March 13, 2018

The Patient Protection and Affordable Care Act: Top Ten Things Employers Need to Know NOW

1. Some changes are already in effect!

The changes under this bill are implemented over a number of years, but some have already started to take effect! It is important that you get up to speed as soon as you can.

2. Small Employer Tax Credit Available

If you have 25 or fewer full-time equivalent employees, you may be eligible for a tax credit of up to 35 percent of employer paid insurance premiums. The credits work on a sliding scale. The fewer employees a business has, the larger the percent credit.

3. Continuous Coverage for Adult Children until Age 26

Under the new plan, dependent adult children must be covered, regardless of the child’s marital status, until age 26. However, grandfathered plans do not need to cover these dependents until 2014 if the dependent is eligible to be covered under another plan.

4. No More Pre-Existing Condition Exclusions

Beginning September 23, 2010, no pre-existing condition exclusions may be imposed for children under the age of 19. This is extended to insureds of any age beginning January 1, 2014.

5. Big Changes to FSA Policies

Beginning in 2011, Flexible Spending Accounts (FSAs) will no longer reimburse for any over the counter medications, unless prescribed by a doctor. In addition, effective 2013, the cap on FSA contributions is limited to $2,500.

6. New W-2 Reporting Obligations

Employers must include the value of the benefit provided by the employer for each employee’s health insurance coverage on the employee’s W-2.

7. No Annual or Lifetime Limits Permitted

Commencing September 23, 2010, insurance companies may not impose annual or lifetime dollar limits on essential health benefits. Essential health benefits include emergency care, hostpitalization, maternity/newborn care, preventative/wellness services, prescription drugs, mental health and substance abuse services, pediatric care, and other basic benefits.

8. $5 Billion Reinsurance Program for Early Retirees

The new bill creates a $5 billion fund to finance a temporary program for employers providing insurance to retirees over 55 years old who are not eligible for Medicare.

9. Rescission of Coverage Prohibited

Beginning September 23, 2010, rescission of coverage is prohibited, except in cases of fraud or intentional misrepresentation, where advance notice is required.

10. Uniform Summary of Benefits

By March 23, 2012, all group health plans must provide a uniform summary of benefits to participants for fully insured plans.

For a summary of all provisions of the new law, see this handy flow chart, available here, or contact us should you have any specific questions.

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