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K-12 Health Benefits Act ESD 113 Superintendents Meeting August 15, 2012. Introductions Overview of ESSB 5940 – The K-12 Health Benefits Act Discuss Issues Facing Districts over next few months and years Discussion of QHDHP’s and HSA’s Questions. Agenda.

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K-12 Health Benefits Act

ESD 113 Superintendents Meeting

August 15, 2012


Agenda

Introductions

Overview of ESSB 5940 – The K-12 Health Benefits Act

Discuss Issues Facing Districts over next few months and years

Discussion of QHDHP’s and HSA’s

Questions

Agenda


Overview

Follows 2010 State Auditor’s Office review of K-12 health benefits

Passed early on April 11, 2012 – first and last day of 2nd special session

Act is effective July 11, 2012 with legislative intent to be effective for 2012-13 school year

If goals of Act are not met, recommendation could be to create new K-12 benefit program similar to Public Employee Benefits (PEB) program for Classified only, Certificated only or Combined

Overview


Legislative goals

Improve transparency [§1(2)(a)] benefits

Create greater affordability and greater equity [§1(2)(b)]

Promote health care innovations, cost savings and reduce administrative costs [§1(2)(c)]

Provide greater parity in state allocations for state employees and K-12 employees [§1(2)(d)]

Retain current collective bargaining for benefits, and retain state, school district, and employee contributions to benefits [§1(3)]

Legislative Goals


Changes in medical coverage 1

Each employee who elects medical coverage must pay a “minimum premium charge” or payroll deduction [§2(2)(c)]

Employee premiums must be structured so that employees who elect richer benefit plans pay higher premium charge [§2(2)(d)]

Make progress toward employee deductions for full family coverage not more than three times deduction for single coverage [§3(4)(b)]

Changes in Medical Coverage – 1


Changes in medical coverage 2

Must offer a Qualified High Deductible Health Plan (QHDHP) and Health Savings Account (HSA) [§3(4)(a)]

Must offer a plan with employee premium share that does not exceed premium share on one of the PEB plans for all tiers [§3(4)(c)]

Changes in Medical Coverage – 2


Oversight

Districts must provide annual reports to Office of Insurance Commissioner (OIC)

OIC required to submit report to Legislature by December 1, 2013, then annually

Health Care Authority (HCA) must report to the Governor and Legislature by June 1, 2015

Joint Legislative Audit and Review Committee (JLARC) must review reports and submit recommendations to Legislature by December 31, 2015

Oversight


What are agencies looking for

That districts are making adequate progress towards meeting goals

That carriers/providers are complying with Act

That coverage is becoming more affordable, especially for families

Whether a new statewide K-12 benefits pool should be created for classified employees, certificated employees or both groups combined

What Are Agencies Looking For?


Issues facing districts 1

Review by 8/31/2012 goals

Offer a High Deductible Health Plan with a Health Savings Account [§3(5)(a)]

Which medical carrier’s plan?

Which HSA administrator?

Should District designate funds from State Benefit Allocation to contribute to HSA?

Do contributions need to be negotiated?

Issues Facing Districts – 1


Issues facing districts 2

Review by 8/31/2012 goals

Each employee electing District sponsored medical coverage pays a minimum premium charge – subject to collective bargaining [§2(1)(c)]

Employees selecting “richer” benefit plans pay the higher premium [§2(1)(d)]

Offer at least one plan in which the employee share of the premium does not exceed state employees share of the premium [§3(5)(c)]

Make progress towards 3 to 1 ratio between Employee/Family and Employee Only coverage [§3(5)(b)]

Issues Facing Districts – 2


Issues facing districts 3

Review by 8/31/2012 goals

Issues 2-5 are all payroll deduction issues

When do they need to be implemented?

What is the best approach to meet goals?

Will flat percent of premium meet goal of richer plans paying more, or is higher percentage needed?

Does each item need to be bargained?

Must you bargain this year or when the contract next opens?

Issues Facing Districts – 3


Issues facing districts 4

Review by 12/31/2012 goals

New reporting requirements [§4(2) to §4(5)]

More detailed reporting to OIC

Details and reporting format are being developed now

Expected deadline is next spring/summer so that the OIC can meet their December 1, 2013 deadline

Failure to substantially comply can lead to OIC recommending to OSPI that coverage be purchased through PEB program

Issues Facing Districts – 4


Issues facing districts 5

Review by 6/1/2013 goals

All contracts subject to competitive procedure [§3(6)]

Benefit plans must make progress on health care innovation and cost savings, and reduce administrative costs [§3(7)]

Contracts or agreements for employee benefits may not exceed one year [§4(1)]

When and how frequently to go to quote?

