Most of this information is from Blue Cross Blue Shield of Nebraska.
PPACA, the Patient Protection and Affordable Care Act (also known as ObamaCare), has regulations that are scheduled to go into effect January 1, 2014. These regulations will bring about significant changes to employer group health plans of all sizes.
Here are changes that the Bancroft-Rosalie School group health plan must comply with:
1. 90 day waiting period maximum.
Waiting periods for coverage cannot be longer than 90 days.
2. Removal of pre-existing condition limitations and/or exclusions.
Coverage must be provided on a guarantee issue basis without any exclusion for pre-existing conditions.
3. Employee cost sharing limits.
Annual cost sharing limits can be no more then the current maximums established for Health savings account eligible high deductible health plans- $6400 for individuals and $12,800 for families in 2014. This cost sharing limit includes all deductibles, coinsurance and copay amounts under the plan.
4. Notice of Marketplace (exchange) availability.
Employers must provide employees with a notice regarding the availability of coverage through the Marketplace (formerly called the Exchange).
5. Minimum value.
In order to avoid paying the Employer Shared Responsibility penalties, all non-grandfathered plans must provide "minimum value", which is defined as providing coverage for at least 60% of the average employee's eligible expenses.
6. Patient Centered Outcomes Research Institute Fee
The IRS is assessing employer group plans a $1 per covered person fee (increasing to $2 October 1, 2013) to fund research on the health care treatments for certain conditions. The Omaha World Herald today had an article about how the University of Nebraska hoped to receive some of these funds for their research projects.
7. Transitional Reinsurance Fund Fee
A per-enrollee fee to fund a transitional reinsurance program (help pay for the added costs of PPACA).
The annual fee for 2014 is expected to be $63 oer covered person. This fee applies to all group health plan participants including dependents (the fee for a family of four would be $252). This fee will be included in the premiums charged.
The school Blue Cross Blue Shield premiums for next year will be going up 6%. Three percent is due to the increased costs of medical service and 3% because of the added fees and costs associated with PPACA, according to information provided by the Nebraska Council of School Administrators.
