Transcript Document

May 2013
UNC Benefits Update
Presented by Brian Usischon
Topics for Discussion
• Legislative Updates
• Health Care Reform
• Benefit Focus Enrollment Platform
• State Health Plan
• Retirement System Updates
UNC Budget & Legislative Policy Priority
• UNC Optional Retirement Program
– Increase the EMPLOYER contribution rate from
6.84% to 8.00% over the next two fiscal years
(increase to 7.42 effective 7/1/2013 and to 8.00
effective 7/1/2014)
– Expand eligibility to SPA employees hired between
August 1, 2011 and December 31, 2012
UNC Legislative Policy Proposals
• Teachers’ and State Employees’ Ret. System
– Remove language that prohibits volunteers during
a retirees’ first six months of retirement
• Tuition Waivers
– Increase the tuition waiver program for faculty and
staff back to three waivers per academic year
• Personnel Authority for SPA Employees
– Move SPA employees from OSP to BOG authority
Retirement System Legislation
• HB 357 – Retirement Governance Act of 2013
– An act to increase citizen oversight and to make other
consolidations and improvements in the governance of
the State Retirement Systems.
• HB 358 Retirement Technical Corrections
– Updates the definition of retirement as a “termination of
employment and complete separation from active
– Allows ORP forms to be filed with RSD electronically
Retirement System Legislation
• HB 359 – Retirement Administrative Changes of 2013
– Makes changes to administration of the State Retirement
Systems that will extend the transfer benefit option to
participants in the 403(b) supplemental plan; clarify the
timing of social security offset for LTD benefits; establish
a 415(m) arrangement.
• H 381 – Retirement Fiscal Integrity Act of 2013
– Provides for the fiscal integrity of TSERS, LGERS, and
the CJS. Directs the Department of State Treasurer to
propose a Teachers’ and State Employees’ Optional
Retirement System---as the sole alternative plan
available to employees.
State Health Plan Legislation
• HB 232 – State Health Plan Statutory Changes
– To make technical and other changes to the state
health plan for teachers and state employees
statutes, as requested by the state health plan
– This bill seeks to make adjustments to the eligibility
requirements for SHP enrollment with the apparent
goal of facilitating compliance with the ACA
Other Legislation
• S 395 – Tricare Supplement for Flex Accounts
– An act to allow a tricare supplement for flexible
compensation plans offered by the state.
Health Care Reform
Health Care Reform - Why It Matters
• Health Care Reform - ACA, PPACA, Obamacare
 ACA is an acronym for the "Affordable Care Act", a set of laws passed
in 2010. ACA is the shortened name for the PPACA, the Patient
Protection and Affordable Care Act.
 The ACA is a very extensive set of laws which sets out to reform the
U.S. healthcare system. The goal of the ACA is to expand coverage to
all Americans and to help control healthcare costs overall.
• Uncertainties now largely gone
 Survived court challenges. The US Supreme Court ruled that the law’s
individual mandate is a constitutional exercise of Congress’s power to
impose tax.
 Survived the 2012 Presidential election.
Coverage Requirement & Expansion
• Phase I: 2010 – 2013
 Beginning in 2010 the ACA required existing and new individual
markets and group health plans to satisfy certain requirement (i.e.
coverage of dependents to age 26, no pre-existing condition limitations,
no annual or lifetime limits).
• Phase II: 2014 and Beyond
 Individual Mandate: mandates that all Americans, with some very
limited exceptions, maintain a minimum level of health insurance or
face a tax
 Insurance Exchanges: creates state-based health insurance
exchanges and provides premium tax credits to assist eligible
individuals with the purchase of coverage
 Medicaid Expansion: allows states to expand Medicaid up to 133% of
federal poverty level
 Employer Mandate: requires all employers, with 50 or more full-time
equivalents, to offer health benefits that meet a defined standard, and
pay a set portion of the cost of those benefits on behalf of their
Health Care Reform – Timeline
Employer Healthcare Mandate
• Coverage Requirements
• Must meet actuarial threshold
• Must cover 95% of eligible employees
• Mandatory health care coverage of full-time employees
(FTE) who work 30 or more hours per week for 3 or more
• Affordability Requirements
• Premiums for individual coverage can’t exceed 9.5% of
household income
Employer Mandate – “Pay or Play”
• Penalty assessment of up to $2,000 annually for employers that
do not provide coverage if at least one full-time employee
receives a premium tax credit or cost sharing reduction.
