Affordable Care Act – Current Issues in Healthcare

ReformAlice Helle - helle@brownwinick.com

Cynthia Boyle Lande – lande@brownwinick.com Harold Schneebeck – schneebeck@brownwinick.com

BrownWinick666 Grand Avenue, Suite 2000Des Moines, IA 50309-2510

Exchanges

Provide information about coverage options Facilitate purchase of health insurance by

uninsured individuals Complete individual exemption determinations Eligibility:

• Must be a U.S. resident

• Must be a U.S. citizen or national

• Cannot be incarcerated

Exchanges – Open Enrollment Periods

Initial open enrollment period began October 1, 2013 and continued through March 2014

2015: November 15, 2014 – February 15, 2015

Subsequent open enrollment periods: October 15 – December 7

Definitions Minimum essential coverage: includes individual market

policies, job-based coverage, Medicare, and Medicaid Essential health benefits:

• Ambulatory patient services• Emergency services• Hospitalization and surgery• Maternity and newborn care• Mental health and substance abuse treatment• Prescription drugs• Rehabilitative and habilitative services and devices• Lab services• Preventative wellness services and chronic disease management• Pediatric services, including dental and vision

Exchanges (cont.)

Coverage levels• Bronze (60/40)

• Silver (70/30)

• Gold (80/20)

• Platinum (90/10)

Iowa’s Exchange

Partnership Model www.healthcare.gov 1-800-318-2596

“Large Employer” Mandate

Obligations of Large (50+) Employer Must offer health coverage to “full-time

employees” (30 hours) or pay a penalty Employers who offer coverage may still

be subject to a penalty unless the coverage offered is “affordable” and provides “minimum value”

Effective Date for Mandate

• Originally effective 2014

• Proposed regulations delayed to 2015

• Final regulations issued 02/10/14 further delayed some provisions and clarified others

Highlights of Final Regulations

Employers with 50 – 99 FTEs Penalties under the employer mandate

are delayed to 2016 IF employer has met ALL of the following requirements since 02/09/14:

Highlights of Final Regs (cont.)

Has not reduced # of employees or their hours for the purpose of falling below 99 FTEs

Has not eliminated or materially reduced health coverage

ER/EE premium split for EE only coverage is unchanged (or ER contribution is at least 95% of 02/09/14 level)

Highlights of Final Regs (cont.)

Employers with 100+ FTEs Penalty for failure to offer coverage (the

$2,000/year penalty)• For 2015 only:

• ER must offer coverage to at least 70% (not 95%) of full-time employees

• Penalty is calculated by excluding first 80 employees (rather than first 30)

Highlights of Final Regs (cont.)

“Seasonal Employee” defined: Customary annual period of employment

is 6 months or less Period of employment should start in the

same part of the year each year Ex:

• Ski instructors

• Detasselers

NASHCO

http://nashco.org/members-co-op/

CoOportunity Health

CoOportunity Health (cont.)

Website: www.brownwinick.comToll Free Phone Number: 1-888-282-3515

OFFICE LOCATIONS:

666 Grand Avenue, Suite 2000Des Moines, Iowa 50309-2510

Telephone: (515) 242-2400Facsimile: (515) 283-0231

616 Franklin PlacePella, Iowa 50219

Telephone: (641) 628-4513Facsimile: (641) 628-8494

DISCLAIMER: No oral or written statement made by BrownWinick attorneys should be interpreted by the recipient as suggesting a need to obtain legal counsel from BrownWinick or any other firm, nor as suggesting a need to take legal action. Do not attempt to solve individual problems upon the basis of general information provided by any BrownWinick attorney, as slight changes in fact situations may cause a material change in legal result.