Handout 1- Health Care Reform 8-13-13 CITY OF ATLANTIC BEACH
Health Care Reform Highlights
Patient Prstection and Affordable Care Act (PPACA)
• PPACA Employer shared responsibilities provisions, "Pay or Play", have been delayed until 2015.
• Individual mandate is still effective 1-1-2014; individuals must have health insurance or pay
penalties.
❖ Current City of Atlantic Beach medical plan options meet PPACA defined minimum coverage
requirements, as well as employer contribution levels to prevent granting of subsidies on
Exchange (cost cannot exceed 9.5% of employee annual income).
+ Health Insurance Exchange, referred to as "Marketplace", will be available 10-1-13 for 1-1-14
enrollment (Federal Exchange in Florida).
❖ Carriers and third parties are creating "private" Exchanges that will be available to employer
groups for health option coverage; these are expected to include multiple plan options, on-line
enrollment, and decision-making support tools.
❖ Employer (City of Atlantic Beach) must send notice to all employees by 10-1-13 of availability of
the Exchange.
❖ Effective 1-1-14, employee waiting period for coverage is limited to 90 days.
❖ Effective 1-1-14, no pre-existing exclusions are allowed for any individual; guaranteed issue and
renewability are required.
❖ Several PPACA fees are being implemented in 2014 — PCORI ($1 per member per year),
Reinsurance ($63 per member per year) and Health Insurance Provider Fee (1.9 — 2.3%); these
will be paid on your behalf, but are included in your health plan premiums (estimated by Florida
Blue at 3-5%).
❖ Individuals applying for subsidies will have to complete lengthy applications; application
process requires family members to be listed, and family members are always tied to the
individual to determine income eligibility for federal subsidy (400% of poverty level).
• City of Atlantic Beach will be required to extend health insurance options to all employees who
work 30 hours or more in 2015; City of Atlantic Beach should begin tracking that eligibility now
to manage a 12 month look back period.
❖ Automatic enrollment for employers with 200+ employees and non-discrimination
requirements are pending; effective date has not been determined, but should be anticipated
and expected by the employer.
April 13,2013