The Health Care Reform Law and You
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 major provisions, or rules of the law, take effect in 2014. Some things may affect you and your family while others may not. Our enrollment materials provide additional information that we hope you will find helpful.
Health Care Reform: 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.
- 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???During each year’s?enrollment, you will receive?a?Summary of Benefits and Coveragein 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:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse 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
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 careservices 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.
Choice of Doctor
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 Over the Counter (OTC) Drugs
You must have a prescription to pay for?most?over-the-counter drugsfrom 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 Accountis $2,500 per?year.
Health Savings Account?Penalty
If you use your?Health Savings Accountfor 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
What’s? Coming Next
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.
The Employer Mandate
Beginning in 2015, employers with 50 or more full-time employees, working 30 hours a week on average, or full-time equivalents may be subject to a penalty if they do not offer health coverage to full-time employees and their dependent children up to age 26. This is referred to as the?employer mandate.?The coverage must be ?affordable? and provide ?minimum value.?
- Affordable?means that the employee-only?contribution?for the lowest-cost plan is no?more than?9.5% of your W-2 wages.
- Minimum value?means that the?plan?pays for?at least 60% of?allowed charges for?covered services.
The Individual Mandate
A new requirement called the?individual mandateis 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 as they are also sometimes called, 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 will 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.
The Exchange Marketplace Notice
As required by the health care reform law, we will be providing you with a notice that provides information about the new Health Insurance Marketplace.?This notice explains the new Marketplace and provides information about how you can learn more.
Essential Health Benefits
Starting in 2014, group health plans sponsored by small employers with no more than 50 full-time employees are required to cover a set of ?essential health benefits.? Here are the 10 general categories:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse 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
Group health plans sponsored by larger employers with more than 50 full-time employees aren?t required to cover essential health benefits. However, anything on the list that’s included in the plan must be covered without annual or lifetime dollar limits.
Taxes and Fees
There are a number of new?taxes and feesimposed by the health care reform law. Some have already been implemented and more will take effect over the next year. From medical devices to brand-name drugs to insurance fees, you may be impacted directly or indirectly.
Benefit Changes for the 2014 Plan Year
What’s Changing for 2014
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??essential health benefits?each year.?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 annual or lifetime dollar limits on those benefits.
Essential Health Benefits – 10 General Categories:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance abuse 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
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.
