Large group health care reform
Health care reform impacts for employers with 51+ employees
From new provisions on Employer Shared Responsibility and policy effective dates, to grandfathering and taxes and fees, there is a lot to learn about how health care reform may affect your large business. Learn who needs to offer coverage, what are potential cost impacts, and how HAP is helping our business groups work with the new health care reform provisions.
Is our Group plan Grandfathered?
Group health plans and health insurance plans that were in place on March 23, 2010, when the PPACA was enacted, are called grandfathered plans and are exempt from some elements of the law. However, to maintain grandfathered status, a plan cannot reduce or eliminate benefits, increase employee cost-sharing above certain thresholds, or reduce the employer share of the premium payment. Once a plan loses its grandfathered status, it must comply with all applicable requirements of the law. It is the employer group’s responsibility to determine if the plan is grandfathered or not.
What taxes and fees apply to businesses with 51 or more eligible employees?
On January 1, 2014, major provisions of the Affordable Care Act (ACA) that expand access to health coverage for the uninsured took effect, along with new taxes and fees included in the law. The following taxes apply to businesses with over 50 eligible employees:
- Health Insurance Premium Tax – An excise tax assessed on all fully insured health plans to help fund the provisions of the ACA
- Transitional Reinsurance Program Fee– Funds a temporary program (2014-2016) intended to stabilize premiums for coverage in the individual market as high-risk individuals become newly insured; applies to fully insured and self-funded plans
- Patient Centered Outcomes Research Institute (PCORI) Fee – Funds the PCORI, which will produce and promote research on clinical effectiveness to help patients and their health care providers make more informed health care decisions; applies to fully insured and self-funded plans
- Health Insurance Claims Assessment Act (HICAA) Tax – A tax applied to certain health insurance claims paid for services provided on or after January 1, 2012; funds generated by the assessment will support Michigan’s Medicaid program; applies to fully insured and self-funded plans