Lockton Health Reform Employee Communications Toolkit

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1 Lockton Health Reform Employee Communications Toolkit L O C K T O N C O M P A N I E S

2 Lockton Health Reform Employee Communications Toolkit CONNECT WITH LOCKTON Follow Lockton Companies for important benefits news and information. and watch for benefits news and updates. Like Lockton Companies on Facebook to see what s happening. Subscribe to the Lockton Health Reform and Compliance Services Blog for breaking news (LocktonHealthReformBlog.com). Get to know all of the Lockton Benefit Group experts on YouTube (look for Lockton Companies we have our own channel).

3 Lockton Health Reform Employee Communications Toolkit INTRODUCTION... 5 INDIVIDUAL MANDATE LETTER/MEMO... 6 POWERPOINT SLIDES... 8 POSTCARD POSTER WHAT ARE EHB AND MEC? LETTER/MEMO POWERPOINT SLIDES POSTCARD POSTER PUBLIC INSURANCE EXCHANGES INSTRUCTIONS FOR PROVIDING MODEL NOTICES REGARDING PUBLIC HEALTH INSURANCE MARKETPLACES/EXCHANGES MODEL NOTICE FOR COMPANIES WITH PLANS... MODEL NOTICE FOR COMPANIES WITH PLANS (SPANISH) MODEL NOTICE FOR COMPANIES WITHOUT PLANS... MODEL NOTICE FOR COMPANIES WITHOUT PLANS (SPANISH) POWERPOINT SLIDES POSTCARD POSTER POTENTIAL OPTIONS FOR 2014 LETTER/MEMO POWERPOINT SLIDES POSTCARDS (2) POSTERS (2) WHAT S HAPPENING TO THE CURRENT PLAN LETTER/MEMO POWERPOINT SLIDES POSTCARDS (3) POSTERS (3)... 77

4 Lockton Health Reform Employee Communications Toolkit WHAT DOES AN EMPLOYEE NEED TO DO? LETTER/MEMO POWERPOINT SLIDES POSTCARD POSTER EMPLOYEES WHO DON T HAVE COVERAGE LETTER/MEMO POWERPOINT SLIDES POSTCARD POSTER INFORMATION FOR VARIABLE-HOUR EMPLOYEES LETTER/MEMO POWERPOINT SLIDES POSTCARD POSTER GLOSSARY LETTER/MEMO POWERPOINT SLIDES FREQUENTLY ASKED QUESTIONS LETTER/MEMO POWERPOINT SLIDES TIMELINE LETTER/MEMO POWERPOINT SLIDES LETTER/MEMO FROM HR TO SENIOR MANAGEMENT LETTER/MEMO FROM HR TO CEO

5 Lockton Health Reform Employee Communications Toolkit INTRODUCING THE LOCKTON HEALTH REFORM EMPLOYEE COMMUNICATIONS TOOLKIT At Lockton, we know the challenges of health reform can be daunting. And keeping your employees informed with easy-to-digest communications can be time-consuming. So with this Health Reform Employee Communications Toolkit, we are happy to provide you with the foundations of an employee communications plan. We hope it will both ease your administrative burden and help keep your employees informed about the basic tenets of the health reform law. This toolkit was designed for maximum flexibility and ease of customization. Add your logo, change the font, insert your company name. There are more than a dozen individual employee communication pieces, many of which are available in multiple formats. Formats include: Standard Word documents for use as an , memo, or letter. Posters for display in a break room or lunchroom. Postcards for mailing to employees homes. PowerPoint slides for use in presentations. Spanish versions of these communications will soon be available. These communications were reviewed by our Compliance Services team. We will periodically review and refresh the content, to keep up with the implementation of the health reform law. Video formats are under development. To share enhancement ideas, please contact your Lockton Account Service Team or Jeannie Wilcox, Director of Communications.

