Health Care Reform
At Jesse Consulting we help employers and individuals understand the historic shift in the American health care system. We continually research this change and strive to educate others. The law requires that everyone has health insurance.
The government regulations are multifaceted and will be implemented over time. The Act requires changes in eligibility, enrollment, and benefits.
Most changes affect fully insured plans. There are a few changes that do not apply to self-funded plans. Large employers and small employers have different timelines. We work with all employers to help implement their action plan for:
- Penalty and tax preliminary calculations;
- Eligibility and enrollment requirements; and
- Benefit compliance.
The Patient Protection and Affordable Care Act (PPACA, also ACA) was signed on March 23, 2010. The purpose of the law is to make health insurance affordable and accessible. The Act defines these three categories:
- Large employers, 50 or more full-time employees;
- Small employers, less than 50 full-time employees; and
- Individuals, U.S. citizen or legal resident.
Large employers can purchase or maintain their plans from the same marketplace that exists today (play/stay). If a large employer does or does not offer a medical plan there may be penalties (pay).
Small employers are not required to offer or continue providing a medical plan. If they do or do not offer a plan they will not be subject to penalties.
Expatriate health plans are affected by health care reform. The U.S. Department of Labor (DOL) defines an expatriate plan as one “ . . . to which enrollment is limited to primary insureds who reside outside their home country for at least six months of the plan year and any covered dependents.”
The DOL has provided transitional relief for compliance until December 31, 2015. However, we recommend that expatriate plans be on the employer checklist before compliance is mandatory.
By January 1, 2014, all U.S. citizens and legal residents will be required to obtain health insurance (play) or they may be subject to a tax penalty (pay). This requirement can be met by having insurance through:
- An employer group medical plan;
- An individual or family plan purchased through the Exchange or directly from an insurance company; or
- A government plan such as Medicaid or Medicare. Read more
The Act requires insurance companies to provide certain benefits, access to coverage, and cost accountability. These requirements are being institutionalized over time.
Your Benefits are Our Business. ™