Home> Content SeparatorEmployers> Content SeparatorEmployee Benefits Security Administration  

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 rates?

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 exchange.

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 penalty requirements.

The Kaiser Family Foundation provides jargon-free information.

The Society for Human Resource Management offers strategies for implementing and managing reform requirements.

How does health care reform affect collective bargaining agreements?

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 law’s provisions.

">Employer FAQs
  • Divider