Health Care Reform

Beginning on March 1, 2013, employers must provide employees written notice of the existence of the health insurance exchange. This provision is currently delayed awaiting further guidance.

For 2012 and earlier years, there was no specific limit on the amount of money an employee or the employer could contribute to an FSA. For 2013 employee contributions to FSAs will be capped at $2,500 per year, increased annually by the cost of living adjustment. This new provision is based on the calendar year, meaning that employees must not exceed $2,500 in FSA contributions from January 1, 2013 through December 31, 2013. Suggestion: Change your 2012/2013 FSA limits – and all relevant plan documents – during this year’s renewal season.

High-income taxpayers will be hit with two big tax hikes under the recently enacted health overhaul legislation: a tax increase on wages and a new levy on investments. To help offset the cost of providing health insurance to millions of Americans, the new law imposes an additional 0.9% Medicare tax on wages above $200,000 for individuals and $250,000 for married couples filing jointly. In addition, for higher-income households, the new law adds a 3.8% tax on unearned income, including interest, dividends, capital gains and other investment income. You can find more information in this IRS Q&A Article.

Section 4191 of the Internal Revenue Code imposes an excise tax on the sale of certain medical devices by the manufacturer or importer of the device. This law imposes a new 2.3% excise tax of the sale price. Generally, no action is required by individual consumers. Because the tax is imposed upon the sale of a taxable medical device by the manufacturer or importer, the manufacturer or importer is responsible for reporting and paying the tax.

Currently, those facing high medical expenses are allowed a deduction for medical expenses to the extent that those expenses exceed 7.5% of adjusted gross income (AGI). The new provision imposes a higher threshold of 10% of AGI (for taxpayers 65 and older, it stays at 7.5% through 2016).

The Affordable Care Act will establish an annual comparative effectiveness fee to fund research comparing the effectiveness, benefits, and potential risks of different treatment options. For the plan year ending after September 30, 2012, there will be a $1 per enrollee tax on fully insured and self-funded group health plans to fund a Patient-Centered Outcome Research program. For plan years ending after September 30, 2013, the fee increases to $2 per enrollee. This fee expires September 30, 2019.

• Insured plans: Insurance companies will pay a fee that equals $1 in the first year ($2 in the following years) multiplied by the average number of lives insured under a group health plan policy.
• Self-Insured plans: The Plan Sponsor (generally the employer) of a self-insured plan will pay a fee that equals $1 in the first year ($2 in the following years) multiplied by the average number of lives covered by the group health plan. Most self-funded insurance companies will provide a tool to calculate fee.

Beginning with the 2012 tax year, employers that are required to issue 250 or more W-2 Forms must report the aggregate cost of employer-sponsored group health coverage on employees’ W-2 Forms. For employers that generate less than 250 W-2s, they will need to comply for the 2013 Tax Year. Click here for the IRS chart requirements.

As directed by the Affordable Care Act, health insurance companies will provide consumers with a concise document detailing, in plain language, simple and consistent information about health plan or individual insurance policy benefits and coverage (blank template). The SBC will help consumers better understand the coverage they have. It will summarize the key features of the plan or coverage, such as the covered benefits, cost-sharing provisions, and coverage limitations and exceptions. The SBC will be available to consumers at important points in the enrollment process, such as when they are shopping for coverage, when they apply for coverage, at each new plan year, and at any time upon request.

The Affordable Care Act- health insurance legislation- helps make prevention affordable and accessible by requiring health plans to cover preventative services. Under the Affordable Care Act, women’s preventive health care – such as mammograms, screenings for cervical cancer, prenatal care, and other services – is covered with no cost sharing for new health plans. The Department of Health and Human Services (HHS) commissioned an Institute of Medicine (IOM) study to review what preventive services are necessary for women’s health and well-being and should be considered in the development of comprehensive guidelines for preventive services for women. Non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012. Click here to see the Coverage Guidelines.