ACA Compliant Plans
Today’s Speakers
Carl Pilger
VP, Legal Counsel
Abigail Pullman
Account Executive
Digital Benefit Marketplace
Wayne Mertel
Agenda
1.“Skinny” Plans
Skinny Plans Defined
Option 1
Limited Benefit Plan
Offered to all employees or select classes as is compliant
with employer laws. (including part-time)
Option 2
Minimum Essential Coverage (MEC)
ACA Compliant affordable choice for newly benefit
eligible employees
Option 3 Minimum Value
Plan (MVP)
ACA Compliant choice for benefit eligible
employees. 60% actuarial value
Option 4
ACA Compliant Major Med
coverage for eligible employees. When paired with other options – not
Are they compliant ?
•
ACA Requirements
–
Pay penalty or offer group health plan (GHP)
•
Minimum essential coverage
•
Eligible employer-sponsored plan
–
Group health plan or group health insurance coverage offered by an
employer to the employee which is offered in the small or large
group market
–
Self-insured health plan of any size
Are they compliant ?
•
GHP Defined
–
Plan, fund, or program that provides participants or beneficiaries,
through the purchase of insurance or otherwise, medical, surgical, or
hospital care or benefits, or benefits in the event of sickness
–
Provides medical care directly or through insurance, reimbursement,
or otherwise.
–
Medical care means amounts paid for diagnosis, cure, mitigation,
Are they compliant ?
•
First-dollar preventive care and wellness benefit
–
Meets requirement to provide preventative and wellness
services and chronic disease management
•
Self-Insurance
Important ACA Terms
•
Applicable Large Employer:
Employer who employs
50 or more full-time employees or full-time equivalents (FTEs).
•
Affordable Coverage:
Employee’s share of plan cost
cannot exceed 9.5% of safe-harbor income. (e.g., W-2, Box 1
wages)
Important ACA Terms
•
Minimum Essential Coverage
(MEC):
– Employer-sponsored plan
• Includes self-insured plan whether or
not offered on Marketplace – Plans in the individual market – Grandfathered health plan – Medicare
– Medicaid – CHIP program – TRICARE
– Certain other Peace Corps, Veterans or Department of Defense plans
– Medicare Advantage
– Refugee Medical Assistance supported by the Administration for Children and Families
– Self-funded student health plans (plan or policy years beginning on or before
December 31, 2014)
– State high-risk pools (plan or policy years beginning on or before December 31, 2014)
Avoiding Employer Penalties
•
Tier 1 Penalty
– $2,000/year for each full-time employee (after subtracting first 30 employees) if offer no coverage and one person gets subsidized Marketplace coverage
– Avoid by offering group health coverage to all full-time employees
• 5% safe harbor
•
Tier 2 Penalty
– $3,000/year for each full-time employee who actually gets subsidized Marketplace coverage because offered inadequate employer coverage
– Adequate Coverage
• Affordable
– Cost of lowest tier employee-only coverage does not exceed 9.5% of employee’s household income – Use income safe harbor (e.g., Box 1, Form W-2)
• Minimum Value
– Plan’s share of total costs of covered services is at least 60% – HHS calculator
Avoiding Individual Penalties
•
Individual Shared Responsibility Tax
–
Applies to any non-excepted individual who fails to obtain MEC
–
In 2014 greater of $95/year for each individual ($47.50 for each
dependent child) or 1% of amount of individual’s household income
above federal tax filing threshold
–
Flat dollar amount capped at 300% (i.e., $285 in 2014)
–
Percentage of income not capped
–
Transition Relief
MEC Plan Components
Design
• Partial self-funded medical plans
• Limited benefits medical plan (buy-up)
• Supplemental health benefits (voluntary buy-up)
Anticipated program outcomes
Savings compared to traditional major medical plans
• Lower cost point for entry into offering insurance options • Provides built in employer expense predictability
Benefits to employees
• First dollar coverage
• Easy access to PPO network providers and discounts • Flexibility and affordability in a changing environment
Employer Profile
Any employer who…
•
Has at least 51 benefit eligible
employees or FTEs
•
Many newly “benefit eligible”
employees in the future
•
Workforce consisting of low wage
and/or variable hour employees
•
Has interest in looking for creative,
multi-tiered solutions providing base
and base-plus benefit options
Targeted Industries
•
Staffing
•
Hospitality
•
Restaurant
•
Retail
•
Convenience stores
•
Healthcare / Nursing Homes
•
Service Industries
What is required to be covered?
What is required to be covered in the MEC
Preventive/Wellness Plan?
•
15 covered preventive services for adults
•
22 covered preventive services for women,
including pregnancies
Frequently Asked Questions
•
Why would I do this now?
•
Who pays for it?
•
Can an employee still go to the public marketplace?
•
What happens after 12 months?
•
If an ER funds for the EE, does that eliminate the EE from
Medicaid?
Articles of Interest
•
Wall Street Journal 5.20.2013
– “Employers Eye Bare-Bones Health Plans Under New Law”
•
POLITICO 7.16.13
– “Obamacare penalties spawn skinny plans”
•
Washington Post with Bloomberg 8.23.2013
All Rights Reserved Digital Insurance
Understanding
Employee Benefits. Simplified.
More than anything, today’s executives, business owners and HR decision-makers most desire one characteristic from an employee benefits strategy:
Simplicity.
With Digital Benefits Marketplace,
you determine how much you want to contribute toward each employee’s benefits.
That’s it.
Your costs are fixed, and you’re done.
Your employees choose the options that work best for them.
Our experts provide complete administration plus individual decision support.
It might be the easiest, most comprehensive approach that serves businesses of any size.
The Three C’s of a
Benefits Marketplace
3. Customer service – including decision support before, during and after enrollment Educational tools including videos
Decision support for medical, dental, vision, life insurance and disability insurance Plan recommendations based on an individual’s personal situation
Benefit counselors – available telephonically and via chat
3. Customer service – including decision support before, during and after enrollment Educational tools including videos
Decision support for medical, dental, vision, life insurance and disability insurance Plan recommendations based on an individual’s personal situation
Benefit counselors – available telephonically and via chat 1. Consolidated benefits administration
Employee enrollment system – that integrates into the carriers & payroll service provider
Employer administrative system – that easily provides the important data to manage the program Benefit administration service team to manage the day-to-day activities of the benefit program
1. Consolidated benefits administration
Employee enrollment system – that integrates into the carriers & payroll service provider
Employer administrative system – that easily provides the important data to manage the program Benefit administration service team to manage the day-to-day activities of the benefit program
2. Complete array of benefits choices
Health Plans: 8-15 health plan choices to meet the many demographics within the workforce Ancillary Benefits: build your own dental, vision, life, disability, accident, critical illness, and more New Benefits: such as telemedicine and concierge medicine
2. Complete array of benefits choices
Health Plans: 8-15 health plan choices to meet the many demographics within the workforce Ancillary Benefits: build your own dental, vision, life, disability, accident, critical illness, and more New Benefits: such as telemedicine and concierge medicine
BEFORE
WITH DIGITAL BENEFITS
MARKETPLACE
Dental Vision Life LTD STD Accident CriticalIllness medicineTele- Wellness Pet
Dental Vision Life
And we simplify it all with one-call customer service!
1 plan 1 plan
HMO
HMO PPOPPO EPOEPO HDHP 1HDHP 1 HDHP 2HDHP 2 HDHP 3HDHP 3
HSA
Defined Contribution
Your Benefits Store – Health
The goal is value-based choices.
Your Benefits Store –
Annual Employer
Cost Comparison
Net employer health plan costs Net employer ancillary costs