6 Health Reform: Individual Mandate Summary January 1, 2014, the health reform law s individual mandate takes effect. What does the individual mandate mean to you? This part of the law requires most individuals to have health insurance. If you do not have health insurance, you will pay a penalty. If you have a family, your family members must also have health insurance. What health insurance plans meet the requirements for the individual mandate? Most employer group health plans, including <Company Name> s plan An individual health insurance policy obtained through a public health insurance marketplace/exchange or elsewhere A government plan such as Medicare, Medicaid, Children s Health Insurance Program (CHIP), TRICARE, or veterans coverage Student health coverage Medicare Advantage plan State high-risk pool coverage Coverage for non-u.s. citizens provided by another country Refugee medical assistance provided by Administration for Children and Families Coverage for AmeriCorps volunteers Does <Your Company> s group health plan meet the requirement? Yes, coverage under our group health plan meets the individual mandate requirement, therefore you have no penalty if you enroll under our plan. OR No, coverage under our company s plan does not meet the individual mandate requirement. <insert options for employees here> ANY STREET WEST, TOWNSVILLE, ST 54321

7 What is the penalty for not complying with the law? If you do not enroll in and maintain insurance for yourself and your dependents you may be required to pay an annual penalty (prorated for the number of months of the year during which you don t have coverage). Penalty YEAR ADULT CHILD* FAMILY* MAXIMUM PENALTY* 2014 $95 per adult $47.50 per child $285 1 percent of family income OR 2015 $325 per adult $ per child $975 2 percent of family income 2016 $695 per adult $ per child $2, percent of family income *Penalty is the greater of the dollar amount or percentage of income. You may be exempt from a penalty if any of the following apply: You cannot afford coverage (would have to pay more than eight percent of annual household income to purchase health insurance after taking into account any employer contributions and subsidies). Your income is below the tax-filing threshold. You qualify for a hardship exemption. You experience a gap in coverage of less than three consecutive months in one calendar year. You are a member of religious group that objects to coverage on religious principles. You are a member of non-profit religious organization that shares medical costs. You are in prison. You are a non-u.s. citizen. You are a Native American tribe member. If you think you qualify for an exemption, please visit for more information ANY STREET WEST, TOWNSVILLE, ST 54321

8 Health Reform The Individual Mandate

9 Summary January 1, 2014, the health reform law s individual mandate takes effect. 2

10 What Does the Individual Mandate Mean to You? Requires most individuals to have health insurance If you do not, you will pay a penalty Family members must have health insurance too 3

11 What Health Insurance Plans Meet the Requirements for the Individual Mandate? Most employer group health plans, including <Company Name s> plan An individual health insurance policy obtained through a public health insurance marketplace/exchange or elsewhere A government plan such as Medicare, Medicaid, Children s Health Insurance Program (CHIP), TRICARE, or veterans coverage Student health coverage Medicare Advantage plan State high-risk pool coverage Coverage for non-u.s. citizens provided by another country Refugee medical assistance provided by Administration for Children and Families Coverage for AmeriCorps volunteers 4

12 Does <Your Company> s Group Health Plan Meet the Requirement? Yes, coverage under our group health plan meets the individual mandate requirement, therefore you have no penalty if you enroll under our plan. OR No, coverage under our company s plan does not meet the individual mandate requirement. <Insert options for employees here.> 5

13 What is the Penalty for Not Complying with the Law? You (and/or your dependents) may be required to pay an annual penalty. Prorated for the number of months of the year during which you don t have coverage 6

14 Penalty Penalty YEAR ADULT CHILD* FAMILY* MAXIMUM PENALTY* 2014 $95 per adult $47.50 per child $285 1 percent of family income 2015 $325 per adult $ per child $975 2 percent of family income OR 2016 $695 per adult $ per child $2, percent of family income *Penalty is the greater of the dollar amount or percentage of income. 7

15 You May be Exempt From a Penalty if Any of the Following Apply: You cannot afford coverage (would have to pay more than eight percent of annual household income to purchase health insurance after taking into account any employer contributions and subsidies). Your income is below the tax-filing threshold. You qualify for a hardship exemption. You experience a gap in coverage of less than three consecutive months in one calendar year. You are: A member of religious group that objects to coverage on religious principles. A member of nonprofit religious organization that shares medical costs. In prison. A non U.S. citizen. A Native American tribe member. If you think you qualify for an exemption, please visit for more information. 8

