Changes that Apply to your Health Care Coverage

  • Employees should receive information from their employers about the Exchange starting October 1, 2013.

Changes that Apply to Groups Under 50

  • FSA Contribution limits are limited to $2500 per year
  • Medicare payroll tax increase of .09% goes into effect
  • A notice must be sent to all employees informing them of the Exchange by October 1, 2013
  • Open enrollment begins in October for the Exchange

Changes that Apply to Groups Over 50

  • FSA Contribution limits are limited to $2500 per year
  • Medicare payroll tax increase of .09% goes into effect
  • A notice must be sent to all employees informing them of the Exchange by October 1, 2013
  • Employers must report employer sponsored health coverage costs on 2012 W-2s if they file 250 or more W-2s

President Obama eliminates the Affordable Care Act’s annual limitation on deductibles for non-grandfathered plans in the small group market, effective retroactively to 2010.

  • Those limits were set at $2,000 for self-only coverage and $4,000 for other than self-only coverage for plan years beginning in 2014; however, certain small group plans were allowed to exceed the limits if necessary to reach a given level of coverage, or metal tier

The annual limitation on out-of-pocket expenses for non-grandfathered group plans was not eliminated and remains in effect

  • Annual out-of-pocket expenses (including coinsurance and copayments, but not premiums) for a plan year beginning in 2014 may not exceed $6,350 for self-only coverage or $12,700 for other than self-only coverage. For 2015, these limits increase to $6,600 and $13,200, respectively.
  • Certain small businesses may be allowed to renew existing group coverage that does not comply with the annual limits on out-of-pocket expenses through policy years beginning on or before October 1, 2016. Not all states and insurers will permit coverage to renew. Businesses that are eligible to continue existing coverage will receive a notice from their insurance companies for each policy year.

Changes that Apply to your Health Care Coverage

  • SHOP Exchanges go into effect for small employers and individuals
  • All insurance plans must include ten Essential Health Benefits
  • All insurance plans will be offered on a guaranteed-issue basis without any pre-existing limitations
  • Small employers and Individual plans will be subject to community rates based on age, location and tobacco
  • Individual mandate to have health insurance goes into effect
  • Dental and vision coverage is not a required benefit that employers must offer under ACA. Medical will be the only benefit that is required and only if you have 50 or more full-time employees or full-time equivalents. HOWEVER, PLEASE NOTE, that oral and vision care coverage are listed as Essential Health Benefits for children under your medical plan

Changes that Apply to Groups Under 50

  • SHOP Exchanges go into effect for small employers and individuals
  • The tax credit is worth up to 50% of your contribution toward employees’ premium costs (up to 35% for tax-exempt employers)
  • The credit is available only if you get coverage through the SHOP Marketplace
  • Small employers and individual plans will be subject to community rates based on age, location and tobacco
  • Premium taxes and fees will take effect and begin appearing on health plan bills in January
  • Dental and vision coverage is not a required benefit that employers must offer under ACA. Medical will be the only benefit that is required and only if you have 50 or more full-time employees or full-time equivalents. HOWEVER, PLEASE NOTE, that oral and vision care coverage are listed as Essential Health Benefits for children under your medical plan

Changes that Apply to Groups Over 50

  • Update: Announced January 9th, 2014, the Obama Administration delayed the Employer Mandate (Large Employer) until January 1st, 2016 – Please Visit the 2015 & 2016 Timeline for more information!
  • Premium taxes and fees will take effect and begin appearing on health plan bills in January

Final Rule Regarding ACA 90-Day Waiting Period Limitation

  • The final regulations require that no group health plan or group health insurance issuer impose a waiting period that exceeds 90 days after an employee is otherwise eligible for coverage. The rules do not require coverage be offered to any particular individual or class of individuals. To ensure that eligibility conditions based solely on the passage of time are not used to evade the waiting period limit, the rules state that such conditions cannot exceed 90 days. Other conditions for eligibility are generally permissible, such as meeting certain sales goals, earning a certain level of commission, or successfully completing an orientation period

Changes that Apply to Groups Over 50

  • Update: Announced January 9th, 2014, the Obama Administration delayed the Employer Mandate (Large Employer) until January 1st, 2015.
  • What Was Delayed?: For employers with 100+ Full Time Employees (FTEs) or equivalents, the entire mandate is delayed until January 1st, 2015 or for non-calendar year plans (and meet certain criteria) first day of the sponsor’s 2015 plan year – numerous requirements apply in order to qualify for the delay.

Changes that Apply to Groups Over 50

  • Update: Announced January 9th, 2014, the Obama Administration delayed the Employer Mandate (Large Employer) until January 1st, 2016.
  • What Was Delayed?: For employers with 50 – 99 Full Time Employees (FTEs) or equivalents, the entire mandate is delayed until January 1st, 2016 or for non-calendar year plans (and meet certain criteria) first day of the sponsor’s 2016 plan year – numerous requirements apply in order to qualify for the delay.

Changes that Apply to Groups Over 50

  • States may elect to allow large employers into the SHOP Exchange

Changes that Apply to Groups Over 50

  • The “Cadillac tax” on high cost insurance plans goes into effect

Disclaimer: This material is intended to be informational and does not constitute legal advice regarding any specific situation. We hope you find this information helpful. If you have any questions, please feel free to contact us at benefits@eESIpeo.com. Revised 04.03.2014.