EMPLOYER REadinEss chEckList

agE-bandEd MEdicaL RatEs

d by enforcing business rules at all levels and automating enrollment, hR intouch will facilitate the conversion to age-banded medical rates and ensure the variation does not exceed the limits imposed by the PPaca.

UnifORM sUMMaRY Of bEnEfits cOvERagE (sbc)

d gives employers the ability to house all relevant information in the employee portal and set up so that employees must submit an acknowledgement form to ensure they receive and review the initial sbc, as well as any changes within the 60 day limit.

d Mobile capabilities allow the employee to conveniently access these documents on-the-go from any web-enabled device.

EMPLOYER REPORting

d Offers a treasury Report that allows employers to report summary and employee-specific information for PPaca-required data, which will be in the treasury department’s required format and can be saved or printed for submission.

EMPLOYEE OPt-OUt sURvEY

d identifies and captures the specific reasons as to why employees are declining coverage through an enrollment questionnaire, helping employers avoid the penalties for employees who opt-out of coverage due to receiving a tax credit or cost-sharing subsidy through the state health insurance exchange.

gRandfathEREd PLans

d Provides plan and benefit summary information to comply with information transparency requirements, allowing consumers to compare plan benefits, cost sharing requirements, renewability and continuation of coverage provisions.

W-2 REPORting

d automatically sends the appropriate deduction amounts broken out by benefit type for each employee to your payroll system so the cost of coverage can be accurately calculated and reported on the W-2.Be

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EMPLOYEE nOtif icatiOns fOR statE ExchangEs

d Enables hR staff to send mandatory notifications about state health insurance exchanges through the Platform, whether or not the employer’s plan meets minimum coverage requirements and how to access information regarding premium subsidies that may be available for exchange-based coverage.

EMPLOYER MandatE

d supports complex business rules and a variety of plans based on benefit design needs and incorporates new essential benefit packages designed by employers to provide a comprehensive set of services, cover at least 60 percent of the actuarial value of the covered benefits, limit annual cost-sharing and are not more extensive than the typical employer plan.

d Requires employees and consumers to acknowledge that they can only be covered in certain situations – for example, if they do not have coverage elsewhere.

Wait PERiOds

d configures wait period to comply with the new requirement of 90 days while proactively identifying all existing sponsors whose medical new hire rules have a wait period of greater than 90 days.

PRE-Existing cOnditiOns

d Pre-existing condition clauses for dependents are eliminated to allow dependents under the age of 19 with pre-existing conditions to be covered, and includes life event and reinstatement options for previously canceled dependents.

d allows carriers and employers to waive pre-existing exclusions for specific employees in 2014, when no member shall be denied coverage due to pre-existing condition(s).

aUtO EnROLLMEnt

d allows employers to configure automatic enrollment through hR intouch, and allows employees to opt-out online through the user portal for compliance with the new legislation beginning in 2015.

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RM300 3-13