Health Care Reform
How National Health Care Reform Affects UMS Health Insurance Plans: Health insurance reform legislation passed by Congress and signed into law by President Obama on March 23, 2010 provides sweeping changes in many areas of the health insurance industry, some of which will affect the University of Maine System health insurance plans. The Patient Protection and Affordable Care Act (PPACA) is phased in over a period of years. Some provisions take effect as early as 2011, and all the changes will occur by 2019.
Effective January 1, 2013:
FSA Health Care Maximum Election Amount: As part of National Health Care Reform, the maximum amount you can set aside in the Health Care FSA is being reduced from $4,000 to $2,500 for calendar 2013. The Dependent Day Care FSA annual maximum remains at $5,000 per household.
2012 Form W-2 Reporting of Employer Provided Health Coverage:
Under federal tax regulations, the University of Maine System must begin reporting the value of health coverage provided by the University on your W-2 for calendar 2012. The exact amounts will vary depending on whether you are covered by the CIGNA Copay or Passive Plans and your coverage level. Approximate values that will be reported on your Form W-2 are as follows:
- $ 6,900 (Employee Only)
- $ 15,300 (Two-Person)
- $ 19,400 (Family)
Under current tax law, the amount on your W-2 is not taxable.
Summary of Benefits and Coverage (SBC): As a result of National Health Care Reform, UMS is required to provide employees with an easy-to-understand summary about a health plan’s benefits and coverage. UMS Summaries are available at: http://www.maine.edu/system/hr/medical.php. All insurance companies and group health plans must use the same standard SBC form to help employees compare health plans.
Specific Preventive Medications at No Cost: In accordance with health reform, certain prescription medications (as well as specific over-the counter medications) will be available to you at no cost (copay, coinsurance and/or deductible).
Effective January 1, 2011:
REMOVAL OF ANNUAL AND LIFETIME MAXIMUMS for ESSENTIAL SERVICES: UMS will be removing all lifetime and annual maximum benefits for essential health services to the extent these exist within our programs.
Essential Health Benefits include at least items and services in the following broad categories:
- Ambulatory patient services
- Emergency services
- Maternity and newborn care
- Mental health and substance abuse use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative services and devices
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
NEW DEFINITION OF ELIGIBILITY FOR ADULT CHILDREN: Adult dependent children can enroll in the medical plan, up to age 26. Note that although National Health Care Reform does not apply to dental, vision and the dependent life insurance programs, UMS will be adopting this new definition for these benefits plans as well. Expenses for adult dependent children are also eligible for reimbursement under the Health Care Flexible Spending Account.
ADOPTION OF THE PREVENTIVE CARE MANDATE: UMS will early adopt the preventive care mandate, which provides first dollar coverage for certain preventive health services. These services will no longer have a copay, and will not be subject to deductibles and coinsurance. Although this benefit will increase UMS costs in the short-term, the hope is to remove any financial barriers for members to receive critical preventive health care and avoid more costly services in the long term. This investment in employee and family health is consistent with the RiseUP program and message of the importance of good health.
FLEXIBLE SPENDING ACCOUNT REIMBURSEMENTS FOR OVER-THE-COUNTER MEDICATIONS: As part of National Health Care Reform, there are new limitations for "over-the-counter" (OTC) items. Many items that used to be considered "eligible expenses" for FSA use are no longer allowed. Other items are still "eligible," but a formal prescription is required to document the need.
Further information about Health Care Reform is available at the following websites:
Although the law contains some positive marketplace reforms, it also adds several new excise taxes and other revenue-generating provisions that will ultimately be passed on to employers and increase our medical plan costs. UMS is committed to partnering with collective bargaining representatives and our employees to carefully monitor increasing plan expenses and find ways to control costs while continuing to offer employees and retirees meaningful, affordable health insurance. With that in mind, we need all employees, retirees, and their dependents to actively participate in the UMS RiseUP wellness program and campus-based health initiatives that will help us improve our health and become more prudent consumers of health care.
If you have a question about benefits enrollment, contact the
UMS Employee Benefits Center toll-free 866-269-9635 (or 973-3373) or email firstname.lastname@example.org. Have your Employee ID number for faster service.
Last Updated: November 7, 2012