ACA AND PEIA EMPLOYERS THE EMPLOYERS ROLE NEW

ACA AND PEIA EMPLOYERS THE EMPLOYER’S ROLE

NEW ACA REQUIREMENTS • • Employer Shared Responsibility (Partially Delayed) Affordable Insurance Exchanges PCORI Fees Reinsurance Fees

EMPLOYER SHARED RESPONSIBILITY • This regulation was originally scheduled to begin January 1, 2014 but has since been delayed to January 1, 2015 • Applies only to employers with 50 or more employees • Uses Common Law standard for determining employee • Regulation defines how to measure employees, look back measurement methods • 4980 H(a) Penalties • 4980 H(b) Penalties • Cannot be liable for both

4980 H(A) • 4980 h(a)– Failing to offer MEC to employees. • PEIA participating employers in full compliance with plan eligibility guidelines will have little to no penalty exposure • Penalty - $2, 000 per full time employee • PEIA eligibility guidelines exceed ACA, 80 vs. 130 hours per month • Part time, temporary or seasonal positions - safe harbor look back measurement period

4980 H(B) • 4980 h(b) • Failing to offer affordable or actuarial minimum value benefits • Penalty $3, 000 per tax credit/cost sharing reduction eligible employee • PEIA actuarial plan value exceeds ACA, Plan B 83% vs. 60%, • Your employee only premium determines the 9. 5% affordability test • Affordability safe harbors using W 2, rate of pay or federal poverty line

EMPLOYER’S ROLE • The employer is responsible for their compliance and reporting for this regulation • Department of the Treasury [REG-138006 -12] • http: //www. irs. gov/pub/newsroom/reg-138006 -12. pdf 144 pages of reading enjoyment

AFFORDABLE INSURANCE EXCHANGES • The Affordable Care Act has developed an Affordable Insurance Exchange • It is designed to provide a place for underinsured or uninsured Americans to buy affordable health insurance • Enrollment will begin this fall for coverage beginning January 1, 2014 • Employers are required to provide notice to all employees about the exchanges • • By October 1, 2013 Regardless of participation with PEIA Regardless of full-time or part-time status of employee Each new hire after October 1, 2013 must be provided the notice within 2 weeks of hire date

MODEL NOTICE • Although it is the employer’s responsibility to provide notice to their employees, PEIA will provide instructions to Benefit Coordinators for completing the fillable PDF form • A form, which will be available on the PEIA website, must be completed for each employee • For more information on the notice and requirements, go to: http: //wwwdol. gov/ebsa/newsroom/tr 13 -02. html.

PCORI FEES • Patient Centered Outcomes Research Institute • It is charged with promoting research to evaluate and compare the health outcomes and clinical effectiveness, risks, and benefits of medical treatments, services, procedures, and drugs • This fee is being paid by PEIA and will be incorporated into plan costs • The fee starts at $1 per member, rises to $2 per member and is then subject to indexing thereafter until 2019 • Plan impact will be an increase in costs of approximately $2. 5 million

REINSURANCE FEES • HHS will operate a temporary reinsurance program for commercial health insurance in the individual market • This fee will provide funding to insurers that incur high claim costs for enrollees in the individual market in an attempt to stabilize premiums in the individual health insurance market • This fee is being paid by PEIA and will be incorporated into plan costs • Reinsurance fees are $63 per member and will be required for years 2014 through 2016 • Plan cost increase estimated at $40 million total