Patient Protection and Patient Protection and Affordable Care Act Affordable Care Act

Notification of Exchange / Notification of Exchange / Marketplace Marketplace

(Thirty (30) Hour Rule)(Thirty (30) Hour Rule)

Presented by

Dr. Michael B. Brinkos Michael Garofalo

Jan Klein

Laws/Uncertainties Laws/Uncertainties

• The laws are as of today. Refer to manuals / As it changes replace the information in the manuals.

• Uncertainties o 30 hour rule (losing union membership, losing

hours, returning to 40 hour work week). o Penaltieso Cadillac Tax o Districts need to be mindful changes will be

coming.

District Action Steps District Action Steps I. Exchange Letters

• Sample letter

II. Tracking of Hours

III. Independent Contractors/Staffing Agencies

IV. Determination of Enrollment and Coverage

V. Penalties

What is the Health Insurance What is the Health Insurance Exchange/MarketplaceExchange/Marketplace• The Exchange/Marketplace is designed to help families

find health insurance that meets their needs and fits their budget.

• The Exchange/Marketplace offers "one-stop shopping" to find and compare private health insurance options.

• Families may also be eligible for a new kind of tax credit that lowers their monthly premium immediately.

• Open enrollment for health insurance coverage through the Exchange/Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.

District Action District Action

I. Federal Exchange/Marketplace I. Federal Exchange/Marketplace

Notice Notice • Under the Patient Protection and Affordable Care

Act (PPACA), the health benefit Exchange/ Marketplace will be operational on Jan. 1, 2014.

• Requires employers to provide a notice regarding Exchange/Marketplace to all employees.o Employers must provide a notice of coverage options to ALL employees.

Note: this is not limited to just those enrolled in health insurance.  ALL of your employees must be notified, even those opting out of coverage.  The only exceptions are listed below:

o A notice does not need to be issued to:• Spouse and dependent• COBRA participants• Retirees

What Must Be Included in the What Must Be Included in the

Notice:Notice:The notice must include:• Information about the existence of the new

Exchange/Marketplace.

• A description of Exchange/Marketplace services.

• Contact information for the Exchange/Marketplace (i.e. www.HealthCare.gov).

District ActionDistrict Action• Employers are required to provide the notice no

later than Oct. 1, 2013.

o The notice is required to be provided automatically, free of charge.

o Employers are required to provide the notice of the Exchange/Marketplace to each new employee at the time of hire beginning Oct. 1, 2013.

Delivery of Notification Delivery of Notification • Two options:

o First Class Mail and/or; o Electronic Distribution

• You may choose one option for all employees or a combination of both (depending on your employee population).

NavigatorsNavigators• Navigators will play a key role as

Exchange/Marketplace launch nears.o “Navigators,” are trained people who will

provide face-to-face assistance. 

o Their job will be to point out differences in plans so enrollees can decide which would best suit family needs and income. 

o The AIU was identified as the receiver of the grant funding to hire “Navigators”.

District Action District Action II.II. Tracking of Hours Tracking of Hours • Past Year:

o How many Employees worked over 30 hours?

o How many of those employees received benefits?

• Future (one year to implement and align)o Tracking of Hours.

o Who are you going to offer benefits to?

Thirty (30) Hour Rule???Thirty (30) Hour Rule???o Originally Effective July 1, 2014

o Under the Allegheny County School Health Insurance Consortium, since our renewal rates are July 1st, the effective date for offering coverage to 30 plus hour employees would be effective July 1, 2015.

District ActionDistrict ActionIII. Independent Contractors / III. Independent Contractors / Staffing AgenciesStaffing Agencies• Include in our contracts with any staffing services

that they are "the employer of record for the Free Rider Penalty under the Affordable Care Act". This would indemnify the organization. o Kelly Services already implemented this practice.

• Amendment to any contacts to ensure the agency assumes the responsibilities with the Affordable Care Act (indemnifications).o Bus Driverso Food Services

District Action District Action

IV. Determination of Enrollment and IV. Determination of Enrollment and

Coverage Coverage • Determination of Employees' Status

o Who are the employees you offer coverage?

o Who are the employees you do not offer coverage?

o Do you, the employer, fall under the 95 percent rule (Safe Harbor Rule)?

 

IV.IV. PenaltiesPenalties• Penalty is $3,000 per person.

o Offering coverage that is not good enough, inadequate, unaffordable (employee pays greater than 9.5 percent of household income).

o If the employee is eligible for Medicare or Medicaid or on spouses coverage or eligible for spouses or declines coverage they will not trigger the penalty.

• Communication to employees.

Future ConsiderationsFuture Considerations• Restructure your work force.

• Is it more affordable to take the "risk" of the $3,000 instead of restructuring your work force?

• Have employees sign a form during enrollment that they were offered coverage.

• What if the employee contribution is more than they earn?

• Create procedures on how they will have to send you the money.

Cadillac TaxCadillac Tax

• If in the ACSHIC this is not applicable at this time.

Requirements for Requirements for 20142014

• Exchange/Marketplace Notices • Summary of Benefits and Coverage • W-2 Reporting • Fees are already built in the components of your

rates and coverage • Transitional Reinsurance Fee• Limits on out of Pocket

Passage of Affordable Care Act-signed into law March 20, 2010

Employer Mandatory Notification of Exchange/Marketplace-employers must distribute by October 1, 2013 for current employees and on-going for new hires.

Employer Notification of Open Enrollment and Summary of Benefits –July 2013.

Enrollment begins in the insurance exchange/marketplace –October 1, 2013.

Grants are awarded for “navigators” to be hired to assist the uninsured or underinsured in purchasing insurance through the exchange. September 2013 –August 2014.

Insurance purchased through the exchange/marketplace becomes effective –January 1, 2014.

Employer mandated coverage for 30 hours employees-July 1 2015 (this action was originally to take effect July 1, 2014.  In July of 2013 the government issued a one-year delay).