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Getting To Know The Affordable Care Act

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We’re starting this new feature in Spotlight so you can better understand and prepare for changes that may affect you as a result of the Patient Protection and Affordable Care Act (PPACA).  This is the act that is also known as “health care reform” and “Obamacare.” In the interest of consistency and brevity, we’ll refer to the entire law as the ACA.

This month, we’ll bring you up to speed with where we are as of February 2013.

Lehigh’s Grandfathered Status

The ACA was signed into law in March 2010, but it is being implemented in phases. Almost all provisions will be in effect by January 2014.

Institutions like Lehigh that already provided medical insurance plans at the time that the law was enacted were eligible for grandfathered status. This means that we are not required to implement many provisions of the ACA until January 2014. At the same time, grandfathering also limited Lehigh to minimal changes in our plans and in the amount of the costs that employees share.

Non-grandfathered plans have enacted various provisions of the ACA according to a timetable established by the federal government.

ACA Provisions Implemented At Lehigh To Date

Even with grandfathered status, there are a number of ACA provisions that we have started implementing. These include:

  • Elimination of Lifetime Limits and Pre-Existing Conditions Exclusions
    Lehigh’s plans already complied with these provisions.
  • Adult Child Health Insurance Coverage
    Lehigh’s medical plans are now accessible to the adult children (under 26 years old) of faculty and staff, if the child does not have access to insurance through their own employer.
  • Limits On Health Care Flexible Spending Accounts (FSA)
    The maximum annual contribution to a Health Care FSA was reduced from $4,000 to $2,500 beginning this plan year (2013).
  • Inclusion Of Value of Health Insurance On W-2 Forms
    By now, you have received your 2012 W-2 form. As we mentioned in last month’s Spotlight, you will see a new entry on this form – Box 12DD – which will contain the dollar value of your medical insurance benefits. This figure is for reporting purposes only and will not impact your taxes in any way.

Changes You Might See At The Doctor’s Office

One particular set of provisions of the law that non-grandfathered plans began  to implement in 2011 is the coverage of and elimination of co-pays for defined  preventive care supplies and services. 

Many doctor’s offices are changing their procedures to reflect this requirement. Some are no longer asking for a co-payment when you or a family member receives a covered service or supply. You should be aware of the fact that Lehigh employees will still be responsible for these co-pays through the end of the 2013 plan year.

You can tell your doctor’s office that your insurance still requires co-pays for wellness and preventive care visits. They may still decline to accept your payment. If so, you should expect a bill for the co-pay amount once the doctor has submitted your claim.

Knowledge Is Power

As we continue to plan for full implementation of the ACA in January 2014, Human Resources (HR) will continue keeping you informed via this column and elsewhere.
If you want to delve deeper on your own, the official website for the ACA – healthcare.gov – is a good source of information about the law and its impact.

As always, the HR Benefits team is here to assist you with any individual questions you might have.  You can email us at inben@lehigh.edu, or you can call the HR office at extension 83900 and ask for a member of the Benefits team.

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Spotlight is published monthly by Human Resources. Please address any comments to Hillary Kwiatek, Spotlight Editor, Human Resources, 428 Brodhead Avenue, send email to hik210@lehigh.edu, or call extension 85165.

Current and past issues of Spotlight can be viewed and searched at: Past Issues.