preparing for 2014

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Preparing for 2014

HCR Updates and Proposed Rules


Health Care Reform UpdateProposed Rules for 2014

I. State Updates

II. Essential Benefits and Actuarial ValueA. Essential health benefits and benchmark plans

B. Cost-sharing standards

C. Actuarial value

III. Market Reforms and Wellness IncentivesA. Rating methodologies

B. Availability, renewability, and risk pooling

C. Wellness incentives

IV. Employer Sharing Responsibility

A. Review of current provisions

B. Discussion of proposed amendments

V. Q & A

State UpdatesPatient Protection and Affordable Care Act of 2010 (PPACA)


State Exchange ActivityInformation from: CIAB - January 31, 2013

TX

AZNM

UT

NV

MT

WY

ID

ND

SD

MN

NE

KS

OK

LA

MSAL

SC

NC

IN

KY

PAIA

WV

ME

AK

CA

OR

WA

COMO

AR

TN

WI

ILOH

MI

NY

GA

FL

VA

HI

MD

DE

NJ

CT RI

MA

VTNH

DC

Operational Exchanges (2)

State Partnership Exchange (6)

State Exchange Established (17+DC)Federally -Facilitated Exchange (25)

Marketplace


Medicaid ExpansionInformation from The Advisory Board Company - January 15, 2013,

Moving Eligibility from 100% FPL to 133% FPL

TX

AZNM

UT

NV

MT

WY

ID

ND

SD

MN

NE

KS

OK

LA

MSAL

SC

NC

IN

KY

PAIA

WV

ME

AK

CA

OR

WA

COMO

AR

TN

WI

ILOH

MI

NY

GA

FL

VA

HI

MD

DE

NJ

CT RI

MA

VTNH

DC

Participating (19)Leaning toward participating (4)Undecided (12)Leaning toward not participating (6)Not Participating (10)

Proposed Rules – Essential Benefits and Actuarial ValuePatient Protection and Affordable Care Act of 2010 (PPACA)


Essential Health Benefits (EHB)(HHS Pre-rule bulletin 12/16/11 and PPACA; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation – 11/26/12 proposed rule)

Definitions

• EHB package – scope of covered benefits and associated limits of a health plan offered by an issuer. It includes:o Ten statutory categories of benefitso Limits cost-sharingo Offers catastrophic planso Provides benefits in a certain manner

• Actuarial value – “a general summary measure of health plan generosity” or the total allowable costs of benefits paid by the health plan

• Base benchmark plan - plan selected by a state from the options provided or a default benchmark plan

• EHB-benchmark plan - Standardized set of EHB that must be met by a QHP or other issuer.


Essential Health Benefits(HHS Pre-rule bulletin 12/16/11 and PPACA; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation – 11/26/12 proposed rule))

Definition

Applies to:• Individual plans• Small employer group

plans• Offered in and out of the

ExchangePlan requirements:• Specific categories of

benefits• Certain cost-sharing

standards• Provide certain levels of

coverage

Items and Services

Must include:1. Ambulatory patient

services2. Emergency services3. Hospitalization4. Maternity and newborn

care5. Mental health and

substance use disorder6. Prescription drugs7. Rehabilitative and

habilitative services8. Laboratory9. Preventive and wellness10. Pediatric services

Applicability

Effective Date:

• First plan year, for individual and small group market, starting on or after January 1, 2014

Plan types that won’t meet the criteria:• Mini-meds • Specified disease or

illness• Accident only coverage• Other types of

“excepted benefits”


Essential Health BenefitsBenchmark Plan SelectionInformation from Kaiser Family Foundation - January 4, 2013,

TX

AZNM

UT

NV

MT

WY

ID

ND

SD

MN

NE

KS

OK

LA

MSAL

SC

NC

IN

KY

PAIA

WV

ME

AK

CA

OR

WA

COMO

AR

TN

WI

ILOH

MI

NY

GA

FL

VA

HI

MD

DE

NJ

CT RI

MA

VTNH

DC

Plan recommended selected by state (26)Default plan – no plan selected (25)


Benchmark Plans

State-specific benchmark plans Each state selects a benchmark plan

• One of the three largest small-group plans, in the state, by enrollment (21 + 22 default)

• One of the three largest state employee health plans, by enrollment (2)

• One of the three largest federal employee health plan options, by enrollment (1)

• The largest HMO plan offered in the state’s commercial market, by enrollment (5)

Carriers EPO PPO POS HMOHDHP/HSA compatible

Aetna 1 Blue Cross Blue Shield 1 29 5 ConnectiCare 1 Hawaii Medical Service Assoc. 1 Health Partners 1 HMO Partners 1 Kaiser 2 Lovelace 1 PacificSource 1 Priority Health 1 Public Employee's Health Program 1Sanford Health Plan 1 The Vermont Health Plan 1 United Healthcare plan 1 1 1Totals 2 34 2 11 2

http://www.statereforum.org/analyses/


Type of Benchmark Plans SelectedKaiser Family Foundation February 1, 2013

TX

AZNM

UT

NV

MT

WY

ID

ND

SD

MN

NE

KS

OK

LA

MSAL

SC

NC

IN

KY

PAIA

WV

ME

AK

CA

OR

WA

COMO

AR

TN

WI

ILOH

MI

NY

GA

FL

VA

HI

MD

DE

NJ

CT RI

MA

VTNH

DC

HMO

POS

PPO

EPO


EHB – Cost-sharing standards(HHS -11/26/12 proposed rule)

Includes: deductibles, coinsurance, copayments, etc.

Excludes: premiums, non-network balance billings, non-covered services, etc.

Definition: any expenditure required by or on behalf of an enrollee with respect to essential health benefits

Deductible limit for 2014:• Applies to all non-grandfathered

plans in the small group market only

• Limit = $2,000 self-only and $4,000 non-self-only

• Proposing that these cannot be offset by FSA, HSA or HRA

Annual cost-sharing limit:• Based on out-of-pocket limit for

high deductible health plan (HDHP)

• Non-self-only is 2x self-only limit• 100% for EHBs once limit is

reached


Actuarial Value(IRS Notice 2012-31 of 4/26/12 and HHS Pre-rule bulletin 12/16/11 and PPACA; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation – 11/26/12 proposed rule)

Methods• HHS and Treasury develop an actuarial

value calculator (AV) or a minimum value calculator (MV)

• Checklists to determine minimum value• Certification by a certified actuary

utilizing approved methods

Actuarial Value (AV) = total allowable costs of benefits paid by health planMinimum Value (MV) = AV of no less than 60% (fully insured individual and small group market

plans). TBD based on standard population of large self-insured group health plans.

Proposed Rules• De minimis variation = ± 2%• Value includes integration of

employer contributions to HRA and HSA in the small group market

Tier AVBronze 60%Silver 70%Gold 80%Platinum 90%

Valu

es

Proposed Rules – Market ReformsPatient Protection and Affordable Care Act of 2010 (PPACA)


Current State Markets(HHS and CMS: PPACA; Health Insurance Market Rules; Rate Review 11/26/12 proposed rule)

* for HIPAA-eligible employees

Number of States Allowing…

Rating Type Individual Small Group

Health 43 38

Age 48 48

Gender 37 35

Industry n/a 37

Guaranteed Individual Small Group

Availability 541*

51

Renewability 50 48

Rating/Pooling 18 47

“Health insurance premiums will no longer be based on enrollees’ pre-existing conditions or gender and health insurance issuers no longer will be able to divide up their risk pools (blocks of business) in order to discriminate against health individuals”


Major Provisions(HHS and CMS: PPACA; Health Insurance Market Rules; Rate Review 11/26/12 proposed rule)

Provision Proposed rules – effective for plan years on or after January 1, 2014

Rating • Limited to age, tobacco use, family size, and geography only• Applies to non-grandfathered individual and small group markets in 2014; large

group markets in 2017 if offered in the Exchange





group markets in 2017 if offered in the ExchangeAvailability • Coverage must be offered to all

• Applies to issuers offering non-grandfathered coverage to individuals and employers, regardless of whether plans are offered through the Exchange

• Can limit to: open and special enrollment periods, employer’s eligible individuals who live, work or reside outside the network area, or other network or financial capacity issues





group markets in 2017 if offered in the ExchangeAvailability • Coverage must be offered to all

• Applies to issuers offering non-grandfathered coverage to individuals and employers, regardless of whether plans are offered through the Exchange

• Can limit to: open and special enrollment periods, employer’s eligible individuals who live, work or reside outside the network area, or other network or financial capacity issues

