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Health Care Reform

The new health care reform legislation has and will cause many changes to the health insurance industry. If you have any questions, check the web site links below or feel free to call us for clarification. We will give you our best interpretation of the law. You may also want to talk to your accountant and/or attorney for more information.

Please understand that all of this information is subject to change!

Changes for 2010

Changes for 2011

Changes for 2012-13


  • Before 10/1/2013, the following Model Notices must be handed out to all employees, regardless of group size.


    Model Exchange Notice for Employers who offer health coverage


    Model Exchange Notice for Employers who do not offer health coverage


  • Employers filing 250 or more W-2 Forms in 2012 must include the cost of employer-sponsored health coverage for informational purposes on the forms beginning in the tax year 2013.
  • Group and individual health insurers (including grandfathered and self-funded plans) have to provide a summary of benefits and a coverage explanation (referred to as an SBC) that meets specified criteria to all enrollees and applicants when they apply, enroll or reenroll, when a policy is delivered and when a material change is made outside a policy renewal period.
  • Group insurers and self-funded plans will have to begin submitting quality reports to HHS. These reports must state whether or not the benefits provided under their plans meet criteria established by HHS on improving health outcomes, preventing hospital readmissions, improving patient safety and reducing medical errors. HHS has yet to issue regulations on this reporting requirement.
  • All non-grandfathered group or individual health insurance coverage must provide coverage for specified women’s preventive care service without any cost-sharing requirements, including contraceptives.
  • Premium tax on fully insured and self-funded group health plans to fund comparative effectiveness research program begins.
  • FSA contributions for medical expenses are limited to $2500 per year, with the cap annually indexed for inflation. IRS guidance issued in June 2012 clarified that the cap applies on a plan year basis beginning after December 31, 2012.
  • The Medicare payroll tax increase of 0.9% goes into effect for individual filers with incomes over $200,000 and joint filers with incomes over $250,000. In addition, there is a new 3.8% Medicare contribution on certain unearned income from high-income individuals.
  • For those who itemize their federal income taxes, the threshold for deducting unreimbursed medical expenses increases from 7.5% to 10% of AGI. The increase is waived for those 65 years and older through 2016.
  • All employers are required to provide notices to their employees informing them of the existence of the state-based exchanges. Details of the content of such notices and a template have not been released. The notices which were to be provided by March 1, 2013 were delayed pending further guidance from the Department of Labor. The DOL announced the delay on January 24, 2013.
    The Model Exchange Notice is now required to be handed out to all employees, regardless of group size, BY OCTOBER 1, 2013. Please see links below.

Changes for 2014


Crawford County 20/20 Roundtable PowerPoint Presentation 6-5-2013


Other links of interest:


Summary of Potential Employer Penalties Under PPACA


Model Exchange Notice for Employers who offer health


Model Exchange Notice for Employers who do not offer health coverage


 If you want more information regarding how your carrier is interpreting these, go to your Carriers website.