The implementation of the various aspects Health Care Reform continues on. Some significant parts of the law have taken effect recently or will be coming soon, including:
The Employer Mandate Employers must offer health coverage to full-time employees and their children up to age 26 or face penalties. This is known as the employer mandate. Beginning in 2015, employers with 100 or more full-time employees must offer health benefits to full-time employees and their children up to age 26. The coverage must be “affordable” and provide “minimum value.” (“Affordable” means that the employee-only contribution for the lowest-cost plan must be lower than approximately $90 per month. • “Minimum value” means that the plan pays for at least 60% of allowed charges for covered services.)
The University’s health plan coverage complies with the employer mandate.
The Individual Mandate A new requirement called the individual mandate took 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 Health Insurance Marketplaces, or Exchanges as they are also sometimes called, opened in all states on October 1, 2013. Marketplaces are 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.
The Exchange Marketplace Notice In the fall of 2013, we provided you with a notice that provided information about the new Health Insurance Marketplace. This notice explained the new Marketplace and provided information about how you can learn more. We will continue to provide this notice to new employees as required by the health care reform law. To view the Department of Labor–New Health Insurance Marketplace Coverage Options and Your Health Coverage notice, please click here.
Essential Health Benefits 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. 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
Taxes and Fees There are a number of new taxes and fees imposed 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.We will continue to keep you posted as additional aspects of health care reform take effect. For more information, please visit www.healthcare.gov.