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Health Care Reform Legislation: Impact on Employers
March 23, 2010 - McDermott, Will&Emery
Employers should carefully review H.R. 4872, which, if
enacted, will affect employer-sponsored group health plans.
On March 21, 2010, the U.S. House of Representatives passed historic health
care reform legislation that, if enacted, will have a significant impact on
employer-sponsored group health plans. The Health Care and
Education Affordability Reconciliation Act (H.R. 4872) consists of a set of
amendments to modify the Patient Protection and Affordable Care Act (H.R. 3590),
which has been passed by both the U.S. Senate and the House of Representatives
and was signed into law by President Obama on March 23, 2010.
The Senate will now consider the amendments made by the act and will need a
simple majority of 51 votes to pass the
legislation.
Following is a preliminary summary of important features of the act as they
affect employer-sponsored group health plans.
Employer Responsibility
Under the act, employers would not be required to offer health coverage or
make a minimum contribution toward coverage. However,
employers with 50 or more employees that do not provide health coverage would be
penalized in the amount of $2,000 per full-time employee. In
addition, if an employer provides gunaffordableh coverage to its employees, but
has at least one full-time employee who receives a premium tax credit toward
purchase of insurance in a health insurance exchange, the employer would be
penalized in the amount of $3,000 per employee receiving such premium
credit. The first 30 employees employed by an employer are
disregarded in calculating the penalty amount. Employers may
still retain waiting periods of up to 90 days without being assessed a penalty,
but longer waiting periods will trigger the penalty. Finally,
part-time employees would be counted for purposes of determining whether an
employer has 50 or more employees, but penalties would only be assessed on
full-time employees who work 30 or more hours per week.
Medicare Part D
Effective 2013, the act would eliminate the federal income tax deduction for
the 28 percent subsidy that an employer receives for providing creditable
prescription drug coverage for retirees. This provision will
have a direct impact on public employers because the elimination of the
deduction will need to be immediately reflected on companiesf financial
statements based on U.S. Securities and Exchange Commission accounting
rules.
In addition, the act gradually closes the coverage gap in Medicare Part D
prescription drug benefits over time, decreasing the coinsurance by 7 percent
per year between 2012 and 2019, so that, effective in 2020, Medicare
beneficiaries will have a 25 percent coinsurance for prescription drug purchases
in excess of the deductible and below the catastrophic limit.
The act also establishes a rebate of $250 in 2010 for those Medicare Part D
beneficiaries who reach the so-called donut hole.
Cadillac Tax
Effective in 2018, the act would impose a nondeductible excise tax of 40
percent on insurance companies and plan administrators (including self-insured
plans) for any health-related coverage for which the combined employer/employee
premiums exceed the threshold of $10,200 for single coverage and $27,500 for
family coverage (indexed). The threshold would be higher for
certain workers with high risk jobs or for retirees aged 55 and
older. The tax would apply to the amount of the premium in
excess of the threshold. The act would also exclude from the
calculation dental and vision coverage.
Health Care Reimbursement
Accounts
Effective in 2013, health care reimbursement account contributions would be
limited to $2,500 per year indexed annually. In addition,
effective January 1, 2011, over-the-counter drugs would no longer be permitted
to be reimbursed from a health care flexible spending account, health
reimbursement account or health savings account, unless prescribed by a
physician.
Limitation on Pre-Existing Condition
Exclusions
For plan years beginning on or after the date that is six months following
enactment, group health plans would not be able to impose pre-existing condition
exclusions on children under age 19. In addition, effective
in 2014, group health plans would be completely prohibited from imposing
pre-existing condition exclusions on plan participants.
Dependent Coverage for Uninsured Young
Adults
For plan years beginning on or after the date that is six months following
enactment, a group health plan would be required to extend coverage to an
employeefs dependent through age 26 if the dependent does not have access to
other health coverage. In addition, the coverage would not be
taxable to the employee or dependent. Further, the act
eliminates the requirement that a dependent not be married in order to receive
the extended coverage. Beginning in 2014, the requirement
that the dependent does not have access to other employer-provided coverage
would no longer apply.
Elimination of Lifetime Aggregate
Limits
For plan years beginning on or after the date that is six months following
enactment, a group health plan would not be able to impose lifetime or
restrictive annual limits on benefits under the plan.
Beginning in 2014, a group health plan would not be able to impose any annual
limits.
Preventive Care Benefits
First dollar coverage will be required for preventive care benefits
(i.e., not subject to the deductible). In addition, no
cost-sharing would be allowed for preventive care (i.e., all employer
paid).
Premium Taxes
Beginning in 2013, a new federal premium tax of $1 on each covered life under
a self-insured or fully insured health plan will be assessed to finance a
comparative effectiveness research program. This amount will
increase to $2 per covered life in 2014, will thereafter be indexed to the
medical component of the consumer price index and will sunset in 2019.
W-2 Reporting of Health Benefits
Employers will be required to report the value of health benefits on Form W-2
effective for the first taxable year after December 31, 2010.
McDermott Will & Emery will continue to monitor this important and
historic legislation as it develops. It will be important for
all employer sponsors of group health plans to analyze their current benefit
plan design and plan for future modifications.