June 2013

Employee Benefits Manager A&M System Office

Ellen Gerescher

The Affordable Care Act (ACA) /

The System Wellness Initiative

An HR Liaison Presentation

Important Highlights of ACA

• Employer Fees– Transitional Reinsurance Fee – Patient-Centered Outcomes Research

Institute Fee • Eligibility Changes

– 30 hours/week = full-time employee • Benefit Changes

– 90-days = maximum waiting period – All inclusive out-of-pocket maximum

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More Highlights

• Employer Penalties related to:– Minimum Essential Coverage– Minimum Value– Affordable Coverage

• Exchange Notices to Employees (Oct‘13) • Exchanges Begin

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Employer Fees

• Employer fee (per covered life, per year)

2014 Fee: $63 $2.8 Million

2015 Fee: $42 $1.9 Million

2016 Fee: $26 $1.1 Million

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Eligibility Changes

• Current benefit-eligible employee:– Works at least 20 hours/week for at least 4.5

continuous months• New definition:

– Works 30 hours or more/week• Problem areas:

– Adjunct faculty, student workers, employees with multiple positions, seasonal/ temporary employees

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Required Benefit Changes

• Full-time employees must be enrolled in health coverage no later than the 90th day of employment.

• Cap on out-of-pocket annual expenses- $6,400 per individual/$12,800 per family

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“Shared Responsibility”

• TAMUS must offer the following or be subject to a tax penalty:

– Offer “minimum essential coverage” to all or “substantially all” of its “full-time employees” and their “dependents”.

– Offer self-only coverage to its full-time employees that has “minimum value” (is adequate) and is “affordable”.

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Definitions

• Minimum Essential Coverage - basically all employer health plans.

• Minimum value - is an actuarial value calculated using the coinsurance percentage, copays, premiums and out-of-pocket maximums. Thus far, our plans are above minimum value.

• An “affordable” plan is one that does not exceed 9.5% of the employee’s hourly wage or monthly salary.

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Exchange Notice

• Must go to new employees by October 13th, and new employees within 14 days of hire date

• Notice must include information about:– Health Exchange Insurance Marketplace

– Contact information for Marketplace

– Availability of premium tax credits

– Loss of employer contribution

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System Wellness Initiative

• Objective: Invest in wellness initiatives coordinated by System members

• Process: Grants awarded covering cost of classes, webinars, and program materials over the coming 2 years

• Grants: To be eligible, each member will be required to conduct a minimum of 4 webinars and a wellness fair

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System Wellness Initiative

• Objective: Ensure employees are active in their personal health through annual exams

• Process: Employees/Spouses will be asked to have annual exams at least every 18 months; no cost to employees for services

• Premium Differential: Those who elect not to have annual exams will have premiums $30/month higher than those who do

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Thank You

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