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Health Reform Discussion. Lisa Evans Director of Healthcare June 20, 2013. Agenda. Health Reform Provisions Employer Health Plan Standards Public Health Exchanges Employer Purchase Options Pay or Play Cadillac Tax. 2014 Health Reform Provisions.

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health reform discussion

Health Reform Discussion

Lisa Evans

Director of Healthcare

June 20, 2013

agenda
Agenda
  • Health Reform Provisions
  • Employer Health Plan Standards
  • Public Health Exchanges
  • Employer Purchase Options
  • Pay or Play
  • Cadillac Tax
2014 health reform provisions
2014 Health Reform Provisions
  • No one can be turned down for coverage for health reasons
  • Everyone must buy health insurance coverage or pay a tax

2014: Greater of 1% of AGI or $ 95 per person

2015: Greater of 2% of AGI or $325 per person

2016: Greater of 2.5% of AGI or $696 per person

Family maximum is capped at 300% of individual tax.

  • Access will be provided through Health Exchanges in each state.
health reform provisions
Health Reform Provisions

2011 Cover up to age 26 for dependents

2012 Unlimited dollar coverage

Preventative Services at 100%

Must report health costs on W-2s

2013 Female Contraceptives covered at 100%

2014 No one can be turned down for coverage

No pre-existing limits are allowed

Reinsurance Fee (2014-2016)

30 hour rule (monitoring starts in 2013)

2018 “Cadillac” tax

employer health plan standards
Employer Health Plan Standards
  • Coverage must be adequate
    • Plan coverage value of at least 60% or more
  • Coverage must be affordable
    • Employee-only premium must not exceed 9.5% of employee’s AGI
  • Offer coverage to at least 95% of full-time employees
public health exchanges
Public Health Exchanges
  • Every state will have option by 2014 or federal government will step in and establish.
  • Minimum coverage is required.
  • Subsidies/credits will be available based on income.
  • Premiums will vary based on age, people covered and zip code within set limits (3:1)
  • Standardized options will be available:

Bronze Silver Gold Platinum

60% 70% 80% 90%

slide7

Health Care Employer Purchase Options

Public Health Exchanges

Cost

Employers

Private Health Exchanges

Subsidies only available in Public Exchanges

Exchange = Marketplace

2014

Time

pay option
Pay Option

Fail to offer

Minimum essential coverage

95% full-time employees/dependents*

Penalty = $2,000 per each full-time employee (-30) annually

  • *and one of those employees receives subsidy in Health Exchange.
play options
PLAY Options

Offered minimum coverage to at least 95% full-time employees & dependents but not adequate/affordable*

Penalty - $3,000 per exchange enrolled employee

(up to maximum of $2,000 per full time employees)

-No Penalty – offer coverage

100% of employees who work >30 hours

AND

Adequate (> 60% value) AND Affordable (single premium cannot exceed 9.5% of employee’s AGI

how will person get coverage in 2014
How will person get coverage in 2014?

*Using dollar estimates of 2014 Federal Poverty Level (FPL)

cadillac tax
“Cadillac” Tax

Effective 2018 and will be indexed by CPI+1%.

“40% tax on value of employer sponsored coverage over a given dollar threshold”

$ 10,200 Employee Only

$ 27,500 Family

Separate High Risk or Retiree Single coverage rate:

$ 11,850 Single Coverage

$ 30,950 Family

questions

Questions?

To sign up for ELM information contact:

Don Betts

betts@gatech.edu

912.381.9003