Patient Protection Affordable Care Act – what you need to know

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Navigating the Patient Protection Affordable Care Act doesn’t need to be a labrynthian task, though it may feel that way to managers struggling to deal with the compliance issues raised by implementation of the ACA. Here’s what you need to know, according to The Society for Human Resource Management.
Effective at the beginning of this year, many ACA provisions required compliance. These include:
  • Minimum value compliance for employer-sponsored group health plans must be determined for the plan year. This information, in turn, must be reported both in written notices about new health insurance exchanges and in summaries of benefits and coverage during annual enrollment.
  • Annual dollar limits are now eliminated on essential health benefits under group plans.
  • Coverage waiting limits can no longer exceed 90 days.
  • Grandfathered health plans can no longer exclude adult children under age 26 who have access to other employment-based coverage.
  • Maximum out-of-pocket limitation will prohibit – for both insured and self-insured non-grandfathered plans – out-of-pocket limits exceeding $6,350 (self) and $12,700 (family) coverage.
If you’re a manager, this is what you should be doing in order to comply with current ACA provisions:
  • For smaller organizations, confirming whether or not they meet the threshold to be subject to the mandate in 2015. This is particularly important if the organization could be considered under common control with other entities sharing some ownership.
  • Confirming how your organization will comply with the mandate. Will you pay or will you play? You should also know how you’ll implement your compliance strategy in 2015.
  • Identifying which employees are full-time, variable-hour or seasonal.
  • Deciding whether to proceed with planned coverage expansions to achieve compliance, delay until 2015, or considering another compliance strategy.
  • Choosing whether and how to use the safe harbor look-back measurement method of figuring out full-time status of employees or new variable hour and seasonal employees.
  • Considering your organization’s use of limited term employees and temporary workers – could this affect compliance? If so, you must develop a strategy to address those issues.
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