Map of State Exchanges Status – July 2011
Contraceptives Free Next Year
Under Health-Care Reform Insurance Coverage for Contraception Is Required – NYT; The Health Resources and Services Administration (HRSA), an arm of HHS, developed the women’s services package to implement the preventive health services provisions of the Patient Protection and Affordable Care Act of 2010 (PPACA).
Federal recommended that major medical plans should include coverage for:
- well-woman visits
- contraception
- screening for the viruses that cause AIDS and human papillomavirus
- breast-feeding support in the basic package of preventive health services benefits.
Health plans must roll this out by Aug 1, 2012. These are in accordance with the preventive care provisions enacted in the Reform Law. Agencies are determining what falls into this category and have amended this provision, see here. While states such as NY already have these benefits built into their plan at no charge the medications are presently not free.
The contraception coverage requirement applies to drugs and devices approved by the federal Food and Drug Administration.
Exemption to religious organizations will be made available. This can be done at renewal time by groups’ broker. Unfortunately, non group individual policies will not allow for this exemption.
While this is a noble reccomendation, this is not as significant to NY and neighboring states. Some argue that the costs will indeed rise even in our region since the Rx will be free. Also, some consumers who currently purchasing supplies over the counter will tap into this free benefit.
Conclusion, not exactly a cost cutting decision as promised by the President to lower medical expenses but he did win over half the voters in time for next election!
The Employer Mandate under Patient Protection & Affordable Care Act (PPACA)
Larger employers that don’t offer minimum essential health coverage to full-time workers may face penalties under health care reform if any full-time employees receive a government premium credit or subsidy to buy their own insurance through an exchange.
The so-called employer mandate and the health insurance exchanges both go into effect in 2014 under the Patient Protection and Affordable Care Act.
The penalties generally apply to all employers with 50 or more full-time equivalent employees. An employer with at least 50 FTEs that provides access to coverage but fails to meet certain requirements, outlined below, may also be subject to a penalty.
To determine the FTE (Full Time Equivalent) you must count FT and PT employees. Full Time Employees are those working 30 hours+/week. See blog post “What does FTE mean?”
Affordability of the employer plan remains a consideration, however, since just one employee qualifying for federal premium assistance for exchange coverage will trigger a penalty for employers with 50 or more employees
Minimum essential coverage generally includes any coverage offered in the small or large group markets. Excepted benefits, such as limited-scope dental or vision offered under a separate policy, certificate or contract of insurance and Medicare supplemental plans, do not qualify.
Penalties explained
Starting in 2014, large employers that don’t offer coverage face a penalty of $2,000 per full-time employee (excluding the first 30) if at least one FTE receives a government subsidy to buy coverage on an exchange. This is sometimes referred to as the “play or pay” penalty.
Employers that offer coverage to employees may still face a “free rider” penalty if the coverage offered is deemed unaffordable or low in value.
If an employer offers coverage, but a full-time employee receives a premium credit subsidy through an exchange, the employer must pay an assessment equal to the lesser of:
- $3,000 for each employee that receives a subsidy
- $2,000 for each full-time employee after the first 30
The monetary penalties listed above are annual figures and may be pro-rated to the number of months for which the penalty applies.
Who’s eligible for a subsidy?
Employees who are offered coverage from their employer could be eligible for subsidies on the exchange if they don’t qualify for Medicaid or other programs, are not enrolled in their employer’s coverage and meet either of the following conditions:
- The employee’s share of the premium exceeds 9.5 percent of their household income
- The plan pays for less than 60 percent on average of covered health care expenses (e.g. coverage offered does not have at least a 60-percent actuarial value).
After 2014, penalty amounts are indexed by a premium adjustment percentage for the calendar year.
The Congressional Budget Office expects the penalties to generate $52 billion toward the overall cost of health reform by 2019. The Department of Health and Human Services estimates that fewer than 2 percent of large American employers will have to pay the assessments.
Disclaimer: This blog is not intended to represent legal advise and one should consult with a tax and/or legal expert.