16 Did You Know? Here s Information About the Health Reform Law

17 PRST-STD U.S. POSTAGE PAID CITY, ST PERMIT NO. XXX The health reform law s individual mandate takes effect January 1, What s that mean to YOU? This part of the law requires most people to have health insurance. If you don t, you ll pay a penalty. If you have a family, your family members must have health insurance too. To learn more, ask our HR Department. <Contact Info>

18 Did You Know? The health reform law s individual mandate takes effect January 1, What s that mean to YOU? This part of the law requires most people to have health insurance. If you don t, you ll pay a penalty. If you have a family, your family members must have health insurance too. To learn more, ask our HR Department

19 What are Essential Health Benefits and Minimum Essential Coverage? You have been hearing about the health reform law, much of which takes effect January 1, Two key terms you may hear a lot about are Minimum Essential Coverage and Essential Health Benefits. Although they sound similar, each has a very different meaning and implication under health reform. Minimum Essential Coverage (MEC) is the coverage needed to satisfy the law s individual mandate (the law requires almost everyone in America to have health insurance or pay a fine). Your companysponsored health coverage is MEC. So you will not be subject to the individual mandate penalty for any month for which you are enrolled in the company-sponsored health plan. Essential Health Benefits (EHB) are 10 categories of benefits that, if offered under your companysponsored health plan, must be covered with no annual or lifetime dollar limits: 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance abuse disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services and chronic disease management 10. Pediatric services, including oral and vision care A common assumption is that minimum essential coverage must include essential health benefits. But the two concepts are not directly related. Just because coverage is minimum essential coverage does not automatically mean it must include essential health benefits. As it happens, however, your companysponsored health plan covers <all><nearly all> essential health benefits ANY STREET WEST, TOWNSVILLE, ST 54321

20 Health Reform What Are Essential Health Benefits and Minimum Essential Coverage?

21 Two Terms, Very Different Two key terms: Minimum Essential Coverage (MEC) Essential Health Benefits (EHB) Sound similar, but each has a very different meaning and implication under health reform. 2

22 Minimum Essential Coverage (MEC) Minimum Essential Coverage (MEC) Coverage needed to satisfy the law s individual mandate. Your company-sponsored health coverage is minimum essential coverage. You will not be subject to the individual mandate penalty for any month in which you are enrolled in the company-sponsored health plan. 3

23 Essential Health Benefits (EHB) Essential Health Benefits (EHB) Ten categories of benefits that, if offered under your company-sponsored health plan, must be covered with no annual or lifetime dollar limits: 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance abuse disorder services, including behavioral health treatment 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 9. Preventive and wellness services and chronic disease management 10. Pediatric services, including oral and vision care 4

24 Common Assumption About MEC/EHB A common assumption is that minimum essential coverage must include essential health benefits. The two concepts are not directly related. Just because coverage is minimum essential coverage does not automatically mean it must include essential health benefits. However, your company-sponsored health plan covers <all><nearly all> essential health benefits. 5

25 Did You Know? Here s Information About the Health Reform Law

26 PRST-STD U.S. POSTAGE PAID CITY, ST PERMIT NO. XXX WHAT S THE DIFFERENCE BETWEEN MEC & EHB? Heard about the health reform law-related terms EHB and MEC and wondered what they meant? Here you go! Minimum Essential Coverage (MEC) is the coverage you need to satisfy the health reform law s individual mandate. The law requires almost everyone in America to have health insurance or pay a fine. Your companysponsored health coverage is minimum essential coverage. Essential Health Benefits (EHB) are 10 categories of benefits that, if offered under your company-sponsored health plan, must be covered with no annual or lifetime dollar limits. To learn more, ask our HR Department. <Contact Info>

