January 30th, 2014

Healthcare Reform Check-Up: Updates on the PPACA

In our recent white paper, “It’s Time to Act”, we provided the insights, strategies and advice you needed to get prepared for the Patient Protection and Affordable Care Act before the New Year. 2014 is here, and so are some important changes to the law. To get you caught up to speed, and help you stay compliant, we’ve put together a list of the most critical updates that you need to know.


The PPACA mandates two fees for employers — transitional reinsurance program fees and patient-centered outcome research fees.

• Transitional reinsurance program

fees:  Fully insured and self-insured group health plans providing major medical coverage will be assessed an annual fee from 2014-2016. In 2014, the fee is set at $63 per plan participant (including spouses and dependants). These fees were established to generate stability for premiums in the individual insurance market.

• Patient-centered outcome research

fees:  Mandated by the IRS, these fees are applicable to health insurance issuers for fully-insured group health plans and plan sponsors of self-insured group health plans. The fee is $2 multiplied by the number of participants (including spouses and dependants) covered under the health plan. These fees are applicable through 2019, and employers must report and record the fee on Form 720.


By January 1, 2014, individual states were required to identify minimum criteria for “essential health coverage,” and plans offered through state exchanges must meet these thresholds. Though large employers (those with 50 full-time employees or the equivalent) are not required to offer coverage meeting these thresholds, offering sub-standard coverage could drive more of your employees to the exchanges which, in turn, could cost you under the employer mandate.


If you offer a health-contingent wellness program that requires your employees to meet a health threshold or achieve a health outcome in exchange for a reward, the amount of the reward has been increased from 20 percent to 30 percent of the total cost of employee only coverage under your healthcare plan. In addition, you must ensure that all employees have reasonable access to the reward. Thus, if your thresholds or targets discriminate against those with disabilities or others within your workforce, you must provide an alternative means of achieving the reward.

To learn more about these changes, or for help mitigating the impact of the Patient Protection and Affordable Care Act, contact your local Ajilon office today.



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