The Department of Labor’s Patient Protection and Affordable Care Act (PPACA) has many aspects that affect employers and employees. Some rules went into effect in 2012, while others have been delayed to 2015 and beyond. Here are 5 quick items every employer should be mindful of midway through 2013:
1. Individual Mandate – Beginning January 1, 2014 every person must obtain minimum essential coverage or pay a penalty. The penalty is the greater of $95 or 1% of household income for 2014, but increases to $325 or 2% in 2015 and $695 or 2.5% in 2016.
2. Mandatory Notice – Open enrollment with state exchanges begins October 1, 2013 for plans effective January 1, 2014. Every employer must distribute the “Notice to Employees of Coverage Options under Fair Labor Standards Act” by October 1, 2013. More information, including model notices, can be found at here. (Xenium will be providing notices to our clients participating in our benefits administration programs.)
3. Premium Credits & Subsidies – Individuals with a household income between 100% and 400% of the Federal Poverty Level who are not eligible for affordable healthcare that meets minimum essentials benefits through their employer may apply for coverage through a local exchange. The government will provide either premium credits and/or subsidies depending on where household income falls. For Oregon residents, Cover Oregon will assist individuals to determine if they qualify.
4. Waiting Period Limitation – Beginning with group renewals in 2014, all health insurance plans must limit the waiting period to not exceed 90 calendar days. This means if your employees currently become effective the first of the month following 90 days of employment, your plan must be amended to at least the first of the month following 60 days to meet this new rule.
5. Deductible Limits – Beginning with group renewals in 2014, non-grandfathered small group health plans must limit their annual deductibles to not exceed $2,000 for single coverage and $4,000 for coverage with dependents.