Can you explain "grandfathered status" as it relates to the Affordable Care Act (ACA)?
A grandfathered plan is generally one that was in existence on March 23, 2010, the date of ACA's enactment. However, plans can lose their grandfathered status if they make any of the following changes:
Is there a tax penalty on anyone, regardless of income, if they do not get health insurance?
- eliminate all or substantially all of the benefits to diagnose or treat a particular condition;
- increase the coinsurance percentage;
- increase the deductible or out-of-pocket limit in effect on March 23, 2010, by more than the percentage of medical inflation since March 2010 plus 15%;
- increase any fixed-amount copayment in effect on March 23, 2010, by more than the greater of: (1) $5 (as increased for medical inflation), or (2) the percentage of medical inflation plus 15%;
- decrease the employer contribution rate for any tier of coverage (e.g., self-only, family coverage) in effect on March 23, 2010, by more than 5 percentage points; or
- make certain changes in annual limits (including changes to add either a new annual limit or a new annual limit that is less than the prior lifetime limit, or changes to decrease an annual limit).
In order for grandfathered status to be maintained, any summary of benefits provided to participants must include a notice regarding the plan's grandfathered status, and the plan sponsor must maintain records regarding the terms of the plan in effect on March 23, 2010.
Individuals whose gross income for a year is below the filing threshold for filing a federal income tax return for that year are not subject to the penalty. Will the Christian Brothers Employee Benefit Trust's (CBEBT) plan be considered a "Gold Plan" and would it be treated in that way?
We are still waiting on Health and Human Services (HHS) guidelines to determine this. In any event, we feel confident all plans offered under the CBEBT will meet the minimum value necessary to be considered a qualified plan. We are under the impression beginning in January, a fee for each employee will be levied by the insurance company (the quoted amount was $63.00) in addition to the premium to help implement the Healthcare Act. Is this correct? Ifso, is there an explanation for this charge?
Yes, effective January 1, 2014 a new fee of $63 per head will apply. The fee is intended to help stabilize the individual market. It is likely that the people who will initially seek coverage once the new rules are in place will be the sickest individuals. Insurers who end up with a disproportionate share of high cost individuals will be eligible for reimbursement. The Christian Brothers Employee Benefit Trust (CBEBT) Trustees have approved the modification of future rates to include these fees. Can you review the procedure for determining whether an employee has insurance and the ramifications to both the employer and the employee should the employee decide they do not want the insurance?
The size of the employer, i.e., if they have 50 or more full-time equivalents, will determine which parts of the Affordable Care Act (ACA), apply - if any. Assuming you have over 50 full-time equivalents, you must either "play" by offering a plan that meets minimum values at an affordable cost or "pay" a penalty as defined by Health and Human Services (HHS).
If the employee is offered affordable insurance that meets the minimum value requirements, but declines, the employee may be subject to a penalty tax unless he or she secures other "minimum essential coverage." Minimum essential coverage can be provided through a governmental sponsored plan such as Medicare or Medicaid, an employer sponsored plan (including a plan sponsored by the employer of employee's spouse), an individual insurance policy, a grandfathered plan or other coverage such as a state benefits health risk pool approved by the Secretary of HHS. Are insurance plans which begin in July, 2013 and end in July, 2014 subject to any Healthcare Act implementations taking place in January, 2014?
Yes, certain aspects of the Affordable Care Act (ACA) apply to all plans regardless of their plan year or calendar year status. Some aspects of ACA are dependent upon plan status. Christian Brothers Employee Benefit Trust will work to determine who is affected, and when. More Information Will Christian Brothers Employee Benefit Trust (CBEBT) provide a list to plan sponsors showing what regulations under the Affordable Care Act (ACA) the Trust is not subject to?
Yes, as soon as we have finalized instructions/guidelines from Health and Human Services (HHS), we will provide. When is the next webinar?
The next webinar will take place on October 10th, 2013 from 1:00 p.m. to 2:00 p.m. Central Time. Details about this webinar are still developing, and this will not be a repeat of previous Healthcare Reform Update webinars. For more information and registration, please visit mycbs.org. All webinares are FREE to members. Are there any websites that can give information and updates on what has been approved?
There are many websites that provide information on the Affordable Care Act (ACA), including ours -- cbservices.org.
In addition, the following websites may also be helpful: