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What To Do Now? Re-forming What We Know About Health Care Reform

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Category: CDHC, Compliance and Regulatory, DOL, Health Care Reform, PPACA,


By Justyn Harkin, Communications Specialist, The Jellyvision Lab

Wow, did someone get the license number from that truck? My head is spinning. I mean, one moment I was just minding my own business, peacefully thinking about clever ways to explain coverage options to employees, and the next—major changes to key provisions of the ACA!

Well, I guess that means it’s time to re-form what I thought I knew about health care reform. Let’s see what that means now with a quick review.

The one-year employer mandate penalty mulligan

Let’s start with the employer mandate, because this is the biggest ACA development so far. Here’s what happened in a nutshell—On July 3, Department of the Treasury Assistant Secretary for Tax Policy Mark J. Mazur announced that the administration would be postponing the employer mandate penalty for one year.

Instead of having to face fines for not providing health insurance to employees in 2014, companies with more than 50 employees have an extra year to figure things out. In other words, they are not under the same pressures to provide health insurance to all employees as they were before.

It boils down to reporting requirements

According to Mazur, the administration is responding to concerns about the ACA’s employer and insurer reporting requirements. The extra year provides time for everyone to work out the kinks in what could be a very complicated system.

Oh, and while we’re on the topic of reporting requirements—consumers will be facing significantly fewer checks (basically, it’s the honor system) of their income and health insurance status when applying for federal tax subsidies to help buy insurance on the health insurance marketplaces.

Many consumer-facing provisions of the law remain unchanged

Yes, the employer mandate delay is a major change, but key components of the law are going forward as planned. At least they are right now. Just work with me on this one.

The point is, many consumer- or employee-facing provisions are still in effect. The following, for instance, have not been changed at all:

  • Individual mandate
  • Guaranteed issue
  • Notification of coverage options before October 1
  • Exchanges going live on October 1
  • Subsidy eligibility rules
  • Medicaid expansion

And if Your Company Is Self-Insured…

Despite all the reprieves and push-backs in other areas, the $63 per covered member per year re-insurance fee looks like it will remain in place for all group plans.

Don’t forget about the notification of coverage options!

Regardless of what your company plans to do during the “transition year,” you still have to inform your employees—and that’s all employees, including full-timers and part-timers—that they have the option to buy health insurance coverage from the marketplaces at the start of 2014.

In addition to having to explain how the marketplaces function, you’ll have to cover things like premium tax credit eligibility and the fact that the company doesn’t make contributions to plans purchased on the marketplace.

If you haven’t already started crafting language yet, you can check out the following links. Right now there are two different versions of the language:

Model for employers who offer health plans to some or all employees
Model for employers who do not offer health plans

Remember, the deadline for getting this information out is October 1, 2013. That’s just around the corner. After October, employers are required to provide notification of coverage options to all new employees within 14 days of their hire date.

Keep employees in the loop.

Yes, there have been some major changes to what we all though was going to happen, and yes, it’s quite possible that still more changes are coming down the road, but no matter what happens next, your employees will be looking to you for information about things like the individual mandate, health insurance marketplaces, subsidies, and Medicaid.

Avoid the temptation to “wait and see” when it comes to your health reform communication. You don’t have to delay a message in order to get the information right. Rather, keep the stream of information steady. Share what you know as soon as you know, and provide updates swiftly if something should happen to change.

The key is going to involve more communication, not less, so be ready to re-form reform messaging in order to keep employees up to date and in the loop.

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