Posted by: danielrashke | December 31, 2013

New Year Challenges

Well, another year has come and gone. And 2014 promises to be an especially important year for those in healthcare related industries, as many core components of the Patient Protection & Affordable Care Act (PPACA) will be enacted. Most notable, the Employer Mandate will require employers with more than 50 full-time equivalent employees to offer adequate health insurance for full-time workers, or starting in 2015, face a penalty. Also starting on January 1, 2014, most U.S. citizens and legal residents must have a qualifying level of health insurance through an employer-sponsored health plan, Medicare, Medicaid, CHIP, or another plan offered in the individual market, or pay a penalty.

The Public Health Insurance Marketplaces created to help US citizens obtain healthcare will impact employee participation in COBRA, with number of participants and duration of their time on COBRA expected to decline slightly from year to year. Further, Health Reimbursement Arrangements (HRAs) integrated with the employer’s health plan will be affected as well. Specifically, if an employee chooses to opt out of an employer sponsored plan and go the marketplace (due to affordability issues), there will obviously be a slight reduction in participation in the employer sponsored health plan and thus the HRA.

Also new in 2014 is a limit on cost-sharing and deductibles for employers with less than 51 employees. According to PPACA, an “essential health benefits” Plan deductible may not exceed $2,000 for single coverage, or $4,000 for any other coverage. Unless this limit is repealed, it will prevent the sale of high deductible health plans combined with an HRA, thereby denying small business owners and their employees access to health coverage options that currently serve millions of Americans.

Insurers must eliminate annual dollar limits on essential health benefits in 2014. Not impacted by this provision are HRA Plans considered embedded or integrated with the health plan. Conversely, HRA Plans considered Section 213 Plans will be affected. TASC posits that our AgriPlanNOW and BizPlanNOW Clients with only one eligible employee will not be subject to this provision.

Finally, PPACA mandates that all non-grandfathered insurance plans must cover what are described as essential health benefits. Depending on the scope of benefits that are required, this may increase the cost of insurance that small business owners offer. Plans will be required to provide the following (a partial list): emergency services, hospitalization, maternity/newborn care, mental health and substance abuse, prescription drugs, rehabilitative services, laboratory services, wellness services, chronic disease management, and pediatric services. This requirement will likely expand the scope of medical services offered by some HDHPs, and increased premiums may follow.

There is a lot here to consider…and we do! Trust your business with a Third-Party Administrator (TPA) who takes the time to research and comprehend PPACA! We continually implement necessary changes and continually update administrative processes to comply. In every instance, we are pro-Client and pro-Participant. This means, as always, that TASC will continue to make every effort to transition promptly, as necessary, and to assuage possible financial harm to Participants or Clients as we do.

On behalf of TASC’s ownership and management we wish you the very best in the New Year!


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