Health Care Reform: 2012 and Beyond

1. Health Care Reform: 2012 and Beyond

2. 2012 • Summary of Benefits and Coverage • Effective for participants and beneficiaries who enroll or re-enroll beginning on the first day of the first open enrollment period that begins on or after September 23, 2012 • For all other enrollments, first day of the plan year that begins after September 23, 2012 • PCORI Surcharge • Starts for plan years ending after September 30, 2012 • $1/$2 average life • No longer applies for plan years ending after September 30, 2019 • Form W-2 Reporting • 2012 reporting due by January 31, 2013

3. Planning for the Future • 2013 • Limits on FSA contributions to $2,500 • Notice to employees explaining the Exchanges • Coverage of additional preventative services for women at 100 percent • 2014 • Pay or play mandate • Treasury and the IRS intend to issue proposed regulations or other guidance: • Allowing employers to use an employee’s Form W-2 wages as a safe harbor for determining the affordability of employer coverage • Addressing the intersection of the employer mandate and the 90 day maximum waiting period, where the employer will not be subject to the mandate penalty during the waiting period

4. Planning for the Future (cont.) • 2014 (cont.) • Pay or play mandate (cont.) • Treasury and the IRS intend to issue proposed regulations or other guidance: • Allowing employers to use a “look-back/stability period safe harbor” not exceeding 12 months to determine whether a current employee is a full-time employee • Providing rules for newly hired employees to determine whether the employee is full-time based on if an employee is reasonably expected to work full-time on an annual basis • Individual mandate • Autoenrollment • Not required to comply until guidance is issued (most likely in 2014)

5. Planning for the Future (cont.) • 2014 (cont.) • 90 day waiting period • The 90 day waiting period begins when the employee is otherwise eligible for coverage • Upcoming guidance will discuss the 90 day waiting period and eligibility periods based on hours of service completed • Maximum deductibles ($2,000/$4,000) and OOP limits (same as HSA compatible HDHP except a different cost-of-living adjustment) • Must cover routine patient costs associated with participation in a clinical trial • HIPAA wellness incentives codified with a differential increase of 30 percent

6. Planning for the Future (cont.) • 2014 (cont.) • No discrimination against a provider acting within the scope of his or her license • Reporting coverage to the IRS and participants and beneficiaries • Disclosure of plan data and financial information • Claims payment policies and practices • Periodic financial disclosures • Data on enrollment • Data on disenrollment • Data on the number of claims that are denied • Data on rating practices • Information on cost-sharing and payments with respect to any out-of-network coverage • Information on enrollee and participant rights • Any other information the Secretary of HHS determines appropriate

7. Planning for the Future (cont.) • 2014 (cont.) • Temporary Reinsurance Program • January 1, 2014-December 31, 2016 • Paid for by a tax on all insurers and self-funded plans • Flat rate: • 2014: $10B • 2015: $6B • 2016: $4B • Proportionate Share: • 2014: $2B • 2015: $2B • 2016: $1B • Insurer contribution proportionately based on its book of business; final regulations do not spell out formula for self-funded plans

8. Planning for the Future (cont.) • 2018 • Excise tax ($10,200 (individual)/$27,500 (family)) • Unknown • Quality reporting on initiatives and efforts that: • Improve health outcomes through implementation of activities such as quality reporting, effective case management, care coordination, etc. • Implement activities to prevent hospital readmissions • Implement action to improve patient safety and reduce medical errors • Implement wellness and health promotion activities

9. QUESTIONS? Chantel.sheaks@buckconsultants.com