Renewability • Must renew at option of plan sponsor or individual• Applies to all grandfathered & non-grandfathered small group and individual plans,

regardless of whether plans are offered through the Exchange• Exceptions: non-payment, fraud or misrepresentation, lack of group meeting

participation or contribution rules, issuer ceasing to offer coverage, no enrollee living, working or residing in network area or employer’s member in bona fide association ceases

• QHP Exceptions: enrollee no longer eligible for coverage in QHP, non-payment, coverage rescinded due to fraud, QHP terminates or is decertified, enrollee changes from one QHP to another during open or special enrollment


Rating Rules and Methodologies(HHS and CMS: PPACA; Health Insurance Market Rules; Rate Review 11/26/12 proposed rule)

1. Issuers = individual member ratings Employers = individual or composite rating

2. Age rating – limited to 3:1

3. Tobacco rating – limited to 1.5:1

4. Family size – individual v familya. Maximum of 3 oldest family members under age

21b. No cap for family members over age 21

5. Geographic regiona. States or CMS can establish one or more rating

areasb. Maximum of 7 rating areasc. One rating area for state, county-based or 3-digit

zip codes, or metropolitan statistical areas (MSAs) and non-MSAs

6. Re-underwriting is prohibited

Will apply to non-grandfathered large group if state permits coverage to be offered through an Exchange in 2017

Applies to non-grandfathered health insurers (not self-funded)

Apportioned to each family member


Rating Rules and Methodologies(HHS and CMS: PPACA; Health Insurance Market Rules; Rate Review 11/26/12 proposed rule)

Annual rate changes at the time of renewal


Catastrophic Plans(HHS and CMS: PPACA; Health Insurance Market Rules; Rate Review 11/26/12 proposed rule)

• Must contain all applicable requirements and only be offered in the individual market

• Provides essential health benefits after the enrolled individual reaches the annual limitation in cost-sharing

• Covers three primary care visits and preventive care with no cost-sharing

• Eligibility:

• Only individuals under age 30 before the beginning of the plan year

• Those certified as exempt from the individual responsibility payment because they cannot afford minimum essential coverage

• Those eligible for a hardship exemption


Risk Pooling(HHS and CMS: PPACA; Health Insurance Market Rules; Rate Review 11/26/12 proposed rule)

Proposal requires health insurance issuers to treat all non-grandfathered business in the individual and small group market, respectively, as a single risk pool

• States may choose to merge individual and small group market pools

• Applies to plans in and out of the Exchange

• Does not apply to excepted benefit or short-term limited duration policies or plans with fewer than 2 participants who are current employees

Beginning in 2014 - an issuer estimates total combined claims experience of all non-grandfathered plans within a state market to establish an index rate. Index rate would be used to set the rates for all non-grandfathered plans of the issuer in the market.

Proposed Rules – Wellness IncentivesPatient Protection and Affordable Care Act of 2010 (PPACA)


Wellness Incentives(Departments joint final regulations issued 12/13/06 - 71FR75014

*Consumer-protection conditions:

a. Total reward does not exceed 20% of the total cost of coverage

b. Reasonably designed to promote health or prevent disease

c. Gives eligible individuals an opportunity to qualify at least once per year

d. Reward available to all similarly situated individuals

e. Plan materials must highlight reasonable alternative standard

Types of wellness programs1. Participatory

a. No required standard related to a health factor OR

b. No reward offered

2. Health-contingent*a. Requires individuals to satisfy

standard related to a health factor AND

b. Offers a reward


Wellness Incentives(Proposed Rule – HHS 11/26/12)

Proposed Rules

Applicability:

• Grandfathered and non-grandfathered plans

• Plan years on or after January 1, 2014

• Extension to individual market

Increase in incentives:

• 30% maximum program reward• 50% maximum tobacco prevention or

reduction reward

ACA:• Reflects the 2006 regulations• Extends nondiscrimination

provisions to individual market

Propose Rules – Employer Sharing ResponsibilityPatient Protection and Affordable Care Act of 2010 (PPACA)


Large Employer DeterminationIRS/HHS Notices 2011-73, 2012-17, 2012-58, DOL 2012-2, IRS §4980H

Employers who employed at least 50 full-time employees, including full-time equivalent employees, on business days during the preceding calendar year

Definition Calculating EmployeesFull-time employees Employees who, on average,

work 30 hours or more per weekA. Add number of employees employed on business days in the year of evaluation

Seasonal employees A worker who performs labor or services on a seasonal basis

B. (Add total number of hours worked during year of evaluation, but no more than 120 hours for any one employee in a given month) ÷ 120

All other non-full-time employees

All other employees who are not full-time or seasonal

C. (Add total number of hours worked during year of evaluation, but no more than 120 hours for any one employee in a given month) ÷ 120

TOTAL Full-time and full-time equivalent employees

Add A + B + C for each monthAdd all months together ÷ 12

Employee Type


“Applicable Large Employer”IRS/HHS Notices 2011-73, 2012-17, 2012-58, DOL 2012-2, IRS §4980H

Who is an applicable large employer?

