TRIBES AS EMPLOYERS: WHAT SHOULD WE BE PREPARED FOR IN 2014?

1. TRIBES AS EMPLOYERS: WHAT SHOULD WE BE PREPARED FOR IN 2014?

2. THE BASICS • Tribes are governments who happen to be employers • Enterprise operations supplement underfunded trust/treaty responsibilities of the Federal government • Goal is communal good not individual wealth • Any efficiencies of scale in our enterprise as well as our delivery services will produces savings that will flow directly to our citizens in the form of health care and other critical services

3. AFFORDABLE CARE ACTWHAT’S AHEAD? • New standards for employer sponsored health plans • No lifetime or annual limits • Dependents under the age of 26 may enroll in parent’s plan • Plan administrative costs capped @ 15% • Preventive services (no co-pay or deductible) • Out of Pocket maximums for exchange plans or new employer sponsored plans • Prohibition on denying coverage due to existing conditions

4. AFFORDABLE CARE ACTWHAT’S AHEAD? • Medical underwriting prohibited for exchanges and small group new employer sponsored plan • Minimum services covered for exchange plans, and small group new sponsored plan and small group self-insured plan • Tax credits for small employers purchasing coverage through an exchange for two consecutive years • Employers providing health insurance coverage to retirees aged 55-64 can receive reimbursement of 80% of claims between $15, 00-$90,000 until the $5 billion nationwide is expended. • Waiting periods for coverage for group health plans are limited to 90 days • Automatic enrollment for employers with more than 200 employees unless the employee opts out

5. WELLNESS Programs • New standards for wellness programs • Employers may offer employee incentives • Five year grant program to encourages small employers to establish wellness programs

6. HEALTH CARE EXCHANGES • New marketplace that will offer a choice of plans with standards of coverage. • Small employers of up to 100 employees can participate when exchanges open by 2014,. State can reduce that number to 50 employees • Large employers could be fined if at least one employee is receives subsidies through the exchange

7. EMPLOYER REPORTING • Must provide information to employees about exchanges beginning in March 2013 • Must report the value of benefits on each employees W-2 form beginning in calendar year 2012 (some exceptions) • If offering minimum essential coverage, must report to the IRS annually with information about coverage offered. Large employers with at least 50 full-time equivalent employees will annually have to file additional information regarding fulfillment of employer responsibilities beginning 2014.

8. TAX ISSUES • High cost plans will be taxed @40% of the aggregate value above a high cost threshold beginning in 2018. • Thresholds $10,200 individual coverage and $27,500 family coverage. • Contributions to a Flexible Spending Arrangement for medical expenses limited to $2500 beginning in 2013 • Tax deduction for employers who subsidize Medicare Part D retiree drug payments effective 2013.

9. IMPACT OF IMPROVED ACCESS, EFFICIENCY AND QUALITY • Strengthening primary care workforce • Encouraging rural providers by increasing reimbursement • Innovations in health care • Improving health care quality • Linking payments to Quality Outcomes • Encouraging integration of health care systems • Educated consumers: quality and price