Just when employers begin to feel they are getting a handle on the Patient Protection and Affordable Care Act (PPACA), an analysis by the National Council on Compensation Insurance, Inc. (NCCI) injects another consideration. The analysis concludes that decisions by employers on the implementation of the PPACA could affect Workers' Compensation premiums.
A March NCCI advisory notes that because administrative options will influence underwriters' tabulation of policy holders' payrolls and premiums, how employers comply with the law "has the potential to affect an employers' Workers' Compensation delineation." Employers' total payroll is a major determinant of premium in NCCI-rated states. Any cash an employer gives to employees as part of their gross wages to buy their own insurance, such as through an exchange, would be considered payroll.
In contrast, employers' payments to group health plans would not be included as payroll when determining Workers' Compensation premiums. Another factor is the rebates employers may receive from health insurers, which do not meet the premium percentage thresholds for spending on claims and quality improvements. This is known as the Medical Loss Ratio (MLR).
When employers that receive a MLR give the full rebate, or a portion thereof, to employees, the full or portion rebate amount is included in payroll for the purpose of determining the employer's Workers' Compensation premium. On the other hand, if the employer receives an MLR rebate from the health insurance provider and applies or uses the full rebate, or any portion of the rebate, for future health insurance premiums for the employee that full or portion rebate amount is excluded from payroll for the purpose of determining the employer's Workers 'Compensation premium.
The advisory also notes: "With regards to the employer handling of MLR rebates and health insurance coverage payments or contributions, it is important to note that per NCCI's standard Workers' Compensation and Employers Liability Insurance Policy, Part Five-Premium, an employer is required to keep records of information needed to compute premium. In addition, the employer must provide those records to the carrier, when requested, for the purpose of auditing the employer's Workers' Compensation policy."
NCCI provides rating service for 38 states and undertook this analysis to help insurers and agents understand the payroll effect and to help employers learn how their group health insurance purchasing decision might influence Workers' Compensation costs.