Issue link: http://www.insightdigital.biz/i/177117
b ack of f i ce dollar limits. Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services including behavioral health treatment, prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services/chronic disease management, and pediatric services, including oral and vision care. » Grandfathered plans must cover dependent children to age 26 (even if child has access to own employerprovided coverage). » The new wellness program requirements still apply. » For small insurance plans (whether in or out of exchange/ marketplace): • overage must include essential C health benefits at bronze, silver, gold or platinum level. • aximum deductible: Individual M $2,000, family $4,000. • odified community rating M (rating classes limited to age, tobacco use, family size and geographic area) applies. • uaranteed issue applies. G • uaranteed renewal (with some G limitations) applies. Employers must also meet these ACA Requirements for 2014: » PCORI (Patient-Centered Outcome Research Institute) fee: July 31, 2013 deadline for reporting and payment of fees for plans that ended Oct. 1, 2012 to Dec. 31, 2012. Employers sponsoring certain group health plans must pay a fee of $1 per covered life per year. » MLR (medical loss ratio) rebates: Timely distribution of any We've Got Connections Meet the Busi Business Demands of Today's Market. The Port of Green Bay can help your business import and export materials to and from the Great Lakes, East coast or international markets. Using the Port's connections to an extensive network of highways and railroads means your goods move faster and keeps your business moving forward. Learn how we can help improve business operations. 920.492.4950 | www.portofgreenbay.com | FTZ #167 18 | / insight on manufacturing • September 2013 MLR rebates the plan may receive. » Summary of Benefits & Coverage (SBC): Must be provided as part of open enrollment. » DOL notice distribution: Department of Labor notice regarding exchange must be distributed by Oct. 1, 2013. » W-2 reporting: Must report health care costs on W-2 (with exemption for employers that issued fewer than 250 W-2s in the prior year or that contribute to a multiple employer plan continues for 2013 W-2). » Transitional reinsurance fee: Due in January 2015. Employers will not need to meet the following requirements for 2014: » Offer minimum essential coverage to 95 percent of full-time employees. » Offer minimum value (60 percent) coverage to full-time employees. » Offer affordable (less than 9.5 percent of income) coverage to fulltime employees. » Consider employees who average 30 or more hours per week full-time for health plan purposes. » Count employee hours to determine whether they average 30 or more hours work per week. Still confused? Wondering where to go from here? One recommendation is don't do this alone. Get some expert help, either from an attorney, consultant or your insurance broker. Understanding 20,000 pages of regulations – and how you need to comply with the law – is cause for anyone to be confused. Manage your confusion by relying on the experts. Mary Felton is founder and president of HR Business Partners, which works with all human resource needs, such as compliance, handbooks, recruiting, training and employee relations. Contact Mary Felton at mfelton@ hrbusinesspartnersllc.com or visit www. hrbusinesspartnersllc.com. w w w.in s i g h t o n m f g .c o m