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Limited plans may help employers avoid health care reform penalty

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Limited plans may help employers avoid health care reform penalty

Employers that provide extremely limited health care plans have a way around paying significant penalties to the government when major provisions of the health care reform law go into effect next year.

A growing number of benefit experts say employers can offer bare-bones plans without running afoul of a Patient Protection and Affordable Care Act provision that imposes a $2,000 penalty per full-time employee for not offering what the health care reform law calls minimum essential coverage.

Employers offering skimpy plans, which might only provide coverage for preventive services and a fixed number of office visits to medical providers, could be liable, however, for a different health care reform law penalty that is imposed on plans that do not pass a minimum value test.

Instead of facing a $2,000 penalty for every full-time employee, employers offering plans that do not meet the minimum value standard would be liable for a $3,000 penalty only for those eligible employees who use federal premium subsidies to buy coverage in a public insurance exchange.

“It is a way to reduce penalties, not to avoid them” altogether, said Steve Wojcik, vice president of public policy at the National Business Group on Health in Washington.

In some cases, those penalties could be minimal if most employees offered bare-bones plans enroll in those plans rather than more comprehensive and expensive exchange plans. The plans could be especially attractive to young and healthy low-income employees.

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“It is a calculated gamble that many employees will not go to the exchanges,” said Frank McArdle, an independent benefit consultant in Bethesda, Md.

Some private sector experts, as well as Department of Health and Human Services and Treasury Department officials, believe only a small percentage of employers would offer the limited health plans.

“I would be surprised if any of our members were thinking of going down this route of offering plans that fall far short of being comprehensive,” said Gretchen Young, senior vice president of health policy at the ERISA Industry Committee in Washington.

“The great majority of employers are determining how to offer comprehensive plans that are affordable for them and for their employees,” said Michael Thompson, a principal at PricewaterhouseCoopers L.L.P. in New York.

Still, “Some companies are looking very hard at this,” said Ed Fensholt, senior vice president and director of compliance services at Lockton Benefit Group in Kansas City, Mo.

Employers most interested in offering such plans are in low-wage, high-turnover and low-margin industries, such as retail and hospitality.

“There are industries where employers can't afford to provide mainstream plans” to all employees, said Rich Stover, a principal with Buck Consultants L.L.C. in Secaucus, N.J.

The focus on offering skimpy plans to avoid or reduce health care reform law penalties is recent as employers were focused on complying with reform law provisions with earlier effective dates.

“People did not focus on it. There were so many other health care reform law provisions where there were imminent deadlines,” said Amy Gordon, a partner at McDermott, Will & Emery L.L.P. in Chicago.

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But as the Jan. 1, 2014, deadline for offering minimum essential coverage draws closer, experts say it is clear that skimpy plans can meet the health care reform law essential coverage standard.

While small-group, individual market and exchange plans have to cover essential health benefits in 10 major benefit categories, the reform law does not impose a comparable requirement on insured large-group or self-insured plans, NBGH's Mr. Wojcik wrote in a memo to members.

Large-group plans are “free to cover whatever benefits they want, with the only limitation being that that if they do cover essential health benefits, they cannot have any dollar limits on those benefits,” Mr. Wojick wrote.

Still, employers need to be cautious, said George Katsoudas, division senior vice president and compliance counsel for Gallagher Benefit Services in Itasca, Ill.

“There could be future guidance that could stop such a design. A prudent step for employers would be to talk to legal counsel before proceeding,” Mr. Katsoudas said.

Others want regulators to provide clear-cut guidance on designs that are permitted and those that do not pass the minimum essential coverage standard.

“We need more specific information on what is allowed and what is not,” said Christine Pollack, vice president of government affairs at the National Retail Industry Leaders Association in Arlington, Va.