Supreme Court Upholds Health Care Law - Checklist for 2012-2013

The Supreme Court has found the Patient Protection and Affordable Care Act (PPACA), also known as Health Care Reform, to be constitutional largely as passed, but the political conversation is sure to intensify as the November elections near. Fortunately, the legislation preserves the employer-based health care system and as health care costs continue to rise, the value placed on health care benefits by employees and dependents is sure to rise accordingly.

Here is a list of the impending PPACA provisions for 2012 and 2013, as well as the assistance ASR/Physicians Care will provide our employer groups:

Summary of Benefits and Coverage
Employers must provide participants and beneficiaries a summary of benefits and coverage (SBC) with the first open enrollment period that begins on or after September 23, 2012 for those enrolling or re-enrolling in group health plan coverage through open enrollment, and the first plan year that begins on or after that date for enrollments occurring outside of open enrollment. ASR/Physicians Care will provide our employer groups with customized SBCs to distribute.

Form W-2s
Employers who filed 250 or more Form W-2s in calendar year 2011 must report applicable employer-sponsored coverage on the Form W-2s no later than January 31, 2013 (for calendar year 2012). Employers who file fewer than 250 Form W-2s in calendar year 2011 are exempt from reporting until further guidance is issued. ASR/Physicians Care will provide our employer groups with the necessary data to meet this obligation.

Comparative Effectiveness Research Fee
Plan sponsors of applicable self-funded health plans will owe a fee payable for plan years ending on or after October 1, 2012 and before October 1, 2019 to fund the Patient-Centered Outcomes Research Trust Fund, a non-profit corporation that will research the clinical effectiveness, risks and benefits of medical treatments, services, procedures, drugs and other strategies that treat, manage, diagnose or prevent illness or injury. An applicable self-insured health plan is any plan established or maintained by one or more employers for the benefit of their employees or former employees except if the plan provides only “HIPAA-excepted benefits” (i.e., limited-scope dental and vision benefits). The amount of fees payable by the plan sponsor is $1 for each covered life for the 2012 plan year, $2 for each covered life for the 2013 plan year, and an increased amount each year thereafter. The fee is due by July 31 of the calendar year immediately following the last day of the plan year (first payment due July 31, 2013 for calendar plan years). ASR/Physicians Care will provide our employer groups with the necessary data to meet this obligation.

Limit on Medical Flexible Spending Account Contributions
For plan years beginning on or after January 1, 2013, the amount an employee may contribute to a medical flexible spending account (FSA) on a pretax basis is limited to $2,500. If the medical FSA includes a grace period, unused pay reduction contributions carried over into the grace period for that plan year will not count against the $2,500 limit for the subsequent plan year. If a Section 125 plan has a short plan year, the $2,500 limit must be prorated according to the number of months in the short plan year. If spouses are eligible for a medical FSA, each spouse may elect to contribute up to $2,500 to his/her medical FSA. The $2,500 limit does not apply to employer flex credits unless they can be converted to cash or a taxable benefit under the Section 125 plan. In future years, the ceiling for allowable contributions will be adjusted annually for inflation.