Issue link: https://www.e-digitaleditions.com/i/177159
The Employer Mandate continued • Small group market definition increases to businesses with up to 100 employees, making more businesses subject to the essential health benefits package and all other insurance market reforms. increases to $13.9 billion. • Individual mandate tax penalty is based on 2016 levels and will rise according to a cost-of-living adjustment. • States and the federal government may allow large employers with 100 or more employees to enter the SHOP exchange. 2017 drug tax rises to $3.5 bil- 2018 • Brand-name lion. • Cadillac tax begins on high-cost • Small business health insurance tax gate value that exceeds threshold amounts of $10,200 for individual coverage and $27,500 for family coverage. • Brand-name drug tax rises to $4.2 billion. • Small business health insurance tax rises to $14.3 billion. • Individual mandate tax penalty is based on 2016 levels and will rise according to a cost-of-living adjustment. K health insurance plans with an aggre- With the Employer Mandate on Hold, What's Still Required in 2014? The delay in the play or pay requirement, also known as the employer mandate, does not affect the insurance market reforms. This means that these requirements are still scheduled to go into effect as of the start of the 2014 plan year (with penalties of up to $100 per person per day for non-compliance). These requirements apply to all plans except as noted: 1. Waiting periods cannot be more than 90 days from the date the employee becomes eligible. 2. All pre-existing condition limitations must be removed. 3. The out-of-pocket maximum cannot exceed $6,350 for individual and $12,700 for family coverage for non-grandfathered plans. 4. Essential health benefits may not have annual dollar limits. 5. Grandfathered plans must cover dependent children to age 26 even if the child has access to his/her own employer-provided coverage. 6. New wellness program requirements will apply. 7. For non-grandfathered small insured plans, whether in or outside the exchange/marketplace, coverage must include the essential health benefits, at the bronze, silver, gold or platinum level, with a deductible in most situations of not more than $2,000 for individual and $4,000 for family coverage. 8. For small insured plans, whether in or outside the exchange/marketplace, modified community rating (rating classes are limited to age, tobacco use, family size and geographic area), guaranteed issue and guaranteed renewal (with some limitations) will apply. Employers also must meet these PPACA requirements: 1. Reporting and payment of the PCORI fee by July 31, 2013 for plans that ended Oct. 1, 2012 through Dec. 31, 2012. 2. Timely distribution of any MLR rebates the plan may receive. 3. Providing a Summary of Benefits and Coverage (SBC) as part of open enrollment (it is currently unclear whether employers will still need to report whether the plan provides minimum value or minimum essential coverage). 4. Distributing the DOL notice regarding the exchange by Oct. 1, 2013 (it is currently unclear whether the content of the notice will be changed because of the delayed application of affordability and minimum value requirements). 5. Reporting health care costs on the employee's W-2 (the exemption for employers that issued fewer than 250 W-2s in the prior year or that contribute to a multiple employer plan will continue for the 2013 W-2). 6. Paying the transitional reinsurance fee, due in January 2015. Source: Byrne, Byrne and Company 30 FEDA News & Views