Healthcare Reform Benefit Consultants Northwest Plan Administrator “ Knowledge is Power in Benefit Management ” Quality Service Integrity Knowledge Support

Healthcare Reform

Benefit Consultants Northwest

Plan Administrator

“ Knowledge is Power in Benefit Management ”

QualityServiceIntegrityKnowledgeSupport

Presented by:

Introducing

www.bcnw.com/getinformed

Call Center 866-422-3393


Table of Contents• Page 1 Small Business Tax credit• Page 2 2010 new taxes• Page 3 2011 new taxes• Page 4 2013 new taxes• Page 5 2014 new taxes• Page 6 Penalties• Page 7 What is in effect now• Page 8 Small Group• Page 9 Large Group• Page 10 Metallic Plans• Page 11 State Exchanges• Page 13 Essential Health Benefits


Healthcare Reform

The following organizations provided information for this presentation: Heritage Foundation Washington State OIC Healthcare.gov

NFIB NAHU HHS

PPACA was signed on Jan 5, 2010Supreme Court ruling June 28, 2012Timeline is found on www.bcnw.com/getinformed


What Were The New Taxes 2010

• 10% tax on Indoor Tanning Services $2.7 Billion

• Repeal special deductions for the Blues $ 400 Million

• Exclude Bio Fuel Producer Credit $24 Billion

• Increase corporation taxes by disallowing certain activities that lower tax liability

$4.5 Billion


Healthcare Reform


What Were The New Taxes 2011

• Impose annual fee on drug manufacturers $27 Billion

• Reduce allowable prescriptions allowed under HSA and FSA (OTC Drugs)

$5 Billion

• Increase penalty for HSA/FSA disallowed purchases from 10% to 20%

$1.4 Billion


Healthcare Reform


What Are The New Taxes 2013

• Increase payroll taxes plus investment income to AGI (2.9% to 3.8%)

$210 Billion

• 2.3% excise tax on medical devices $20 Billion

• Raise floor for medical deductions to 10% $15 Billion

• Eliminate corp deduction for retiree Rx $4.5 Billion

• Increase taxes on health insurance companies

$ 600 million


Healthcare Reform


What Are The New Taxes 2014

• Mandate coverage for individuals $65 Billion

• Annual fee on health insurance providers

$60 Billion

• Limit FSA to $2,500 $13 Billion

• 40% Tax on Cadillac health plans (2018) $32 Billion

• Total New Taxes over 10 years $503 Billion


Healthcare Reform


Penalties / Taxes• Mandate coverage for individuals in 2014 if

no coverage: tax is $95 or 1%, increases to $695 or 2.5% in 2016.

• Small Business (50 or less FTE) no mandate, but if you provide coverage must have the 10 Essential Health Benefits. (Bronze level plan)

• Large business (over 50 FTE). $40,000 plus $2,000 per employee over 50 if no coverage. If employer provides coverage it must cost the employee less than 9.5% of wages and be at least a Bronze level of benefits.


Healthcare Reform


What is in effect now?

• No out of pocket for Preventive• No lifetime caps• Must cover Child’s Pre-existing

condition• Children up to age 26 can stay on

parent’s plans• Small Business tax Credit• Federal medical loss ratio standards• Federal review of unreasonable rate

increases• Expanded coverage for early retirees


Healthcare Reform


Small Group Employers 50 FTE or Less

• Small Business Tax Credit• Limits on HSA/ FSA • No out of pocket for Preventive• No lifetime caps• Must cover Childs Pre-existing


parent’s plans• Federal medical loss ratio standards

80%• Emergency Services in and out of

network benefits must be the same


Healthcare Reform


Large Group 51 FTE or More• Mandate coverage at the Bronze level • No out of pocket for Preventive• No lifetime caps• Must cover Child’s Pre-existing


parent’s plans• Federal medical loss ratio standards

85%• Penalty approx $2,000 per employee

for no coverage• 40% tax on Cadillac Plans paid by

insurer/employer


Healthcare Reform


Metallic Plans

• Platinum 90% actuary value• Gold 80% actuary value• Silver 70% actuary value• Bronze 60% actuary value

• Actuary value means: The percentage the insurer is expected to pay in claims. The remainder is paid by the insured. On July 10, 2012 Jeff Roe, CEO of Lifewise Insurance, stated that most small business plans today are at the 40% to 45% actuary value.


Healthcare Reform


State Exchanges

• Each state will have an exchange, if states do not set one up the Feds will

• Web based site that will compare plans within a state

• Insurers must offer plans within and outside of the exchange

• Subsidies are received through the exchange

• Businesses can compare products through the Small Business Health Options Program (SHOP)

• Individuals can compare like products


Healthcare Reform


It is the law of the land

• In less than 18 months all Americans are required to have health insurance

• It is an individual mandate • Companies over 50 employees will be

fined if not offering insurance at the Bronze level

• States will have exchanges for you to shop for coverage

• BCNW and ASA will be there to help you through this transition of Healthcare Reform


Healthcare Reform

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Essential Health Benefits

• Ambulatory patient services• Emergency services• Hospitalization• Maternity and newborn care• Mental health and substance use disorder services,

including behavioral health treatment• Prescription drugs• Rehabilitative and habilitative services and devices• Laboratory services• Preventive and wellness services and chronic

disease management• Pediatric services, including oral and vision care


Healthcare Reform

Documents

Healthcare Reform Benefit Consultants Northwest Plan Administrator “ Knowledge is Power in Benefit Management ” Quality Service Integrity Knowledge Support