(Second in a three-part series)
- Sept. 23, 2012: Summaries of Benefits and Coverage: For open enrollment periods beginning on or after Sept. 23, 2012, health insurance issuers and group health plans must provide Summaries of Benefits and Coverage, commonly known as SBCs, to eligible employees. The SBC’s content and format is specifically prescribed by applicable federal rulemaking.
- Oct. 1, 2012: Fee on Sponsors of Self-Insured Health Plans and Issuers of Health Insurance Policies: Sponsors of self-insured health plans and issuers of health insurance policies will be responsible for paying a fee to fund the Patient-Centered Outcomes Research Institute, created under the ACA. The institute “will provide patients, their caregivers and clinicians with evidence-based information needed to make better-informed health care decisions.” For policy years ending on or after Oct. 1, 2012, the fee is $1 per covered life, increasing to $2 per covered life for plans ending after Sept. 30, 2013. The tax is scheduled to cease in 2019 but until then will be subject to adjustments based on National Health Expenditures.
- Jan. 1, 2013: Flexible Spending Account Limits: Beginning in 2013, healthcare Flexible Spending Accounts will be subject to a $2,500 cap. The cap will be indexed for inflation in coming years.
- 2012 Tax Year: W-2 Reporting: Employers filing 250 or more W-2 forms will be required to report the aggregate value of the employer-sponsored group health plan on each employee’s W-2 form.
- March 1, 2013: Notice of Exchange: Employers must provide written notice no later than March 1, 2013 for current employees (or at the time of hire for new employees) about the state healthcare exchange and employee tax credit eligibility and employer contribution, as specifically described in the ACA.
- Jan. 1, 2014: Grandfathered Health Plans: Health plans in existence prior to March 23, 2010 (when the ACA was adopted), may become “grandfathered” and allowed to remain in place subject to certain qualifications. Such grandfathered plans are not subject to all the provisions of the ACA but must meet certain thresholds (for example no lifetime limits on coverage) as of Sept. 23, 2010. Of note, grandfathered plans may not: (1) Significantly cut or reduce benefits; (2) Raise co-insurance charges; (3) Significantly raise co-payment charges or deductibles; (4) Significantly lower employer contributions; (5) Add or tighten an annual limit on what the insurer pays; (6) Change insurance companies; The employer or insurance provider must provide employees notice of its decision to remain a grandfathered plan and employees may choose to participate in state exchanges.
- Jan. 1, 2014: Play or Pay: Employers with 50 or more employees will have to decide by this date whether to ‘Play or Pay’ (that is, pay a tax for dropping group health benefits or continue to offer group health benefits). Penalties for employers with 50 or more employees could be significant, as much as $3,000 per employee per year, for not offering affordable coverage under the ACA. (See a Kaiser Family Foundation chart at healthreform.kff.org/the-basics/employer-penalty-flowchart.aspx.