ACA News & Publications

Burnham’s Guide to Post‐Election Health Care Reform

November 12, 2012

The polls have closed and the results are in... Like it or not, health care reform is here to stay. Following the conclusion of the election, many of our clients have approached us and asked “what’s next?” or “what do we need to do now to be in compliance?” If you have embraced the wait‐and‐see approach in regard to your health care reform planning, you are not alone. But now, it’s time to act.

The good news: The law has not changed; we know the game plan. Burnham is prepared and we have kept our clients primed and ready for what’s coming. The better news: Most plan sponsors are already in compliance with many of the requirements of the Patient Protection and Affordable Care Act (PPACA), or are planning on making the necessary adjustments at open enrollment to meet those constraints.

A Quick Overview of What’s In Store For 2013:

  • Report aggregate medical plan contributions on employee W‐2’s
  • $2,500 limit on health FSA’s
  • Provide Summary of Benefits & Coverage (SBC’s)
  • Provide 60 day advance notice of plan changes (not related to renewals)
  • Include Enhanced Women’s Preventative Health Benefits
  • Notify employees of existence of Health Insurance Exchanges
  • Increased Medicare taxes for high wage earners

For most fully insured plans, the carriers are making the mandatory changes to ensure that the plan benefits and SBC’s are in compliance. For self‐insured plans, the carriers and TPA’s are working with us to do the same. Most payroll providers should be providing you with the resources to comply with the increase in taxes and W‐2 reporting. Lastly, your trusted Burnham Benefits Advisor is here to make sure that all points are being executed and implemented properly, as well as providing appropriate education, support, and guidance along the way.

What You Should Be Keeping Your Eye On:

  • Final rulings on non‐discrimination testing (Fully Insured Plans)
  • The launch of the state‐sponsored exchanges
  • Guidance on Automatic Enrollment (>200 Employees)

How Burnham Can Help You Address Future Healthcare Reform Challenges:

  • Pay or Play Financial Modeling
  • Cadillac Tax Modeling / Benefit Planning
  • Plan & Contribution Design‐ to avoid “unaffordability penalty,” losing membership to the Exchange, and staying in compliance
  • Wellness Plan Design and Implementation

If benefits are not currently offered to your entire population, or if you feel it’s not sustainable to continue to do so, Burnham can assist you with Pay or Play Financial Modeling to clear up this determination. If you are fearful that your plan is going to be subject to the Cadillac tax in 2018, Burnham can assist you with benefit modeling/planning to help keep you out of the penalty box. Finally, one top component of the PPACA is its focus on wellness programs. Plan sponsors can offer preferred premium structures and incentives to wellness participants in order to drive healthy lifestyles and improve claims experience. Let the Burnham Wellness team help you customize a wellness solution unique to your employee population that will improve overall health and drive costs downward.

PPACA will continue to evolve, experience delays, sustain challenges, and go through various forms of implementation. As these challenges and changes occur, Burnham Benefits is here, prepared, to help you every step of the way. It is our personal goal to help you navigate the complicated waters of health care reform.

For More Information
For more information about this ACA Pathways or about any other health care reform-related provisions, please contact your Burnham Benefits consultant or Burnham Benefits at:

Burnham Benefits

This ACA Pathways is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice. Readers should contact legal counsel for legal advice.

The information contained in this ACA Pathways includes emerging health care news from a limited perspective and does not encompass all views. The information was selected from a wide range of sources selected on the basis of their potential impact on employers and/or their employee benefit plans. For more information, please contact Burnham Benefits.

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