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Healthcare Reform Overview

As one of the top employee benefits firms in the nation, Sequoia is a leader in understanding and interpreting the changes to employer’s benefits programs due to healthcare reform laws. Sequoia is committed to helping our clients navigate the ever-changing complexities of the Affordable Care Act. As with any change in our marketplace, we try to simplify challenging issues and help our clients take actions to maintain compliance and take advantage of potential opportunities. Sequoia has invested in many resources to assure our clients are kept informed on how to best thrive under the new rules.

The following are highlights of some of the key changes due to healthcare reform in chronological order. Click on the year to view additional details on the relevant changes during that time.

  • Small Business Tax Credit Applies
  • Medicare retiree drug subsidy tax treatment
  • Early retiree medical reinsurance
  • Medicare prescription “donut hole” rebate
  • Dependent coverage to age 26
  • No lifetime dollar limits
  • No rescissions
  • Wellness grants to small employers
  • Income-based Medicare Part D premiums
  • No annual dollar limits (determined by HHS)
  • Over-the-counter drugs not eligible for HSA, HRA, or FSA reimbursement
  • Mandatory preventive care in-network with no cost-sharing
  • Insurers subject to medical loss ratio rules
  • No pre-existing condition limitations for enrollees up to age 19
  • 20% tax penalty on unqualified HSA distributions
  • Non-discrimination provisions for insured plans
  • Form W-2 reporting for health coverage
  • Employers to distribute uniform summary of coverage
  • Coverage for additional women’s preventive care services
  • Employers to provide 60-day notice of material modifications
  • Comparative effectiveness group health plan fees begin
  • $2,500 health FSA contribution cap (indexed)
  • Employers notify employees about exchanges
  • Higher Medicare payroll tax on wages exceeding $200,000/individual or $250,000/couples
  • Change in Medicare retiree drug subsidy
  • State-based exchanges for individuals and small groups (1 – 100)
  • Individual coverage mandate
  • Employer responsibility (“pay or play” 50 employees or more)
  • Dependent coverage to age 26 for any covered employee’s child
  • Limit waiting periods to 90 days
  • Subsidies in exchange for lower-income individuals
  • Require employers with more than 200 employees to automatically enroll employees
  • No annual dollar limits
  • Medicaid expansion
  • Additional reporting and disclosure
  • No pre-existing condition limits
Coming in 2018
  • 40% excise tax on “high cost” or Cadillac coverage