Less than 50 full-time equivalents

50 or more full-time equivalents

Seasonal exception applies:50 or more for no more than 4 calendar months due to seasonal

UNLESS…


Employer Mandate ToolIRS/HHS Notices 2011-73, 2012-17, 2012-58, DOL 2012-2, IRS §4980H

• 1 - Full-time employees = total number of employees who work, on average, 30 hours per week

• 2 – Add all actual hours worked, in each month, by seasonal employees

• 3 - Add all actual hours worked in the month for those employees who are not accounted for as full-time or seasonal employees

Employer mandated to offer coverage per PPACA → NO

PPACA - Employer Sharing ResponsibilityAre you mandated to offer coverage under PPACA?

Applicability - §4980H Enter Year (YYYY) of Evaluation

Employers who employed at least 50 full-timeemployees, including full-time equivalent employees, on business days during thepreceding calendar year

Full-Time Equivalent Employees

MonthFull Time

employees1

Hours for all seasonal

employees2

Seasonal employees

converted to full-time equivalents

Hours for all other non- full-

time employees3

January 0 0 0.0 0February 0 0 0.0 0


Employer Sharing Responsibility(Proposed amendments to REG-138006-12; pub. 1.2.13)

Proposed rules for determining:• Status as a large employer and large employer member• Full-time employees• Assessment of a nondeductible excise taxes under IRC §4980H(a) and

IRC §4980H(b):• (a) not offering coverage to full-time employees and their

dependents• (b) offering coverage to full-time employees and their dependents

that does not meet the ACA’s standards for affordability and minimum value

• Administration and assessment of nondeductible excise taxes


Applicable Large Employer(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

Review of prior rules:

• All employees, including seasonal, are counted for purposes of determining status as an applicable large employer

• An employee is an individual who is an employee under common law standard

• Leased employees are not cross-referenced under §4980H so are not counted by the service recipient

• A sole proprietor or 2% S-corp. shareholder is typically not an employee

• All full-time and full-time equivalent employees are counted

• IRC §4980H applies to all common law employers, including governmental entities, churches, tax exempt organizations and foreign companies with at least 50 full-time equivalent employees performing work in the US with US source compensation


Controlled Groups(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

IRC §414

For purposes of IRC §414 , all employees under the following categories are considered as employed by a single employer

IRC §414 (b) – Employees of controlled group of corporationsIRC §414 (c) – Employees of partnerships, proprietorships, etc. which are under common controlIRC §414 (m) – Employees of an affiliated service groupIRC §414 (o) – Regulations as prescribed by the Secretary

Aggregation rules:

• Determination is based on controlled group rules under IRC §§414(b), (c), (m), or (o).

• Penalties are only assessable to the individual entities

• In calculating liability under §4980H, an applicable large employer is only allowed one reduction of 30 full-time employees – this should be allocated based on each member’s number of full-time employees

• Each large employer member is liable for its own tax penalties and is not liable for the penalties of any other member


Employee Definitions(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

Employees included in calculations:• All full-time employees with, on average, 30 hours or more of service per week;

130 hours if using a monthly standard• Part-time, variable, or seasonal employees• Hours for services performed outside the U.S. for which an individual receives U.S.

source income

Special rules:• Teachers and employees of educational

organizations – traditional breaks in academic school year will often be periods of paid leave so would be counted as hours of service

• Commission-based employees, transportation employees, adjunct faculty and analogous employment positions – non-standard employees paid on commission or subject to safety regulations, e.g. airline pilots – under review. In interim consider all hours necessary to perform work


Employee Definitions - continued(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

Definition of seasonal employee:• The 120-day period referred to is relevant

only for determining status as an applicable large employer and not for determining whether an employee is a seasonal employee

• DOL, Treasury and IRS have determined that seasonal worker is not limited to agricultural and retail workers.

