Rip Van Winkle – Waking Up 4 Years Later


Have you been asleep for a while, like Rip Van Winkle, and just waking up to learn about health care reform? Or just not been interested in watching the minutiae of health care reform?  Or have you just become responsible for health care reform compliance?  We have plenty of posts about what you need to knowthe top five things, etc.  There have been political debatesjudicial battles and more, but what is the status of health care reform today?  Well, there is this notice and that notice, but you might want a higher level summary.

Four years ago, some health care options had lifetime limits, had pre-existing condition exclusions, or required payments for preventive treatments.  Health insurance was hard to compare and did not use consistent terminology.  If an employee and the employee’s spouse were choosing between a couple of health options, it was difficult to do an apples to apples comparison.  Some people did not have health insurance.

Today, some things haven’t changed – employers still provide health insurance for most employees.  But due to insurance mandates, individual mandates (and eventually employer mandates), much has changed.  These days, most plans are not grandfathered and cannot require payment for preventative treatments.  All plans had to remove lifetime limits and pre-existing condition exclusions for everyone, not just kids.  All insurance and employer plans must use a “Summary of Benefits and Coverage” to consistently explain the benefits and costs (other than premium).  The SBCs, as they are called, allow for apple to apple comparisons for major differences between health plans.

As you probably heard, the exchanges, or “marketplaces,” are available, but the rollout was a little bumpy.  If an individual does not have health coverage during 2014, he or she will pay a tax penalty – known as the individual mandate, and there is no delay for this mandate.  To inform people about the exchanges, many employers gave an exchange notice.  The exchanges coordinate the individual and small employer insurance market.  The key to the exchanges are access to the tax incentives and subsidies.  There is room for improvement, but then again, was any major change in American history implemented smoothly?

To help smooth the transition for employers, their mandate has been delayed.  And we are still waiting for guidance, despite already passing the law’s fourth anniversary.  We don’t know howautomatic enrollment will work.  We don’t know whether large employers will be allowed to use the exchanges.  We don’t know how the “Cadillac” excise tax on rich health insurance will be enforced.  By the time that we have all the answers, you may not recognize health care reform, like Rip Van Winkle didn’t recognize his surroundings.  To bring you up to date, here are a fewquestions and answers for employers on health care reform.

Today’s post was contributed by Megan E. Hladilek