Issue link: http://www.insightdigital.biz/i/201303
insight on HEALTH CARE By Mar y Felton Understanding compliance Businesses still need to take action on some provisions of health care reform A CA, PPACA or Obamacare? Confused? What is this all about? We've all heard the acronyms or terms. We may not know what each stands for, but it is something we all need to pay close attention to. The Affordable Care Act (ACA), Patient Protection Affordable Care Act (PPACA), or "Obamacare," is reshaping the benefits world. The law is so vast and has so many provisions written into it, and employers are struggling to stay on top. With more than 20,000 pages of regulations, it's no wonder this is happening. Implementing the provisions of the ACA is extremely complex compared to almost any other piece of legislation ever written before. The primary goal of the ACA is to reduce the number of uninsured Americans. Under the provisions of the law, any employer with 50 or more fulltime or full-time equivalent employees must choose between providing affordable health insurance coverage to qualifying employees or pay a penalty. All of the provisions of the ACA are to go into effect on Jan. 1. However, because of the vehement complaints from employer groups about the administrative burden of reporting requirements, as well as the confusion over the provisions of the law, the Obama Administration has postponed the Affordable Care Act employer mandate penalties for one year, until Jan. 1, 2015. The Department of the Treasury announced the delay on July 2, along with a similar delay for 34 | Insight • N o v e m b e r 2 013 The primary goal of the ACA is to reduce the number of uninsured Americans. Under the provision of the law, any employer with 50 or more full-time or full-time equivalent employees must choose between providing affordable health insurance coverage to qualifying employees or pay a penalty. –Mary Felton, founder and president of HR Business Partners information reporting by employers, health insurance issuers and self-funded plan sponsors. Even though this news may cause you to breathe a sigh of relief, realize there are some provisions that have not been postponed – and are still scheduled to go into effect at the start of the 2014 plan year with penalties of up to $100 per person, per day for non-compliance. Employers designing a health plan must include the following provisions: » Waiting periods cannot be more than 90 days from the date the employee becomes eligible. » All pre-existing condition limitations must be removed. » Out-of-pocket maximum: Individual $6,350, family $12,700. » Essential health benefits may not have annual 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 a child has access to employer-provided coverage). » The new wellness program requirements still apply. For small employer insurance plans, or those with 49 or fewer employees (whether in or out of exchange/marketplace): • overage must include essential C health benefits at bronze, silver, gold or platinum level. w w w. i n s i g h t o n b u s i n e s s . c o m