• Until further notice, employers may use a good faith interpretation of the statutory definition of a seasonal worker.

Standard Definition

Definition: “[l]abor is performed on a seasonal basis where, ordinarily, the employment pertains to or is of the kind exclusively performed at certain seasons or periods of the year and which, from its nature, may not be continuous or carried on throughout the year. A worker who moves from one seasonal activity to another, while employed in agriculture or performing agricultural labor, is employed on a seasonal basis even though he may continue to be employed during a major portion of the year”


Variable hour/seasonal rulesIRS Notice 2012-58

Standard Measurement Period (SMP)

Administrative Period

Applicable Stability Period (SMP = Full-time)

Applicable Stability Period (SMP ≠ Full-time)

A “look back” period of 3-12 consecutive calendar months

• Cannot reduce or lengthen SMP or stability period

• Can be up to 90 days

• Needs to overlap prior stability period

• At least 6 consecutive calendar months

• Cannot be shorter duration than SMP

• Begins after SMP and any applicable administrative period

• Cannot be longer duration than SMP

• Begins after SMP and any applicable administrative period

Full-time status of on-going* employees* On-going = employee who has been employed by employer for at least one complete standard measurement period


Variable hour/seasonal rulesIRS Notice 2012-58

Initial Measurement Period (IMP)


Applicable Stability Period (IMP = Full-time)

Applicable Stability Period (IMP ≠ Full-time)

A “look back” period of 3-12 consecutive calendar months

• Cannot exceed 90 calendar days

• Administrative period can be limited further when applying combined duration rule*

• Must be the same length as the stability period for on-going employees

• At least 6 consecutive calendar months

• Cannot be shorter duration than IMP

• Begins after IMP and any applicable administrative period

• Cannot be more than 1 month longer than the IMP

• Must not exceed the remainder of the SMP plus any associated administrative period in which the IMP period ends.

Full-time status of newly hired variable hour and seasonal employees

*IMP and administrative period cannot extend beyond, at most, 13 months and a fraction of a month from the employee’s start date


Variable Hour Determination ToolIRS Notice 2012-58

Adding Employees

Waiting period New Hire On-Going Employees

Will you always add employees on the first

of a month? Y/N

# of Days Initial Measurement Period (IMP)(in months)

Proposed Stability Period

(in months)


(in days)

Standard Measurement Period (SMP)(in months)

Proposed Stability Period

(in months)


(in days)

60 Evaluation: Acceptable Unacceptable Unacceptable Unacceptable Unacceptable Unacceptable Unacceptable

Overall validation of proposed eligibility plan

All rules are not satisfied - please try changing some of your optionsValidation messaging provided for each eligibility rule Plan appears to satisfy all rules - proceed to Step 3

OR


Look-back measurement period(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

Standard measurement and stability periods must be uniform for all employees except the following:

• Each group of collectively bargained employees covered by a separate collective bargaining agreement;

• Collectively bargained and non-collectively bargained;

• Salaried and hourly employees

• Employees whose primary places of employment are in different states

Standard measurement and stability periods can be changed in subsequent years as long as they are done prior to the date they begin.

A new variable or seasonal employee with change in status during initial measurement period (IMP):

• treated as a full-time employee as of the first day of the 4th month following the change in status , OR

• If averaging more than 30 hours of service during IMP, the first day of the month following IMP


Look-back measurement period(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

Re-hired Employees

• If an employee goes with no hours of service for at least 26 consecutive weeks, they are treated as a new hire

• Employer may apply a rule of parity (less than 26 weeks)

• Must be at least four weeks• Must be longer than the

employee’s period of employment immediately preceding that period with no service hours

Resuming Employees

• If an employee goes with no hours of service for less than 26 consecutive weeks, they are treated as a resuming employee

• The measurement and stability period that would have applied to the employee had they not been gone will resume

• Can use an averaging method for periods of special unpaid leave, e.g. FMLA, USERRA or jury duty


Temporary and staffing firms(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

Comments solicited regarding the categorization and rules for the following scenarios:

• Employees on long-term assignments• The ability of employees to accept or reject assignments• Employees participating with more than one leasing or temp agency/firm• Appearance of employee on active roster when there is no intent to accept assignments• Situations where the temporary agency is not the common law employer


Assessments - §4980H(a), (b)(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