• Penalty assessment of up to $3,000 for employers that provide
coverage but employee opts out of the plan and receives a
premium tax credit or cost share reduction because employer
coverage for EMPLOYEE only coverage is unaffordable.
• Exchange subsidies are premium tax credits or cost share
reductions that are available to employees whose coverage is
Definition of Full-time Employee
• A full-time employee is a common law employee who is
 on average at least 30 hours of service per week; or
 130 hours of service in a month
• Hours of service means:.
 Each hour for which an employee is paid or entitled to payment for
the performance of duties for the employer; and
 Each hour for which an employee is paid, or entitled to be payment,
for the period of time where no duties are performed due to
vacation, holidays, illness, layoff, jury duty, incapacity (disability),
military duty or leave of absence
Methods of Counting
• The proposed regulations require an employer to count actual
hours of service for employees paid on an hourly basis. For
employees not paid hourly, an employer may use one of the
following three methods to determine hours:
 Actual hours of work
 A days worked equivalency, with eight hours of service credited for
each day worked
 A weeks-worked equivalency, with 40 hours or service credited for
each week worked.
• An employer can use different methods for different classification
of non-hourly employees, as long as the classifications are
reasonable and consistently applied.
Full-time Employee @ UNC
• The proposed regulations will require UNC to cover employees
not otherwise eligible for health care coverage including:
 Student employees that work 30 or more hours per week
 Temporary employees (non-student employees) that work 30 or
more hours per week
 Post-docs, Graduate RA/TAs
 Adjunct faculty
Impact of “Full-time” on UNC
• IRS acknowledges higher ed has unique employment
• IRS issued preliminary rules but not responsive to higher
• Until further guidance is provided, must use a “reasonable”
criteria to determine eligibility
Student Healthcare
• College and Universities not required to provide Student
Health Insurance.
• Student Plans can be “self-insured” or “fully insured plans.
Only about 30 colleges offer self-funded plans.
• Self-insured student plans are exempt from ACA
• Fully-insured “Student” plans resemble employersponsored plan requirements
• Fully-insured plans can be “experience” rated rather than
“community” rated.
Student Healthcare
• Student workers may be considered “employees” if
they ‘work’ 30 hrs/wk or more
• Coverage as “student” or “employee”?
• Consider:
• Student Insurance – They pay
• Employee Insurance – You pay
What is a Measurement Period?
• Employer may use an initial “standard measurement
period” of between 3 and 12 consecutive months to
determine whether or not an employee averaged at least
30 hours of service per week.
• If an employee is determined to be “eligible for coverage”
during a “defined” standard measurement period (a.k.a
look back period), then the employee would be eligible for
coverage during an associated “stability period.” This
period must be equal to or greater than the measurement
period. The stability period can be no less than six months.
• Can have different measurement/stability periods for
different categories of employees (i.e. salaried employees,
hourly employees, collective bargained employees)
What is an Ongoing Employee?
• An “ongoing employee” is an employee who has been
employed at least one full standard measurement period.
• An employer may determine each ongoing employee's fulltime status by “looking back” at a measurement period of
not less than three but not more than 12 consecutive
After Measurement, then Stability
• If employee was employed on average at least 30 hours of
service per week during the standard measurement period,
then the employer treats the employee as a full-time
employee during the subsequent stability period.
• If not, the employer would be permitted to treat the
employee as not a full-time employee during the
immediately following stability period.
What about New Employees?
• A “new employee” is an employee who has been employed
for less than one complete standard measurement period.
• If a new employee is reasonably expected to work on
average at least 30 hours per week for three of more
months the employer must offer coverage no later than
three months after hire date to avoid penalties.
