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Poll Finds Uninsured Consumers More Willing To Accept Narrow Networks For Lower Premiums.

According to a new survey from the Kaiser Family Foundation, many Americans may be willing “to trade access to a wide range of medical providers for lower premiums” on their health insurance. As the Los Angeles Times Share to FacebookShare to Twitter (2/27, Levey) reports network limits stemming from the Affordable Care Act “have drawn criticism from opponents” of the law. However, the poll suggested this may not remain a point of contention, as “54% of those between the ages of 18 and 64 who are uninsured or who buy health coverage on their own said they would rather have a health plan that costs less, even if it has a limited range of doctors and hospitals.”

Bloomberg News Share to FacebookShare to Twitter (2/27, Chen) reports that the poll shows “consumers shopping on the Obamacare exchanges are thriftier than the general public,” or as Dan Mendelson, chief executive officer of Avalere Health puts it, “The individual market has always been more sensitive to costs.”

The Kaiser Health News Share to FacebookShare to Twitter (2/27, Rau) “Capsules” blog notes that among those who purchase coverage through their employer, the numbers are reversed: “fifty-five percent would rather buy a plan that costs more but allows them to see a wider range of doctors and hospitals.”

We have several employees who waive our group health plan coverage. Will waivers be permitted under the new law?

Yes. However, employers with more than 200 employees with health plans must auto-enroll new full-time employees. Adequate notice must be provided to allow these employees time to opt out. The Department of Labor has indicated that guidance on this will not be ready until after 2014.
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Are there any other PPACA requirements that aren’t getting so much media attention?

Yes. There’s a new voluntary long term care program. There are new nutritional labeling requirements. Chain retailers and vending machines must display nutrition information, mainly calories. Indoor tanning services pay a 10% tax. Nursing mothers get extended break times and private facilities (other than a bathroom). New adoption assistance includes new tax breaks.

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We offer health insurance only to our executives. Will we be able to continue this plan?

Under the PPACA, employers may still offer health insurance only to their executives in grandfathered plans. For new plans, a new nondiscrimination rule applies.

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We currently have a 180-day waiting period before coverage becomes effective. When will that have to be changed?

Under the Patient Protection and Affordable Care Act (PPACA, a.k.a. Obamacare), beginning in 2014 employers providing group medical coverage must provide it within 90 days of hire.

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Are there any other taxes or fees for PPACA?

New taxes under the PPACA for 2014 include a fee on insurers providing health insurance for any U.S. health risk. This fee is apportioned according to their market share of premiums written for the prior year. This fee will be assessed to policyholders. Excluded coverages include insurances for long term care, disability, accidents, specified illnesses, hospital or other fixed indemnity, medical benefits that are secondary or incidental to other benefits, and Medicare supplemental.

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How will the PPACA affect Medicare eligible employee coverage?

Medicare eligible employees are affected by PPACA as follows:
• Provides a $250 rebate to those who reach the Part D coverage gap in 2010.
• Phases down to 25% by 2020 the beneficiary coinsurance rate in the Part D coverage gap.
• For brand-name drugs, requires drug makers to provide a 50% discount on Part D prescriptions filled in the Part D coverage gap, in addition to federal subsidies of 25% of brand-name drug cost by 2020.
• For generics, provides federal subsidies of 75% of the generic drug cost by 2020 for prescriptions filled in the Part D coverage gap.
• Reduces, between 2014 and 2019, the out-of-pocket amount that qualifies an enrollee for catastrophic coverage.
• Possible reduction in access to providers or coverage options because of changes to provider reimbursement levels.

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What types of coverage will allow employees to satisfy the “minimum essential coverage” under the PPACA?

Individuals are required to meet the “minimum essential coverage.”  This includes having coverage under any of the following:

  • Government sponsored programs including Medicare, Medicaid, CHIP, TRICARE for Life, and veterans benefits.
  • Eligible employer sponsored plans.
  • Health plans offered in the individual market within a State.
  • Grandfathered plans.
  • Certain other health benefits risk pools.

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Health benefits coverages to report on employee W-2 forms.

Employee benefits coverages that must be reported on the W-2 include all health coverages such as:

  • Medical, Dental, and Vision coverages
  • Prescription drug coverage
  • Executive physical benefits
  • On-site clinics
  • EAPs that provide medical care
  • Wellness programs that provide medical care

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Is it true we will have to make changes to what we report on our employee’s W-2?

Under the PPACA, reporting on employee’s W-2 forms changes.  Employers must report the aggregate cost of employer sponsored health coverage on employee W-2 forms, code DD in box 12. This amount is not included in employee gross income.

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