What is Health Care Reform and what does it mean to you?
A Summary of Changes to Impact US-Based Standard Motor Products Benefit-Eligible Employees & Dependents
For the past few years, Health Care Reform has been a frequently discussed issue. It’s a tough topic to digest, let alone figure out how different laws and bills have an impact on you. We’ve dissected what’s relevant to you while covered by Standard’s medical plan so that you can begin to learn what these laws mean to Standard and what, in turn, they mean to you.
After a year of debate, Congress passed comprehensive health care reform legislation. On March 21, 2010, the House of Representatives passed the Senate-version legislation, the Patient Protection and Affordable Care Act (the “Affordable Care Act”) and a separate budget reconciliation bill, The Health Care and Education Reconciliation Act of 2010 (the “Reconciliation Act”), which addresses the House Democrat’s desired modifications to the Affordable Care Act. The president signed the Affordable Care Act into law on March 23, 2010 and signed the Reconciliation Act into law on March 30, 2010.
As the health reform legislation stands today, the provisions of the law affecting you and Standard Motor Products as of January 1, 2011 are outlined below. Take a look at the various ways our plan is impacted, and continue to check back here for updates or changes to the law that has been passed as of today.
Effective January 1, 2016, employees should expect to receive an annual 1095-C form from SMP within the first few months of each year. This form is used to report both offers of health coverage to each employee and whether or not the employee accepted or waived the offer in the previous year. This information is also reported to the IRS. Employees should hold on to this form in case they are ever audited by the IRS.
Dependent Coverage has Expanded
Effective January 1, 2011, medical plans are required to provide coverage for dependent children up to age 26, regardless of whether or not they are a full time student. Under SMP's plan, dependent children are eligible to remain covered under our benefits until the end of the year in which they turn 26.
The Reconciliation Act states that the cost of health coverage for dependent children through age 26 is excluded from taxable income. Thus, the coverage is available at the pre-tax rate even if the child is not the employee’s “dependent” for tax purposes.
Lifetime Limits/Restrictive Annual Limits are Prohibited
More benefit available for Employees & Dependents
Effective January 1, 2011, medical plans are prohibited from having lifetime limits on coverage or restrictive annual limits. This clause means the claims that you incur, in the event that you or one of your dependents have a catastrophic health event, will not be denied after you reach a certain dollar amount.
Pre-Existing Condition Limitations Banned
Effective January 1, 2011, there can be no pre-existing limitation for coverage of children under age 19. This change had no impact on SMP employees/dependents because Standard’s plans already included coverage for pre-existing conditions for adults and dependent children.
Effective January 1, 2011, over-the-counter items are no longer be eligible expenses under an FSA, unless prescribed by a physician. This means that the use of your FSA is limited for the purpose of paying your deductible, coinsurance and Rx copays. If, however, your doctor prescribes a specific over-the-counter medication to you for a specific medical condition, then that item may be allowed under the new FSA provision. In this instance, your doctor would need to provide you with the medical necessity in writing.
Preventive Care Mandate
Free Annual Physicals, Immunizations & Preventative Care
Effective January 1, 2011, many preventive care procedures are covered by group and individual health plans with no copays or deductibles. Minimum preventive coverage also includes immunizations recommended by the CDC (Center for Disease Control and Prevention), cancer screenings and annual physicals (for more information visit The US Department of Health & Human Services). Additional services for women are also included. This means there that there is no copay or deductiple applied to preventitive care services.