With October 1st just past and January 1, 2014 right around the corner, a new wave of attention is being focused on health care reform, the Marketplaces, and the future of ACA. New options, new coverages, new eligibility rules, and sometimes misleading or half-truths in the media create uncertainty and confusion. Whatever your political leanings, the need to level set some basic information is key to setting a clear path and clearing through the clutter for your employees.
Whether your philosophy is to “inform and over-inform” or to “keep it to the bare facts,” I recommend implementing a robust communication plan. Not only will you be viewed as well-versed in these challenging topics, you will also be serving to reduce employee stress about the multitude of changes and choices that lie ahead. Consider communicating these topics the way you would ramp up communications for open enrollment. Create posters, emails and payroll stuffers by utilizing the language I’ve suggested below in part or in whole:
Health Care Reform Overview
The Health Care Reform law, officially known as the Patient Protection and Affordable Care Act, was signed by President Obama in March 2010. The law is intended to expand access to affordable quality health care for Americans.
The law will be implemented over a 10-year period. Several rules of the law take effect in 2014. Some things may affect you and your family while others may not.
What’s Taken Effect So Far?
Here is a quick review of what has taken effect so far as a result of the health care reform law. For more information, review the interactive timeline on www.healthcare.gov or visit this link.
• Children Covered to Age 26 – Your dependent children up to age 26 can be covered under your medical plan, even if they are married, not living with you or not financially dependent on you.
• Summary of Benefits and Coverage (SBC) and Uniform Glossary – During each year’s enrollment, you will receive a Summary of Benefits and Coverage in paper or electronic form with information about our plan in a standard format so you can compare our plan to other coverage such as your spouse’s plan.
• W-2 Reporting – Each January, we will report the total value of your medical plan for the previous year on your W-2 tax form. This is for your information only and does not affect your income or taxes.
• No Lifetime Maximum – There is no lifetime dollar limit on the amount your medical plan will pay for “essential health benefits.” This refers to a set of benefits including the 10 general categories listed below. All plans may not include or cover all of these categories. However, for those items that are included, that plan cannot place lifetime dollar limits on those benefits.
Essential Health Benefits 10 General Categories:
1. Ambulatory patient services
2. Emergency services
4. Maternity and newborn care
5. Mental health and substance abuse disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care
• Additional Medicare Taxes – Individuals earning more than $200,000 and couples earning more than $250,000 began paying additional Medicare taxes in 2013.
• Preventive Care – Preventive care services like annual physicals and immunizations are covered at no additional cost to you. Effective August 1, 2012, non-grandfathered plans were required to cover additional women’s preventive services with no coinsurance, copays or deductibles, including certain health screenings, breast-feeding equipment and supplies, and contraceptives.
• Doctor Choice – If your plan requires you to choose a primary care doctor, you can select a general practitioner, family practitioner, internal medicine specialist or pediatrician. Women can also visit an obstetrician/gynecologist without a referral.
• Emergency Care – Emergency room services from any hospital are paid at the in-network level – even if the hospital isn’t in our plan’s network.
• Prescriptions for OTC Drugs – You must have a prescription to pay for most over-the-counter drugs from a Health Savings Account, Health Reimbursement Account or Flexible Spending Account.
• Flexible Spending Account Annual Contributions – The maximum amount you can contribute to a Health Care Flexible Spending Account is $2,500 per year.
• Health Savings Account Penalty – If you use your Health Savings Account for purchases not listed as eligible health care expenses under the federal tax code, you will pay a 20% penalty on those purchases.
Health Care Reform in 2014 and Beyond
You may have read or heard about some of the health care reform rules coming in the future. From the new Health Insurance Marketplaces to new requirements for having medical coverage, some significant parts of the law are taking effect in the coming months. To understand how health care reform may or may not impact you and your family, consider visiting www.healthcare.gov for more information.
The Individual Mandate
A new requirement called the individual mandate is taking effect on January 1, 2014. All U.S. citizens and legal residents, with a few exceptions, are required to have “minimum essential coverage.” Coverage under one of our medical plans will satisfy this requirement. Other types of coverage that meet the individual mandate include plans provided by another employer, Medicare, Medicaid or individual health insurance.
The Exchange Marketplace
You may have heard about Health Insurance Marketplaces, or Exchanges, that all states are scheduled to open this fall. Marketplaces are being developed as new options where people can compare and purchase standard health insurance plans.
Federal subsidies may be available to assist low to moderate income individuals in paying the premium for health insurance purchased through the new Health Insurance Marketplaces. Eligibility for a subsidy is based on income. However, individuals who are eligible for employer-sponsored coverage that is “affordable” and provides “minimum value” are not eligible for the subsidy.
Coverage under policies purchased through the Marketplace can begin as early as January 1, 2014, and individuals can start enrolling on October 1, 2013. Connecticut’s Marketplace is AccessHealthCT www.accesshealthct.com
The Exchange Marketplace Notice
As required by the health care reform law, we will be providing/have provided you with a notice that contains information about the new Health Insurance Marketplace.
There are several reform-related benefit changes taking effect in 2014, including:
• No Pre-existing Condition Limits – No one will be denied coverage based on a pre-existing condition.
• No Annual Dollar Limits – There are no annual dollar limits on the amount our plan will pay for each year.
• Coverage Waiting Period – The waiting period before coverage begins will not be more than 90 days.
• Coverage for Clinical Trials – If you participate in a clinical trial, our plan will cover routine patient costs for care you receive as part of the clinical trial.
My hope in providing you the information above is to arm you with the most important information that you should be communicating with your employees, in language that is easily understandable. Your goal as an advisor for your employees is to clear through the clutter for them, and give them the best information possible so that they can be educated consumers of their health care. If you utilize the above content in a well thought-out communication plan, you deliver it in bite sized, easily understandable pieces, and you do it consistently, then the visits to your office should dwindle.
This post is for general informational purposes only and is not intended for and should not be used as legal or tax advice. While we have attempted to provide current and accurate information, users should seek professional advice from their legal, tax and benefit plan advisors.