Is health care innovation/administrative costs a carrier or district issue?

Will WEA going to quote satisfy requirement?

Issues Facing Districts – 5


Issues facing districts 6

Review by 8/31/2012 goals

  • Open Enrollment ending by October 1st (or start of plan year)

  • This issue is not related to K-12 Health Benefits Act

  • Section 125 rules stipulate that elections be made prior to start of plan year, except:

    • New hires

    • Qualifying event

  • Congress instructed and funded Department of Labor to audit groups (also auditing for PPACA compliance)

Issues Facing Districts – 6


Issues facing districts 7

Review by 12/31/2012 goals

  • Non-Discrimination Rules

  • Effective 9-23-2010, suspended 12/23/2010.

  • New regulations expected by end of 2012

  • Cannot favor highly compensated individuals with:

    • Better benefits

    • Shorter elimination period

    • Greater contributions

  • Excludes those covered by Collective Bargaining. Includes all non-bargained employees

Issues Facing Districts – 7


Penalties for non compliance

If do not comply with OIC reporting rules, OSPI could require purchase of benefits through PEB

If inadequate progress, OIC, HCA and JLARC could recommend creation of statewide K-12 pool to 2016 legislature

Employees or unions could sue based on non-compliance with K-12 Act

Section 125 rules – potential huge tax liability

Non Discrimination rules – plan could be subject to fines of $100 per day per person discriminated against

Penalties For Non-Compliance


Payroll deduction illustration
Payroll Deduction Illustration require purchase of benefits through PEB


Qualified high deductible health plan

  • A QHDHP must meet Internal Revenue Code requirements including:

    • Minimum deductible of $1,200 for single coverage or $2,400 for family coverage

      (increasing to $1,250 and $2,500 in 2013)

    • Maximum annual out-of-pocket maximum of $6,050 for single coverage or $12,100 for family coverage

      (increasing to $6,250 and $12,500 in 2013)

    • All services must subject to deductible with exception of preventive care

Qualified High Deductible Health Plan



Health savings accounts hsa s

  • To be eligible to deposit funds into an HSA, the account holder must:

    • Be enrolled on a QHDHP

    • May not have any other medical coverage

    • May not be eligible to receive benefits from Health Care Flexible Spending Account or VEBA – even spouses

    • Could have limited purpose HCFSA or VEBA which covers dental and routine vision expenses

Health Savings Accounts (HSA’s)


Hsa s 2

HSA belongs to the account holder holder must:

Funds are available as soon as deposited

HSA funds can be used for expenses incurred after account is opened, even if deposited later

Maximum HSA contribution for 2012 tax year is $3,100 for single coverage or $6,250 for family coverage

(increasing to $3,250 and $6,450 for 2013)

Maximum is pro-rated

$1,000 catch-up provision if 55 or older

HSA’s – 2


Hsa s 3

  • Tax advantages: holder must:

    • Deposits are pre-tax or tax deductible

    • HSA earnings are tax free

    • Withdrawals are tax free as long as they are for eligible health are expenses

  • Eligible health care expenses include medical plan costs such as deductibles, copays, coinsurance, dental expenses, and routine vision expenses

  • HSA expenses can be paid for spouse or any tax dependent even if they have their own insurance and are not on QHDHP

HSA’s – 3


Scenario 1 limited medical plan expenses

1 preventive exam, 1 illness per year, & 2 prescriptions holder must:

Scenario 1 – Limited Medical Plan Expenses


Scenario 2 expensive medical treatment

30 day hospital stay with $250,000 in claims holder must:

Scenario 2 – Expensive Medical Treatment



Additional resources

  • OSPI Weekly Updates of FAQ’s holder must:

    • http://www.k12.wa.us/finance/insurancebenefits5940.aspx

  • Publication 969 Health Savings Accounts and Other Tax-Favored Health Plans

    • http://www.irs.gov/pub/irs-pdf/p969.pdf

  • IRS Publication 15-B Employers Tax Guide to Fringe Benefits

    • http://www.irs.gov/pub/irs-pdf/p15b.pdf

  • IRS Publication 502 Medical and Dental Expenses

    • http://www.irs.gov/pub/irs-pdf/p502.pdf

Additional Resources


Questions? holder must:

Suzanne Lewis

[email protected]; 253-761-3461

Bob Bentley

[email protected]; 253-310-4028


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