• A new variable hour employee or a seasonal employee
may be evaluated during an initial measurement period.
Variable/Seasonal Employees
• Don’t know if they’ll work 30 hours
• If an employer uses the look-back measurement method to
determine the full-time status of its ongoing employees, the
employer may also use a similar process with a
measurement period, a stability period and an optional
administrative period for its new variable hour and seasonal
If full time…
• If an employee is determined to be a full-time employee
during the initial measurement period, then the new
employee must be offered coverage during the new
employee stability period or else the employer could be
liable for a penalty.
• The new employee's stability period must be the same
length as the stability period for ongoing employees.
If not full time…
• If a new employee found not to be a full-time
employee, employer can treat the employee as not a
full-time employee during the new employee stability
• This stability period must not be more than one month
longer than the initial measurement period.
• Must not exceed the remainder of the standard
measurement period (plus any associated
administrative period).
New employee to ongoing employee
• Once new employee has been employed for an entire
standard measurement period, the employer must test the
employee for full-time employee status, beginning with that
standard measurement period, at the same time and under
the same conditions as apply to other ongoing employees.
The safe harbor means….
• If an employer complies with these rules and the
employee's position is not materially changed during the
initial measurement period, then no penalty will be
assessed with respect to the new employee during the
initial measurement period or the administrative period.
Taxes and Fees
New Medicare Tax
 Imposes an additional “employee” Medicare Tax. There is no
“employer match” on this additional Medicare Tax.
 Adds a 0.9% additional Medicare Tax on wages over the
following thresholds:
 $250,000 for joint return
 $125,000 married filing separately
 $200,00 in all other cases (i.e. head of household)
 Requires employers to withhold the additional tax on wages or
compensation it pays to employees in excess of $200,000 in a
calendar year.
 Employer only required to start withholding the additional
Medicare Tax once an employees wages or compensation
exceed $200,000
Taxes and Fees
Patient Centered Outcomes Research Inst. (PCORI) Fees
Establishes a private non-profit whose mission is to “research” the
outcomes and clinical effectiveness, risk and benefits of medical
treatments to help with informed health decisions. In the first year
(2012) the fee is $1 times the number of plan participants
(employees and dependents). For the plan year starting July 1, 2013
the fee will increase to $2 and will be indexed in future years. This
fee is charged directly to insured and self-insured health plans.
Temporary Reinsurance Program
This three-year transitional reinsurance program was established to
help stabilize premiums in the individual health insurance market
from 2014 to 2016. This program is funded by contributions from
insurers in the individual, small group and large group markets, and
self-insured group health plans. Fee expected to be $63 per
participant (employee and dependents).
Health Insurance Industry Tax
 In 2014 the tax will add an estimated 2.0-3.0% in cost to insured plans.
Health Care Reform – Things to Consider
Move more employees to regular, fulltime status
(cost of healthcare + other benefits)
Limit number of ‘temporary’ employees including
contingent faculty
Strictly limit ‘hours worked’
Create separate health care plan for these types
of employees?
