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What are Cadillac plans?
“Cadillac” plans are defined by total premium cost, not
benefits or how much a patient pays for a provider visit. Currently, a
“Cadillac” health plan is defined as costing more than $10,200 for an individual
or $27,500 for a family, including worker and employer contributions to
flexible spending and health savings accounts. Stand-alone vision and dental
benefits are not included.
In 2018, insurers or plan sponsors, not employees, will
have to pay a 40 percent excise tax on the plan’s value ABOVE the currently
defined threshold. So an individual plan valued at $10,700 will have an excise
tax on $500, the amount over the $10,200 threshold.
Learn more at:
'Cadillac' Insurance Plans Explained
How will health care reform affect HealthPlus’ plan
Large-group employers, those with more than 51 full-time
equivalent employees, should anticipate a “bump” in 2014 rates because of
mandated federal government taxes and fees. Small businesses, those with 2 to
50 full-time equivalent employees, who provide health insurance coverage, can
also expect rate increases. These groups will be required to provide Michigan’s
essential health benefits package in 2014.
Small group employers may qualify for tax incentives up
to 50 percent in 2014. To be eligible, a business must cover 50 percent of the
employee coverage cost, pay average annual wages lower than 50k, have fewer
than the EQUIVALENT of 25 full-time workers and buy coverage on the insurance
Learn more at:
The Department of Labor
Will HealthPlus offer plans comparable to bronze- and
silver-level exchange plans?
Yes. HealthPlus will offer plans that meet the
requirements of the “metal” plans, which will be found on the Michigan state
exchange. HealthPlus will be compliant with the law’s essential benefits
provision and its “metal” plans will meet designated actuarial values, which
will be different according to platinum, gold, silver and bronze plans.
Learn more at
What is the PCORI tax?
The comparative effectiveness research fee, or PCORI, is
going to be collected every year between 2013 and 2019 to fund the nonprofit
Patient-Centered Outcomes Research Institute. Fully insured businesses are not
required to pay the fee: the health insurance company pays it. However,
self-insured businesses are responsible for paying the fee, which is $1 per
person covered by the plan. The tax increases to $2 per person after Oct. 1,
2013. The first payment is due July 1, 2013.
Learn more by reading IRS Bulletin 2012-52:
Fees on Health Insurance Policies and Self-Insured Plans for the Patient-Centered Outcomes ResearchTrust Fund
What are “grandfathered” plans?
A group health plan created, or an individual health
insurance policy purchased, on or before March 23, 2010. Grandfathered plans
are exempt from some Affordable Care Act requirements. Plans or policies may
lose “grandfathered” status if they make changes that reduce member benefits or
increase costs. A health plan must disclose in its plan materials whether it
considers itself a grandfathered plan and must advise consumers how to contact
the U.S. Department of Labor or the U.S. Department of Health and Human
Services with questions. New employees and new family members may be added to
grandfathered group plans after March 23, 2010.
Learn more at:
Where can I get more information about subsidies,
taxes and penalties?
The Federal Register
provides specific ACA language of the Act.
The Internal Revenue Service
has a list of tax and
The Kaiser Family Foundation
The Society for Human Resource Management
offers strategies for implementing and
managing reform requirements.
How does health care reform affect collective
The law says health insurance that is part of a CBA
ratified before March 23, 2010 is not subject to the rules and requirements of
the law until the last of the CBAs entered into, prior to the law’s enactment,
terminate. But, a CBA may be amended early to include all or parts of the new