Deign Your

Essential Benefits

Under

stand

Needs

Keep Informed

Stay

Com

pliant

Control Costs

Educate and Engage

What are the penalties associated with non-compliance?Employers may be assessed fees for any month they:

1. Fail to offer employer-sponsored minimum essential coverage to FTEs and their dependents

a. AND at least one person enrolls for coverage, from the Exchange, and receives a subsidyb. Assessment = 1/12 of $2,000, or $166.67 per month, for each FTE, less the first 30

employees

2. Offer employer-sponsored minimum essential coverage to FTEs and their dependents but the employee contribution is deemed unaffordable

a. AND 1 or more employees enroll for coverage, from the Exchange, and receive a subsidyb. Assessment = the lesser of:

i. 1/12 of $3,000, or $250 per month, for FTE receiving a subsidy ORii. 1/12 of $2,000, or $166.67 per month, for each FTE, less the first 30 employees


Compliance with §4980H(a), (b)(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

Deign Your

Essential Benefits

Under

stand

Needs

Keep Informed

Stay

Com

pliant

Control Costs

Educate and Engage

Assessment penalties can be avoided if the employer offers minimum essential coverage under an employer-sponsored plan to its full-time employees and their dependents.

• Minimum Essential Coverage (MEC): to be defined in a future regulation

• Definition of dependent: An employee’s child under age 26 – does not include spouse

• Employers will not face a tax penalty if not offering coverage to spouses, who will be able to seek a federal premium tax credit to purchase health insurance in an Exchange if other minimum essential coverage is not available.

• Offer of coverage in case of non-payment: Employer will not be deemed as not offering coverage if employee fails to pay their portion of the premium – this regulation adopts the COBRA 30-day grace period rule

• Offer of coverage: Employer will satisfy requirement as having offered if they offer to 95% of their employees

• Assessment payments: These are not tax deductible


Compliance with §4980H(b)(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

Deign Your

Essential Benefits

Under

stand

Needs

Keep Informed

Stay

Com

pliant

Control Costs

Educate and Engage

Affordability Safe Harbors – applies only for purposes of whether the employer satisfies the 9.5% affordability test

1. Form W2 safe harbor – wages to be reported in Box 1 of Form W2a. Must offer its full-time employees (and their dependents) the opportunity to enroll in minimum

essential coverage under an eligible employer-sponsored plan; ANDb. The required employee contribution toward self-only premium for the employer’s lowest cost

coverage that provides minimum value (the employee contribution) not exceed 9.5% of the employee’s Form W2 wages for that calendar year.

2. Rate of pay safe harbora. Take the hourly rate of pay for each hourly employee who is eligible to participate in the health

plan as of the beginning of the plan yearb. Multiply that rate by 130 hours/month (benchmark for FT status under 4980H)c. Determine affordability based on the resulting monthly wage amount

3. Federal poverty line safe harbora. Commenters suggested the employees whose income qualifies them for Medicaid be

disqualified (since they are ineligible for a tax credit), i.e. <100% of FPLb. Employer can use FPL for a single to set premium contribution, i.e. set employee contribution

for self-only coverage of the lowest cost plan to ≤9.5%.c. Can use the most recently published FPL guidelines as of the first day of the plan year.


Transition Relief(Proposed amendments to Employer Sharing Responsibility REG-138006-12; pub. 1.2.13)

• No assessments will be made in 2014, if an employer has a fiscal plan year as of 12/27/12 and an employee is offered affordable, minimum value coverage IF:

• The mandate and look-back starts on the first day of the plan year on or after January 1, 2014 (applies to eligible employees as of 12/27/12)

• At least 25% of all employees were enrolled in the fiscal year plan or 1/3 of all employees were offered coverage under the fiscal year plan at the last open enrollment (applies to employees who were not eligible on 12/27/12)

• Transition relief will allow employers, with fiscal plan years beginning in 2013, to update their plan documents to grant one or both of the following:

• The right for an employee to revoke or change elections once during the plan year without regard to a change in status

• An employee who did not make the salary reduction election would be permitted to make a prospective election on or after the first day of the 2013 plan year without regard to a change in status

• Can use any six consecutive months to determine of applicable large employer

Health Care Reform Q&A

preparing for 2014

Documents

benchmark planscost

default benchmark

state partnership exchange

common benchmark selection

states commercial market

states existing mandates

largest enrollment

largest small group