection of participant’s contribution

� Non-ERISA Plan, e.g., Church – Entire rebate returned to participants of plan rebate applies,

unless policy holder provides written assurance that rebate will be apportioned according to rules for non-Federal Gov’tplans.

– Without written assurance, insurer required to divide entire rebate equally among participants of plan rebate applies and distribute


� Tax consequences for participant rebates (lump sum or premium reduction) – IRS guidance– Pre-tax insurance premium contributions – rebate is

taxable, subject to Federal /state income tax and employment taxes

– After-tax premium contribution – rebate not taxable

– Distribution to COBRA participants – rebate treated as after-tax contribution

IRS Medical Loss Ratio (MLR) FAQs:

http://www.irs.gov/uac/Medical-Loss-Ratio-(MLR)-FAQs


Disclosure Requirements - Delayed

� Reporting of Health Insurance Coverage (Insurers and Employers that Self-insure) [Code § 6055(c)] – One-year implementation delay to January 1, 2015; first report due

by January 31, 2016

– Report to IRS showing any individual with “minimum essential coverage during prior calendar year; reporting form and additional guidance required of IRS

– Written notice to covered individual with same information provided to IRS

– Possible coordination of reporting with large employer reporting requirement – awaiting additional guidance


� Reporting of Health Insurance Coverage (Large Employers and “Offering Employers”) [Code § 6056(c)] – Large employers (50+ FTEs) to report to the IRS whether they

offer their full-time employees and their employees' dependents the opportunity to enroll in “minimum essential coverage and certain other information

– Reporting employers must also provide a related written statement to their full-time employees

– Purpose is to enable IRS to verify needed information related to Employer Shared Responsibility provisions (“Play or Pay” penalty assessment)

– Same reporting time as Insurer Reporting requirement – January 31st for prior calendar year, effective January 1, 2015 (first reporting by January 2016)


Employer

Mandate


Employer Shared Responsibility � Small Employer – fewer than 50 (average) full-time equivalent

employees (FTE’s) in preceding calendar year*- If offering group health coverage, must meet essential health

benefits package requirements (Grandfathered Plan exception)

- No Employer Shared Responsibility Payment assessment liability

� Large Employer – 50+ (average) FTE’s in preceding calendar year*- Employer Shared Responsibility Payment liability starting 2015

- Penalty liability effective plan renewal month in 2015 for non-calendar year health plans – Transition Rules application

*Preceding Calendar Year = any consecutive 6-month period


� Proposed Rules issued January 2, 2013– Transition Rule for non-calendar year plans/large employer

provisions• Controlled Group and Affiliated Service Group application –

Code § 414 (b), (c), (m) and (o)

– Full-time Equivalent Employee (FTE) –• Common-law employee (W-2 wages)

• Average of 30 service hours/week (130 hours/month)

• Service Hours = all paid hours + unpaid hours for reason of vacation, holiday, illness, incapacity (including disability), layoff, jury duty, military duty or leave of absence (e.g., FMLA)

• Seasonal worker exception – meets statutory definition application and works no more than 120 business days


Employer Size Determination Example: 65 employees: 7 FT; 58 PT and seasonal employees6-month calculation period : July 1 – Dec 31

1. FT ee’s (7 x 6) ÷ 6 = 7

2. Total service hours of all other ee’s:Jul: 7540Aug: 7600Sep: 7580Oct: 7000Nov: 5800Dec: 5500Total: 41020 ÷ 6 ÷ 130 = 52.59 FTE’s

3. 7 + 52.59 = 59.59 = 59 FTE’s

Large Employer in 2014

1. Total number of full time employees (employees classified as FT by employer) employed on any business day during each month of 6-month calculation period / 6 = average FT employees

If average number of FT employees is at least 50 no need for further calculation –Large Employer

2. Total all service hours for all otheremployees employed on any business day during 6-month calculation period (PT, seasonal, temporary)/ 6 / 130 = average number of FTE’s

3. Add FT number to FTE number = total average FTE; if 50 or greater (disregard any fraction) – Large Employer

Note: if 50+ total is solely attributable to seasonal workers – not a Large Employer


“Play or Pay” Penalty Assessment

� Beginning in 2015, certain large employers may be subject to a penalty assessment for either of the following:1) Failing to offer health care coverage to substantially all full-time

employees.$2,000/year ($166.67/month) for every FT employee (minus the first 30)

2) Offering less than “minimal value” plan – the plan's share of the total allowed benefits is less than 60%, or Offering minimum essential coverage that is deemed unaffordable. (>9.5% of W-2 wages for cost of individual coverage).