Turnover / Unemployment costs if layoff or
reduce hours
Benefit Focus Enrollment
Benefit Focus
• Ancillary Enrollment Options
• NC Flex Plans – no charge
• Data Capture Enrollment – no charge
• Data Transmission Plans (not NCFlex) - $750 set up fee
and $750 per month per product, per agency
• Payroll Integration
• For existing campuses with Payroll Connect – no charge
• For new integrations with Payroll Connect– $1,950 set up
• Single Sign On (SS)
• For existing campuses with SSO– no charge
• For campuses electing SSO – $10,000 set up fee
Benefit Focus – Phase I (Spring 2013)
• Conversion from Aon Hewitt to Benefit Focus
scheduled for completion in May 2013
• All NCFlex plans expected to be up and running on
Benefit Focus by June 1, 2013
• Aon Hewitt and Benefit Focus will be running
concurrent platforms during June 2013
Benefit Focus – Phase II (Spring 2014)
• Plans to be included for all Campuses & Affiliates
• Teachers’ and State Employees’ Retirement System
• UNC Optional Retirement Program
• UNC 403(b) Plan
• State 401(k) Plan
• State 457(b) Plan
• UNC Supplemental Disability – The Standard
• UNC Supplemental Disability – Liberty Mutual
• Other campus plans (i.e. Group Life Insurance)
• Benefit Statements
State Health Plan
State Health Plan Changes
• North Carolina State Health Plan’s Board of
Trustees approved proposals to change the plan
year and offer new health plan options for teachers
and state employees
– Plan Year changes to calendar year effective
January 1, 2014
– Short Plan Year to run from July 1 through
December 31, 2013
– New consumer driven plan option (high deductible
plan with a health reimbursement account)
available effective January 1, 2014
– There will be three surcharges applicable to active
and non-Medicare retirees who enroll in the buy-up
80/20 plan or the Consumer Driven Health Plan
Annual Enrollment – Effective July 1, 2013
• Annual Enrollment for July 1, 2013 effective date
runs from May 20 through May 31
• Shortened benefit year from July 1, 2013 through
December 31, 2013
• Deductibles and coinsurance maximums will be
cut in half as a result of the short benefit year.
Otherwise most copayments will remain the same
for the PPO plan options
• This is a “negative enrollment”—employees DO
NOT need to take any action during this
enrollment unless they want to make a change
Annual Enrollment – Effective July 1, 2013
• Online Enrollment for COBRA
• Telephonic Enrollment
• Uniform Coverage Document
• PCP Functionality Available
• Employer Portal/Electronic Billing
Annual Enrollment - Eff. January 1, 2014
• Healthy Incentives - the PPO 80/20 and the Consumer
Driven plans will cover preventive services at 100 percent.
If you select a primary care physician during enrollment you
will receive a $15 copay reduction for any office visit to that
designated physician.
• There are also copay reductions available for providers in
the Blue Select Network. More detailed information about
these incentives will be available prior to the October
enrollment period.
• Premiums for members and dependents are projected to
increase by 4.7%
• Annual Enrollment to be held in October. Dates to be
Summary of Plan Options – 1/1/2014
Other Items for Discussion
• SHP “Paid as Billed” effective July 1, 2013
• Verifying Dependent Eligibility
• Exception Requests from campuses
• Maintaining Terminations in Benefit Focus (under
ACA terminations cannot be processed
Review from December
• Long Term Care Insurance
– General Assembly repealed LTC as offering from
the State Health Plan effective January 1, 2013.
Prudential to send existing participants with payroll
deductions notification to continue coverage via
bank draft.
Retirement System Updates
Retirement System and FY13 Leave
• Retirement System and FY 13 Leave Payouts
– Special leave balances shall not be paid out upon
termination of employment except in the case of
separation due to immediate retirement from a
State-supported retirement system.
– The retirement separation effective date must occur
between July 1, 2012 and June 30, 2013 and the
retirement effective date must occur immediately
upon termination of employment. Immediate is
defined as the first day of the month following the
effective date of the separation.
– For example, if an employee separates due to
retirement on August 10, 2012, the effective date of
the retirement shall be September 1, 2012.
RSD Updates
• Reemployment Earnable Allowance Limits Increased for
2013. The allowance is the greater of:
– 50 percent of the member’s compensation during the 12
months of service before retirement, excluding any
termination payments, as increased by 1.7% or
– $30,680
• Teachers’ and State Employees’ Handbook updated for
• 2010 Annual Benefit Statements for active employees
available until March 31, 2013
Return to Work Penalty Assessment
• Phase 1 – Violation Review
• Phase 2 – Penalty Assessment and Appeals Process
• Phase 3 – Reducing the Penalty if the agency meets
• Timely Self-reporting Incentives
– Active Reporting (letter or email to RSD)
– Passive Reporting (ORBIT)
– Anonymous Reporting – (RSD determines non-reporting or
receives notice from an outside source)
Outstanding Issues with RSD
• UNC campuses found in violation of the return to work laws
according to RSD
• UNC Health Care employees who enrolled in the ORP and
cannot withdraw or transfer their employees funds