Transcript Health Care Reform

The Patient Protection and
Affordable Health Care Act
Lifetime limits will be banned on medical
coverage:
District employees already have the benefit
of no lifetime limits.
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Physical Therapy and Occupational Therapy
under Medical Mutual of Ohio will change
from 40 visits per year to:
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40 visits annually for Physical Therapy
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40 visits annually for Occupational Therapy
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Orthodontics for children will be added as
of 2011.
Maximum lifetime limit will be $1,500.00
per child.
This is not offered to employees in the
AFSCME Union.
There is no special enrollment necessary.
Health insurance will be extended to
dependents up to age 26 under Federal
law:
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The child does not have to live at home
The child does not need to be a dependent
on the parent’s tax return
The child does not need to be a full-time
student
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The child may be married (only the child is
eligible for coverage not his/her spouse or
child)
The child must be not employed by an
employer that offers any health benefit plan
under which the child is eligible for
coverage
In addition, the Ohio Department of
Insurance extends this insurance up to
age 28 and all criteria must be met:
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The child must be unmarried and
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The child must be a natural child, stepchild
or adopted child of the employee and
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The child must be a resident of Ohio or a
full-time student at an accredited public or
private institution of higher education and
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The child must be not employed by an
employer that offers any health benefit plan
under which the child is eligible for
coverage and
The child must not be eligible for Medicare
or Medicaid programs and
The child must be under the age of 28.
Special enrollment forms will be available
from Medical Mutual of Ohio and Kaiser
Permanente.
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Expect to provide certification of eligibility
annually.
An Attestation form will be required to state
that the child is not eligible for healthcare
coverage under his/her employer.
Expiration under Federal Law is midnight on
the child’s 26th birthday.
Expiration under State Law is midnight on
the child’s 28th birthday.
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Employee w/single coverage would go to
employee + 1
Employee + 1 would go to Employee +
Family
Cost would be incremental to the next tier
when the over age dependent is added.
This applies under Federal Law until age 26.
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Ages 26 through 28 healthcare coverage is
provided under House Bill 1, under the Ohio
Department of Insurance
Adding an OAD will increase the employee’s
premium (in the appropriate tier of
coverage) by approximately 40% of the cost
of single coverage for each dependent age
26 – 28.
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The cost is the responsibility of the
employee parent.
For 2011 ONLY the District will pay this
cost.
Keep in mind, although these regulations
are in effect, there is still the possibility that
the government or medical carrier will
change the cost.
Portable term-life insurance for employee &
spouse ($10K to $500K)
Portable child life - $5K (6 months to 18
years /age 23 if FT student)
Issue up to $100K (<60 & No on medical
questionnaire)
Enhancement to District’s short-term
disability benefit
Annual enrollment
Premium deducted from your paycheck post
tax
You will pay taxes on money added to your
paycheck
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If you enroll in DIPPO and go on disability,
your disability payments will be tax-free
If you do NOT enroll in DIPPO and go on
disability, you will be required to pay taxes
on your disability payments
Flexible Spending Account (FSA) for
Health Care:
This eliminates reimbursements using taxfree dollars except for prescribed
medications or a Note of Medical Necessity
(NMN) from a physician.
Allergy & Sinus
Cold sore remedies
Motion sickness
Antibiotic products
Cough, cold & flu
Pain relief
Anti-diarrhea
Digestive aids
Respiratory
treatments
Anti-gas
Feminine antifungal/itch
Sleep aids &
sedatives
Anti-itch & insect
bite
Hemorrhoid preps
Stomach remedies
Antiparasitic treatments
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Consider these new rules when estimating
the dollar amount to put in your FSA 2011
2011 Cap remains at $4,000.00
FSA funds will be capped at $2,500.00
effective for 2013
NO changes to the Dependent Care
Flexible Spending Account, cap remains at
$5,000
Employers are required to disclose the value
of benefits provided by the employer for
each employee’s health insurance coverage.
The amount shown on your W-2 is not
being taxed. It is a reporting tool to show
the value of your healthcare.
Group health plans or insurance companies
providing group plans are prohibited from
rescinding coverage once an enrollee is
covered under a plan.
Exception will be in the case of an individual
who has performed an act or practice that
constitutes fraud or makes an intentional
misrepresentation of material facts.
Email your questions to:
[email protected]
Call the Open Enrollment Line (216) 432-7309
or ext. 6064
Hang in there, we will get through the changes together!
Questions?