Affordable Care Act – Current Issues in Healthcare Reform

1. Affordable Care Act – Current Issues in Healthcare Reform Alice Helle - helle@brownwinick.com Cynthia Boyle Lande – lande@brownwinick.com Harold Schneebeck – schneebeck@brownwinick.com BrownWinick 666 Grand Avenue, Suite 2000 Des Moines, IA 50309-2510

2. Exchanges • Provide information about coverage options • Facilitate purchase of health insurance by uninsured individuals • Complete individual exemption determinations • Eligibility: • Must be a U.S. resident • Must be a U.S. citizen or national • Cannot be incarcerated

3. Exchanges – Open Enrollment Periods • Initial open enrollment period began October 1, 2013 and continued through March 2014 • 2015: November 15, 2014 – February 15, 2015 • Subsequent open enrollment periods: October 15 – December 7

4. Definitions • Minimum essential coverage: includes individual market policies, job-based coverage, Medicare, and Medicaid • Essential health benefits: • Ambulatory patient services • Emergency services • Hospitalization and surgery • Maternity and newborn care • Mental health and substance abuse treatment • Prescription drugs • Rehabilitative and habilitative services and devices • Lab services • Preventative wellness services and chronic disease management • Pediatric services, including dental and vision

5. Exchanges (cont.) • Coverage levels • Bronze (60/40) • Silver (70/30) • Gold (80/20) • Platinum (90/10)

6. Iowa’s Exchange • Partnership Model • www.healthcare.gov • 1-800-318-2596

7. “Large Employer” Mandate Obligations of Large (50+) Employer • Must offer health coverage to “full-time employees” (30 hours) or pay a penalty • Employers who offer coverage may still be subject to a penalty unless the coverage offered is “affordable” and provides “minimum value”

8. Effective Date for Mandate • Originally effective 2014 • Proposed regulations delayed to 2015 • Final regulations issued 02/10/14 further delayed some provisions and clarified others

9. Highlights of Final Regulations Employers with 50 – 99 FTEs • Penalties under the employer mandate are delayed to 2016 IF employer has met ALL of the following requirements since 02/09/14:

10. Highlights of Final Regs (cont.) • Has not reduced # of employees or their hours for the purpose of falling below 99 FTEs • Has not eliminated or materially reduced health coverage • ER/EE premium split for EE only coverage is unchanged (or ER contribution is at least 95% of 02/09/14 level)

11. Highlights of Final Regs (cont.) Employers with 100+ FTEs • Penalty for failure to offer coverage (the $2,000/year penalty) • For 2015 only: • ER must offer coverage to at least 70% (not 95%) of full-time employees • Penalty is calculated by excluding first 80 employees (rather than first 30)

12. Highlights of Final Regs (cont.) “Seasonal Employee” defined: • Customary annual period of employment is 6 months or less • Period of employment should start in the same part of the year each year • Ex: • Ski instructors • Detasselers

13. NASHCO http://nashco.org/members-co-op/

14. CoOportunity Health

15. CoOportunity Health (cont.)

16. Website: www.brownwinick.com Toll Free Phone Number: 1-888-282-3515 OFFICE LOCATIONS: 666 Grand Avenue, Suite 2000 Des Moines, Iowa 50309-2510 Telephone: (515) 242-2400 Facsimile: (515) 283-0231 616 Franklin Place Pella, Iowa 50219 Telephone: (641) 628-4513 Facsimile: (641) 628-8494 DISCLAIMER: No oral or written statement made by BrownWinick attorneys should be interpreted by the recipient as suggesting a need to obtain legal counsel from BrownWinick or any other firm, nor as suggesting a need to take legal action. Do not attempt to solve individual problems upon the basis of general information provided by any BrownWinick attorney, as slight changes in fact situations may cause a material change in legal result.