Health care reform and open enrollment for 2011
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Health Care Reform and Open Enrollment for 2011. March 23, 2010 President Obama. The Patient Protection and Affordable Health Care Act. PPAHCA. Lifetime limits will be banned on medical coverage: District employees already have the benefit of no lifetime limits. Change to Annual Limits.

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Health Care Reform and Open Enrollment for 2011

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Health care reform and open enrollment for 2011

Health Care Reform and Open Enrollment for 2011


March 23 2010 president obama

March 23, 2010President Obama

The Patient Protection and Affordable Health Care Act


Ppahca

PPAHCA

Lifetime limits will be banned on medical coverage:

District employees already have the benefit of no lifetime limits.


Change to annual limits

Change to Annual Limits

  • Physical Therapy and Occupational Therapy under Medical Mutual of Ohio will change from 40 visits per year to:

  • 40 visits annually for Physical Therapy

  • 40 visits annually for Occupational Therapy


New offering under ancillary benefits

New Offering under ancillary benefits

  • Orthodontics for children will be added as of 2011.

  • Maximum lifetime limit will be $1,500.00 per child.

  • This is not offered to employees in the AFSCME Union.

  • There is no special enrollment necessary.


Health care reform and open enrollment for 2011

Health insurance will be extended to

dependents up to age 26 under Federal

law:

  • The child does not have to live at home

  • The child does not need to be a dependent on the parent’s tax return

  • The child does not need to be a full-time student


Health care reform and open enrollment for 2011

  • The child may be married (only the child is eligible for coverage not his/her spouse or child)

  • The child must be not employed by an employer that offers any health benefit plan under which the child is eligible for coverage


Health care reform and open enrollment for 2011

In addition, the Ohio Department of Insurance extends this insurance up to age 28 and all criteria must be met:

  • The child must be unmarried and

  • The child must be a natural child, stepchild or adopted child of the employee and

  • The child must be a resident of Ohio or a full-time student at an accredited public or private institution of higher education and


Health care reform and open enrollment for 2011

  • The child must be not employed by an employer that offers any health benefit plan under which the child is eligible for coverage and

  • The child must not be eligible for Medicare or Medicaid programs and

  • The child must be under the age of 28.

  • Special enrollment forms will be available from Medical Mutual of Ohio and Kaiser Permanente.


Enrollment 0f overage dependent

Enrollment 0f Overage Dependent

  • Expect to provide certification of eligibility annually.

  • An Attestation form will be required to state that the child is not eligible for healthcare coverage under his/her employer.

  • Expiration under Federal Law is midnight on the child’s 26th birthday.

  • Expiration under State Law is midnight on the child’s 28th birthday.


Cost to add over age dependent to age 26

Cost to add Over Age Dependent to age 26

  • Employee w/single coverage would go to employee + 1

  • Employee + 1 would go to Employee + Family

  • Cost would be incremental to the next tier when the over age dependent is added.

  • This applies under Federal Law until age 26.


Cost to add over age dependent to age 28

Cost to add Over Age Dependent to age 28

  • Ages 26 through 28 healthcare coverage is provided under House Bill 1, under the Ohio Department of Insurance

  • Adding an OAD will increase the employee’s premium (in the appropriate tier of coverage) by approximately 40% of the cost of single coverage for each dependent age 26 – 28.


Cost to add over age dependent under ohio dept of insurance house bill 1

Cost to add Over Age Dependent under Ohio Dept. of Insurance House Bill 1

  • The cost is the responsibility of the employee parent.

  • For 2011 ONLY the District will pay this cost.

  • Keep in mind, although these regulations are in effect, there is still the possibility that the government or medical carrier will change the cost.


Voluntary life insurance ad d

Voluntary Life Insurance & AD&D

Portable term-life insurance for employee & spouse ($10K to $500K)Portable child life - $5K (6 months to 18 years /age 23 if FT student)Issue up to $100K (<60 & No on medical questionnaire)


Health care reform and open enrollment for 2011

Voluntary Life Insurance/ AD&DAD&D: Individual & Family - Automatic guaranteeMust apply as new hire or during open enrollmentPayroll deduction


Disability insurance premium payment option dippo

Disability Insurance Premium Payment Option (DIPPO)

Enhancement to District’s short-term disability benefit

Annual enrollment

Premium deducted from your paycheck post tax

You will pay taxes on money added to your paycheck


Dippo

DIPPO

  • If you enroll in DIPPO and go on disability, your disability payments will be tax-free

  • If you do NOT enroll in DIPPO and go on disability, you will be required to pay taxes on your disability payments


Health care reform and open enrollment for 2011

Over-the-counter drug costs, not prescribed by a physician, cannot be reimbursed through Flexible Spending Accounts or any Health Spending Accounts that your spouse may have.

Flexible Spending Account (FSA) for

Health Care:

This eliminates reimbursements using tax-free dollars except for prescribed medications or a Note of Medical Necessity (NMN) from a physician.


The otc items affected include items in the following categories

The OTC items affected include items in the following categories:


Other fsa information

Consider these new rules when estimating the dollar amount to put in your FSA -2011

2011 Cap remains at $4,000.00

FSA funds will be capped at $2,500.00 effective for 2013

NO changes to the Dependent Care Flexible Spending Account, cap remains at $5,000

Other FSA information:


The value of employer paid benefits will be reported on w 2 forms with your wages from 2011

The value of employer paid benefits will be reported on W-2 forms with your wages from 2011:

Employers are required to disclose the value of benefits provided by the employer for each employee’s health insurance coverage.

The amount shown on your W-2 is not being taxed. It is a reporting tool to show the value of your healthcare.


No rescissions

No rescissions:

Group health plans or insurance companies providing group plans are prohibited from rescinding coverage once an enrollee is covered under a plan.

Exception will be in the case of an individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of material facts.


Information sources

Information Sources

Email your questions to: [email protected]

Call the Open Enrollment Line (216) 432-7309

or ext. 6064


Health care reform 2010 2011

Health Care Reform 2010-2011

Hang in there, we will get through the changes together!

Questions?


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