SCHOOLCARE HEALTH BENEFIT PLANS

Health Care Reform Discussion

Lisa J. Duquette

Program Administrator

lduquette@schoolcare.org

August 17, 2010

SCHOOLCARE HEALTH BENEFIT PLANS

Health Care Reform

Senate Bill HR 3590: Patient Protection and Affordable Care Act

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Reconciliation Bill HR 4872: The House Reconciliation Act

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Final Health Reform Law

Signed March 23, 2010

SCHOOLCARE HEALTH BENEFIT PLANS

Today’s Focus

Near term effect on NH schools

Insight into future issues

SCHOOLCARE HEALTH BENEFIT PLANS

Provisions Effective

First plan year starting on or after September 23, 2010 (6 months)

July 1, 2011– NH school group health plans subject to insurance reforms

SCHOOLCARE HEALTH BENEFIT PLANS

2010

3/30/2010 Elimination of Imputed Income§IRC 105(b) amended to exclude taxability of medical benefits for adult dependents children

6/1/2010 Early Retiree Reinsurance Program reimbursement for 80% of cost for retirees age 55 - 64 who have claims in excess of $15,000 and below $90,000. (Program ends in 2014 or when the $5B funding is exhausted)

SCHOOLCARE HEALTH BENEFIT PLANS

2011

1/1/2011 OTC medications – unless prescribed by a doctor over-the counter medications are no longer eligible for reimbursed pre tax reimbursement from FSA, HSA, or HRA

SCHOOLCARE HEALTH BENEFIT PLANS

2011 – July 1st!

Increase age limit to age 26 for uninsured dependents – No tax dependent requirement

– Married/unmarried

– NOT child or spouse of dependent

– Up to 1/1/2014 grandfathered plans may exclude dependents if eligible for employment based coverage

Be sure payroll system is updatedEnsure FSA administration includes expense reimbursement for a

dependent child until the year in which the child attains age 27

SCHOOLCARE HEALTH BENEFIT PLANS

2011 – July 1st!

Lifetime on essential benefits prohibited Annual dollar limits on essential benefits prohibited

(presumption that # of visits, # of procedures, and limits on cost are permissible)

Cost sharing on preventive care prohibited (grandfathered plans exempt)

Increased premium cost of 1-4% for

improved plan provisions

SCHOOLCARE HEALTH BENEFIT PLANS

2011 – July 1st!

Automatic Enrollment Requirements for employers with 200 or more FT employees– No regulations have been issued by DOL yet– Some interpret that this provision will be effective 1/1/2014

CLASS Act – national voluntary long term care program…need more HHS guidance– employers required to automatically enroll employees and

facilitate payroll deductions

– employees must opt-out of program if not wishing to participate

– pays cash benefits averaging $50 per day

– five year (5) vesting period

SCHOOLCARE HEALTH BENEFIT PLANS

2011 – December 31st

W-2 reporting of the value of employer provided coverage (issue in January 2012)

Information only

Need to accumulate information required for reporting.

SCHOOLCARE HEALTH BENEFIT PLANS

2012

9/30/2012 Tax Assessments on group health plans of $2 per participant for “comparative effectiveness research”

– Applies to self-funded and insured plans– Reduced to $1 per participant 9/30/2013– Scheduled to “sunset” for plan years ending after 9/30/2019

Increased cost from assessments passed along to employers/employees

SCHOOLCARE HEALTH BENEFIT PLANS

2013 – 2014

1/1/2013 FSA max limits reduced – may not exceed $2,500

2014 - prohibits waiting periods greater than 90 days

Consider current collective bargaining agreement terms