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The Patient Protection and Affordable Care Act (Healthcare Reform)

The Act was signed on March 23, 2010 and covers a broad spectrum of changes affecting employers and individuals. This Act will affect your next plan renewal.  Employers with self insured plans must pay special attention to the new rules.

HR Service Team

We are HR professionals who happen to be Insurance Geeks - a rare commodity.  As insurance agents (brokers) we are helping our clients ensure reform compliance by providing them the opportunity for a "no charge" benefit plan audit.  Our Company thrives on providing our clients with value-added services.  The benefit audit is just one example of the many services we provide at no additional cost.   

Healthcare Reform Timeline  

 A timeline of the key changes that affect Employer Group plans is outlined below. Some plans may be able to receive "grandfathered" status. Key plan documents will have to be updated.  HR Service Team can help you navigate through the changes. 

2010 Changes - Affect plans that renew after 9/23/2010 
  • No lifetime maximums
  • Restricted annual maximums (to be defined by the Department of Health and Human Services (HHS) by September 23, 2010).
  • No pre-existing conditions on dependents below age 19
  • Extension of dependent coverage for married and unmarried adult children up to age 26 (with corresponding tax exclusion for adult children).
  • Insured plans subject to medical loss ratio rules (85% large group; 80% small group) and rebates.
  • Eliminates co-payments and deductibles for preventive care for new plans (beginning in 2018, this requirement applies to all plans).
  • OB/GYN, Pediatrician and ER Services preauthorization or referral requirements prohibited.
  • New rules prohibiting discrimination in favor of highly compensated employees (105(h) rules now apply for fully insured plans).
  • Tax credit for some small employer
  • Creation of a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare (effective June 23, 2010 until January 1, 2014).
  • Prohibition on rescission
2011 Changes 
  • Establishment of a national, voluntary insurance program for purchasing long-term care insurance (CLASS Act), employers must allow contributions to be made through payroll deductions.
  • Employers must disclose value of health plans (health, dental, vision) to employees on W2 forms (costs will be similar to COBRA premium less administrative fee).
  • Increase from 10% to 20% tax on non-qualified Health Saving Accounts and Medical Savings Account distributions.
  • No over-the-counter (OTC) medication reimbursements for Flexible Spending Account, Health Reimbursement Account, and Health Savings Account.
  • Wellness grants for up to five years for small employers that establish wellness programs. 
2012 Changes
  • Covered employers must submit reports on the quality of care in their health plans to the HHS.
  • Employers must distribute Uniform Summary of Benefits based on standards developed by HHS for all plans by March 23, 2012.
  • Establishment of simple cafeteria plans for small businesses
  2013 Changes 
  • Limits on Flexible Spending Account contributions to $2,500, indexed to CPU (Consumer Price Index)
  • Medicare payroll tax increase from 1.45% to 2.35% for individuals earning $200,000 and families earning $250,000/year
  • 3.8% tax on some investments income for individuals above certain income levels
  • Eliminates Retiree Drug Subsidy deduction for expenses allocable to Medicare Part D for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.
2014 Changes
  • Annual dollar limits are prohibited
  • Pre-existing condition exclusions prohibited for all enrollees
  • Pay or play penalties on employers with more than 50 fulltime employees (FTEs) if the employer does not offer health coverage and has at least one FTE receiving a subsidy for healthcare coverage. Other penalties apply to employers who offer healthcare coverage if at least one FTE receives a subsidy.
  • Minimum essential coverage for all plan designs offered by employers with more than 50 FTEs.
  • Large group reporting of "minimum essential coverage" to the Secretary regarding whether it offers to its fulltime employees (and their dependents) the opportunity to enroll in minimum essential overage under the employer-sponsored plan, the length of any applicable waiting period, the lowest cost option in each of the enrollment categories under the plan, and the employer's share of the total allowed costs of benefits provided under the plan.
  • Employee "Free-Choice" voucher for exchange
  • Auto enrollment required for employers having over 200 employees
  • Waiting periods over 90 days no longer permitted
  • State health insurance exchanges established
  • Minimum Value of Employer Coverage - if the actuarial value of the plan is below 60%, employees under 400% of the federal poverty level are eligible for subsidized Exchange coverage. If elected, employer is assessed the play and pay penalty.
  • Codifies HIPAA Wellness incentives, but with a maximum differential of 30%; Secretary can raise to 50%.
2018 Changes
  • High-cost insurance excise tax (Cadillac tax) established
Special Note: Collective bargaining agreements for multi or single employer plans in effect on March 23, 2010 are not subject to the reform law rules until the date on which the last bargaining agreements related to coverage terminates. 

Benefit Plan Renewal

HR Service Team is different from other brokers. We bring human resource and insurance experience into the broker relationship. The Patient Protection and Affordable Care Act (Healthcare Reform) will add extra complexity to your next plan renewal. We offer our clients a "no cost" benefit audit to help them ensure compliance.   We pride ourselves on finding the best plans and negotiating the best rates for our clients.

 Insurance agents (brokers) are just that - an agent, they have not worked as a HR professional.    Our HR experience allows us to close the gaps that an insurance agent simply cannot provide . Once the HR Service Team has found the benefit plan that is right for you, we will put our plan management skills into action for you.  We will perform an administrative services review, to establish a baseline for future work. From there we will help you with branding your benefit offerings, prepare you fully for open enrollment, and provide ongoing benefit administration assistance.

Included in our benefit package is the HR Backstop service. This service assigns you a designated HR Consultant. Whenever you have an HR question your assigned consultant will be there to assist you. Whether it’s an employee relations question, a staffing problem, or just a new idea to discuss, you will always get the same consultant and that consultant will know you and your situation.

Highlights of our offerings are:

Benefit Plan Performance Evaluation

  • Market Trend Analysis
  • Plan Coverage -- Current and Proposed (Side-by-Side)
  • Cost Structure Analysis – Current and Proposed
  • Provider Network Analysis

Benefit Plan Administration Support

  • Benefit Branding Strategy
  • Administrative Services Review
  • Open Enrollment Assistance
  • Benefit Administration Assistance

HR Backstop; an HR Service Team exclusive

Our job does not stop once your Benefits Plan is in place. We remain your partner throughout the Plan year.