How Does Health Care Reform Affect Your Health Insurance Coverage?

Many businesses are confused about the impact of the Affordable Care Act (ACA) on their health insurance coverage and are asking what they need to do to prepare. UHA has been monitoring and will continue to monitor health care reform developments and we are here to answer any questions you may have.

UHA Benefits Changes

Essential Health Benefits (EHB)

Since January 1, 2014, the ACA has required new health plans to include coverage for essential health benefits (EHB). This law requires small businesses with 50 or fewer employees to include minimum coverage for prescription drugs, pediatric oral (dental), and pediatric vision care for their employees. Businesses of 51 or more employees and grandfathered plans are exempt from this requirement. Until October 1, 2016, existing UHA groups (effective prior to November 1, 2013) that do not already include all of the essential health benefits may elect to keep their current benefits instead of adding the essential health benefits if they wish to do so.

Please check with your plan administrator or legal counsel on compliance issues if you are a self-funded group.


How do I calculate my Full-Time Equivalent (FTE) Employee count?

If you have an accountant or tax advisor, they can assist you with determining your group’s FTE count. There are also a variety of resources available:


A Small Business (50 or fewer employees)

The actual pricing impact is uncertain pending clarification, interpretation and guidance from federal and state regulators defining the scope of EHBs. EHB requirements become effective for each plan as of the first plan year that commences on or after January 1, 2014. Enhanced UHA benefits to be EHB compliant are as follows:

  • No annual maximum or lifetime maximum
  • Prescription Drugs
    Drug Plan S will have an annual maximum out-of-pocket. When a member's total annual maximum out-of-pocket reaches the annual limit in any calendar year, UHA will pay 100% of the eligible charge for covered drugs for the rest of that calendar year. Exclusion: mandatory generic substitution and any other "Dispense as Written" penalties. Please refer to your plan documents on the UHA Member Portal for your current annual maximum out-of-pocket.
  • Pediatric Vision
    These are services for UHA members under the age of 19. UHA will pay 100% of the eligible charge for an eye exam and refractions per member, per calendar year. Appliance reimbursement is up to $130 every calendar year towards the purchase of eyeglasses, contact lenses, frames, lenses, or any combination thereof.
  • Pediatric Dental
    These are services for UHA members under the age of 19. Hawaii Dental Service will be the third party administrator for UHA to provide this benefit.


A Large Business (51 or more full-time employees) & Grandfathered Plans

  • No annual maximum or lifetime maximum
  • Prescription Drugs
    Drug Plan S will have an annual maximum out-of-pocket. When a member's total annual maximum out-of-pocket reaches the annual limit in any calendar year, UHA will pay 100% of the eligible charge for covered drugs for the rest of that calendar year. Exclusion: mandatory generic substitution and any other "Dispense as Written" penalties. Please refer to your plan documents on the UHA Member Portal for your current annual maximum out-of-pocket.
  • Vision Plan
    UHA will pay 100% of the eligible charge for an eye exam and refractions per member, per calendar year. Appliance reimbursement is up to $130 every calendar year towards the purchase of eyeglasses, contact lenses, frames, lenses, or any combination thereof.


W-2 Compliance Report

The Patient Protection and Affordable Care Act (PPACA) requires employers to report the amount paid in premiums for each employee's medical coverage on the employee's W-2. To assist our clients with this requirement, UHA is capable of running a year-end report showing total premiums paid for each employee's coverage.

To comply with the PPACA W-2 reporting requirement, please contact your UHA Account Representative at 532-4000, extension 356 or 357


Forms 1094-B, 1095-B

The Affordable Care Act (ACA) includes many reporting and disclosure requirements. Section 6055 of the Internal Revenue Code (as added by Section 1502 of the ACA) requires any person, including health insurance issuers and plan sponsors who provide individuals with “minimum essential coverage” to file Forms 1094-B and 1095-B with the IRS. Minimal essential coverage includes eligible employer-sponsored plans such as those purchased by your group through UHA.

1094-B Forms

The 1094-B Forms are the Transmittal of Health Coverage Information Returns, and UHA will complete and submit these to the IRS. This is the responsibility of UHA and not the employer groups.

1095-B Forms

UHA will be completing and sending the 1095-B forms directly to your employees in order for them to document that they had insurance coverage in 2015. It is a federal requirement that these forms be provided directly to your employees, therefore UHA will not be providing copies to our Employer Groups.

Employer groups are responsible for certain additional reporting requirements as well. Please refer to the IRS website or consult your accountant or tax advisor for further guidance regarding reporting requirements.


Forms 1094-C, 1095-C

Employers with 50 or more full-time employees (including full-time equivalent employees are considered Applicable Large Employers (ALE). If an employer falls into this category in the previous calendar year, they must file one or more Forms 1094-C and a Form 1095-C for each employee who was a full-time employee of the employer for any month of the calendar year. The copy of the Form 1095-C (or a substitute form) must be provided to the employee.

For more information, please refer to the IRS website.
 

UHA Health Care Reform Related Documents