$3,000/year ($250/month) for each FT employee enrolled in Exchange plan and receiving premium assistance


Additional ACA Provisions and Fees/Taxes

� 90-Day Maximum Waiting Period- Effective plan year beginning on or after January 1,

2014- Applies to small/large employer, fully-insured/self-

insured; no Grandfathered Plan exclusion – all health plans

- Offer of coverage (enrollment) must occur by 91st day of eligibility for coverage

- From date of hire for FT employees- From first day of FTE eligibility determination for all others


� Patient-Centered Outcomes Research Institute (PCORI) Fee– The fee applies from 2012 to 2019, based on plan/policy years ending on or after

Oct. 1, 2012, and before Oct. 1, 2019

– The fee is due by July 31 of the year following the calendar year in which the plan/policy year ended

– The first fee was due July 31, 2013, for November, December 2012 and January 2013 plans

– The first fee is not due until July 31, 2014, for plan years that start February through December 2013

– The fee will be calculated and paid by:• Insurer for fully-insured plan (probably passed thru to plan sponsor)

• Plan sponsor (generally employer) for self-funded plans, including HRA’s. Health FSA’s generally excepted. Not applicable to HSA’s (not a health plan)

– Fee reported on IRS Form 720. Revised form and instructions just released. Download form and instructions: www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions

– $1 per covered life (plans ending before Oct. 1, 2013); $2 per covered life (subsequent years, adjusted for medical inflation)


� Transitional Reinsurance Fee– Purpose is to stabilize premiums in the individual market during the initial

phase of Exchange operation (2014 – 2016)– Applicable to fully insured and self-insured health plans that are “major

medical coverage”• Does not apply to HRA’s integrated with group health plan, HSA’s or Health FSA’s

• Medicare Secondary Payer rules apply; e.g. retiree plans

– Fee is $63/year per covered life ($5.25/month); COBRA (or other continuation) participants included in count

– Fee calculated and paid to HHS by:• Insurer for fully-insured plans

• Plan Sponsor (or TPA) for self-funded health plans

– Info provided to HHS by Nov. 15th (plan data from Jan – Sep); HHS will notify entity within 30 days (or Dec. 15th ) of amount due within 30 days

– Per IRS, Plan Sponsors and Insurers may deduct cost of fee as ordinary and necessary business expenses – (considered an expense of the Plan)


� Health Insurer Fee– Effective starting each calendar year after 2013; first fee due

September, 2014– Applicable only to insurers (fully-insured health plans)

• Does not apply to self-funded health plans• Governmental entities and certain nonprofit entities are also

excluded

– IRS to calculate each covered entity's portion of the aggregate fees for each fee year

– Controlled group application – regs apply 50% ownership standard

– IRS proposed regulations, that information would be provided on Form 8963 (Report of Health Insurance Provider Information)


DOMA

Decision

Impact


Marriage (spouse) Definition Impact on Employee Welfare Benefit Plans

� ERISA – state insurance and benefits regulations override ERISA preemption; e.g., Maryland’s Civil Marriage Protection Act– Insured health plans – state insurance regulations apply

– Self-insured health plans – plan document defines spouse/dependent – caution

� Other Federal laws impacted:– Family and Medical Leave Act (FMLA)

– COBRA continuation


� Tax Issues– Federal tax – depends on spousal status and dependent status

under federal law• Questions still exist on whether non-DOMA definition of spouse will be applied

retroactively for federal tax purposes

– DOMA Section 2 – residency provision still intact – states can define spouse

• Awaiting guidance regarding whether states and employers will be required to recognize same sex spouses who are legally married in one state move to another that does not recognize same sex marriage

– Section 125 Plan – pre-tax contributions for spouse

– “Gross up” policy review


There are currently 13 jurisdictions that recognize same-sex marriage (plus the District of Columbia), and 9 states recognize some form of same-sex union recognition (being either civil unions or domestic partnerships):

� Same-sex Marriage: Connecticut, District of Columbia, Delaware, Iowa, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont, Washington (legal Domestic Partnerships will convert automatically 1/1/2014)

� Civil Union Recognition: Colorado, Hawaii, Illinois, Oregon

� Domestic Partnership legal status: California (carries same rights as other states Civil Union laws), Maine (same-sex and opposite sex), Nevada, New Jersey, Wisconsin


Today’s Presenter

Richard J. Princinsky & Associates, Inc. RJP & Associates, Inc. was founded in 1976 to help employers develop, understand and manage their group insurance and employee benefits. RJP continues to partner with companies to deliver effective group benefit programs, helps to control insurance costs, and provides strategic insight for health care legislation. Our client groups are comprised of a variety of industries and multi-state locations. RJP has developed a specialty focus in non-profit and social service agencies, being recognized as the preferred employee benefits provider for many association groups, such as the MACS, MARFY, as well as professional organizations including the MACPA.

Sandra C. Krauer, Director, Client Risk Management ServicesSandy brings 27 years multi-state human resources management and employee welfare benefit plan regulatory compliance expertise to the RJP management team. Sandy’s professional career has included oversight of the HR function for Maryland-based employers encompassing strategic planning, company reorganization and acquisition integration; company policy and procedure design and implementation; employee welfare benefit plan regulatory compliance under ERISA, COBRA, HIPAA, IRC §125 and the Affordable Care Act. In addition to providing ongoing technical expertise and compliance tools to our staff and client groups, the CRM Services team provides employee welfare benefit and HR education through the development and presentation of in-person and web-based seminars focusing on Health Care Reform, Cafeteria Plans, Sexual and Other Workplace Harassment and other topics relevant to employer groups.

Sandy graduated (summa cum laude) from the University of Baltimore, Robert G. Merrick School of Business, and is a longtime member of the national Society for Human Resource Management (SHRM).

[email protected] / 410-773-4300 ext. 4337
