Health Care Reform: Tools,
Techniques and Alternatives
Cammie Scott
MSIE, LUTCF, RHU, REBC, CLTC, ChHC, SPHR
CK Harp & Associates
479-750-4411
The things kids say
Employer Requirements
• 50 or more FTEs must offer coverage or
pay a penalty
– This is not full time employees, but Full Time
Equivalents
– Must meet minimum value – 60% - an
actuarial value
– Must meet affordability guidelines – 9.5% of
box 1 W-2
Your Friends at the IRS
• IRS 4980h Regulations
– http://www.gpo.gov/fdsys/pkg/USCOD
E-2011-title26/pdf/USCODE-2011title26-subtitleD-chap43sec4980H.pdf
– Shared Responsibility for Employers
Regarding Health Coverage
• Full time employee 30 hours/week
• Hours of service
Who gets benefits?
• Variable hour employees
– Seasonal workers – retail,
golf courses, landscaping
companies, snow removal,
PRN employees in
medical or banking
• Notice 2012-58
– Safe harbor methods
• 12 month look back
period
Who is a variable hour employee?
An employee is a variable hour employee if,
based on the facts and circumstances at
the date the employee begins providing
services to the employer (the start date), it
cannot be determined that the employee is
reasonably expected to work on average
at least 30 hours per week.
New Terms
• Initial Measurement Period
– For new variable hour employees
– At least 3 months not more than 12 months
• Initial Stability Period
– For new employees who have completed their
measurement period
– At least 6 months, but not less than the measurement
period
• Ongoing Measurement Period
– Completed at least one “Standard Measurement
Period”
Take Aways
• Evaluate your workforce
– Safe Harbor - Offer coverage to 95% of
eligible employees or pay a penalty
• Who is full time
• Who is part time
• Who is benefit eligible
– Evaluate your systems – what about time and
attendance software
– Document decisions
• Prepare as if you are preparing for an audit
HealthCare.gov
roving
Marketplace
Health Insurance Marketplace online application isn't available from approximately 1 a.m. to 5 a.m. EST daily while we make improvements. Additional do
• Supposed start enrolling people October
1, 2013
• Lots of problems
• President had no idea
• Sebelius called to Congress
• Lots of confusion
Notices
• Employers subject to FLSA
• Model Exchange Notice to all existing employees
by October 1, 2013
• All new employees at the time of hiring
• Must tell the following:
– Description of the Exchange, the services they provide
and who to contact for additional information
– If the plan offered meets the minimum value
requirements
– Model notices posted with this material
Confusion
• Affordability – based on employee’s box 1 W-2 income for
the lowest cost plan for individual coverage
– If the employer offers affordable coverage that meets
the minimum value then neither they nor their family are
eligible for a subsidy
• UNLESS
– Medicaid – based on family income, not just employee
income
Quick Check Chart
Do I qualify to save on health insurance
coverage?
How do I apply?
1.
2.
3.
4.
Online
Paper
Phone
In Person
Online Process
Online –
• Set up an account
• Fill out the online application
• Compare your options
• Enroll after you choose your plan.
Process
Paper –
• Fill out a paper application and mail it in.
• Get a determination letter/notice
• Go online to compare, choose and enroll in a plan or contact the call
center and a customer service representative will help you.
• If you or someone on your application are eligible for Medicaid or
CHIP, a representative will contact you to enroll.
• Get the paper application on line at healthcare.gov or call and have
one mailed to you
• http://marketplace.cms.gove/getofficialresources/publications-andarticles/marketplace-application-for-family-instructions.pdf
Phone Process
• 1-800-318-2596, 24 hours a day, 7
days a week (TTY: 1-855-889-4325).
– A customer representative will work with
you to complete the application and
enrollment process.
– Many of them are using the same on line
system and you must wait for your
eligibility determination.
Process
In Person –
• Most common request has been
Medicaid eligible individuals – go to
DHS office
• Others who can help
–
–
–
–
–
Navigators
Application Assisters
Agents
Certified application counselors
Government agencies such as State
Medicaid
– Children’s Health Insurance Program
(CHIP) offices
The Moose Hunt
Contact Information
Cammie Scott
CK Harp & Associates
Consultants
479-750-4411
[email protected]