HealthCare Reform . . . Where are we so far?

What has already gone into effect?

  • Small Business Tax Credit applies to plans effective on or after January 1, 2010.  On the surface, the law is for employers with fewer than 25 "Full Time Equivalent" employees and average wages of $50,000 or less.  In reality, the full 35% credit (25% Non-profit) applies to up to 10 "Full Time Equivalent" employees with average wages of $25,000.  “Full Time Equivalent” (FTE) means employees working 30 hours or more per week and excludes 2% owners, sole proprietors, partners, and anyone who owns more than 5% of any other business.  The credit applies only to employers who pay a “uniform percent” of not less than 50% of the employee only coverage.

*After 2014, this credit only applies to those in the “Exchange”

  • Coverage for adult children up to age 26 applies to plans effective on or after September 23, 2010.  Plans renewing after this date must allow adult children under 26 years old up to 30 days to join the plan, regardless of whether they are employed, dependent, students, or married. To qualify, they must not have access to another employer-sponsored plan (in 2014, this requirement will no longer apply).
  • W-2 reporting of the employer portion of insurance premiums for medical, prescription drug, Health Reimbursement Arrangements (HRAs), Executive physicals, On-Site Clinics, Medical Supplement and Employee Assistance plans. (2011)
  • After January 1, 2011, FSA, H.S.A., and HRA funds will not cover over the counter medications unless prescribed by a physician.  H.S.A. penalty from goes from 10% to 20% for non-qualified withdrawals. (2011)
  • Coverage changes.  No lifetime coverage limits, no annual limits on certain types of benefits, 100% coverage for certain “in network” preventative care services, no pre-existing condition limitations for children under 19, mandatory coverage of emergency services, when required - selection of any primary care physician. (2010)
  • Internal and external claims appeal process and notice to employees. We have not seen the required notice as of this date, but expect that the insurance companies will provide/take care of this. (2010)
  • Early retiree reinsurance program, operational as of June 29, 2010.  $5 Billion to help reinsure retirement plans.
  • Temporary high-risk pool, operational as of July 1, 2010.  This is for US Citizens who have not had coverage due to a pre-existing condition for 6 months.
  • Small Group Wellness Program Grants.  $200 million in funding for fiscal years 2011-15. (10/1/2010)

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