Patient Protection Affordable Care Act (PPACA), also known as Obamacare, is approaching fast. All HR professionals should be fully informed and be prepared early to mitigate any risks and liabilities. View this powerpoint as a resource and contact CIGNA directly if you have any questions.
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AGENDA
• Employer mandate in 2014• “Affordability” for individuals versus employers • Actuarial Value and Minimum Value calculators• Essential Health Benefits and employer impacts• Other 2014 provisions to consider• Questions Kathy Vaccaro
Employers with 50 or more full-time employees/equivalents must offer:
“Affordable” coverage – employee contributions are less than 9.5% of:• Employee’s W-2 wages• Employee’s monthly wages, OR• Federal Poverty Level for a single individual
A plan that provides “minimum value” – pays 60% of the costs of covered health services
Coverage to full-time employees and their dependent children up to age 26
Plans that currently begin on a date other than January 1 will not face penalties if they comply upon the first day of their 2014 plan year.
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A BETTER UNDERSTANDING OF ESSENTIAL HEALTH BENEFITS
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Who must cover EHBs:• All individual and fully insured small group non-grandfathered plansWho doesn’t have to cover EHBs:• Large group plans, self-funded small group plans and grandfathered individual
and small group policies are not required to cover EHBs Dollar Limits:• All plans of any size, funding, grandfathered/non-grandfathered status that
cover any EHBs cannot impose annual or lifetime dollar limits
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More clarity:• All benefits in the benchmark plan become EHBs for the state• Self-funded, large and grandfathered group plans must use an EHB definition
authorized by HHS• Pediatric is defined as under the age of 19• States can define Habilitative Services if the benchmark plan does not• MHSA Parity is extended to individual and small group markets• EHB applies to In-Network services only
• Effective for plans beginning on or after 1/1/14• Limits apply to all In-Network benefits included in the plan
BENEFIT PLAN COST SHARING LIMITS
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• Intended to inform employees of: • The public Exchanges and the services provided by them• Employer plan requirements and their potential eligibility for a subsidy
with a plan purchased on an Exchange
• The March 1, 2013 effective date delayed to late summer or fall
• The Department of Labor is considering:• Providing model language• A template for employers • Flexibility and adequate time to comply
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Employee Notice of the ExchangeA written notice to all employees from all employers
"Cigna" is a registered service mark and the "Tree of Life" logo is a service mark of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by such operating subsidiaries and not by Cigna Corporation. Such operating subsidiaries include Connecticut General Life Insurance Company, Cigna Health and Life Insurance Company, and HMO or service company subsidiaries of Cigna Health Corporation and Cigna Dental Health, Inc. All models are used for illustrative purposes only.