27 Did You Know? WHAT S THE DIFFERENCE BETWEEN MEC & EHB? Heard about the health reform law-related terms EHB and MEC and wondered what they meant? Here you go! Minimum Essential Coverage (MEC) is the coverage you need to satisfy the health reform law s individual mandate. The law requires almost everyone in America to have health insurance or pay a fine. Your company-sponsored health coverage is minimum essential coverage. Essential Health Benefits (EHB) are 10 categories of benefits that, if offered under your company-sponsored health plan, must be covered with no annual or lifetime dollar limits. These include: Ambulatory patient services; Emergency services; Hospitalization; Maternity and newborn care; Mental health and substance abuse disorder services, including behavioral health treatment; Prescription drugs; Rehabilitative and habilitative services and devices; Laboratory services; Preventive and wellness services and chronic disease management; and Pediatric services, including oral and vision care. To learn more, ask our HR Department

28 Public Health Insurance Marketplaces/Exchanges Instructions for Providing Model Notices Regarding Public Health Insurance Marketplaces/Exchanges The obligation to inform employees about the public health insurance exchanges applies to employers subject to the Fair Labor Standards Act (FLSA). Please see the Lockton Health Reform Advisory Practice Alert from May 15, 2013, for more information, including: Who gives and receives the notice What must the notice include, and When and how employers must supply the notice Please also see the Lockton Health Reform Advisory Practice Alert from August 9, 2013, for answers to frequently asked questions about public exchange (marketplace) communications.

29 New Health Insurance Marketplace Coverage Options and Your Health Coverage Form Approved OMB No (expires ) PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. 1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. How Can I Get More Information? For more information about your coverage offered by your employer, please check your summary plan description or contact. The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. 1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

30 PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. 3. Employer name 4. Employer Identification Number (EIN) 5. Employer address 6. Employer phone number 7. City 8. State 9. ZIP code 10. Who can we contact about employee health coverage at this job? 11. Phone number (if different from above) 12. address Here is some basic information about health coverage offered by this employer: As your employer, we offer a health plan to: All employees. Some employees. Eligible employees are: With respect to dependents: We do offer coverage. Eligible dependents are: We do not offer coverage. If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages. ** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses, you may still qualify for a premium discount. If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here's the employer information you'll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.

31 The information below corresponds to the Marketplace Employer Coverage Tool. Completing this section is optional for employers, but will help ensure employees understand their coverage choices but will help ensure employees understand their coverage choices. 13. Is the employee currently eligible for coverage offered by this employer, or will the employee be eligible in the next 3 months? Yes (Continue) 13a. If the employee is not eligible today, including as a result of a waiting or probationary period, when is the employee eligible for coverage? No (STOP and return this form to employee) (mm/dd/yyyy) (Continue) 14. Does the employer offer a health plan that meets the minimum value standard*? Yes (Go to question 15) No (STOP and return form to employee) 15. For the lowest-cost plan that meets the minimum value standard* offered only to the employee (don't include family plans): If the employer has wellness programs, provide the premium that the employee would pay if he/ she received the maximum discount for any tobacco cessation programs, and didn't receive any other discounts based on wellness programs. a. How much would the employee have to pay in premiums for this plan? $ b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly If the plan year will end soon and you know that the health plans offered will change, go to question 16. If you don't know, STOP and return form to employee. 16. What change will the employer make for the new plan year? Employer won't offer health coverage Employer will start offering health coverage to employees or change the premium for the lowest-cost plan available only to the employee that meets the minimum value standard.* (Premium should reflect the discount for wellness programs. See question 15.) a. How much will the employee have to pay in premiums for that plan? $ b. How often? Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly Date of change (mm/dd/yyyy): An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs (Section 36B(c)(2)(C)(ii) of the Internal Revenue Code of 1986)

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35 New Health Insurance Marketplace Coverage Options and Your Health Coverage Form Approved OMB No (expires ) PART A: General Information When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace. What is the Health Insurance Marketplace? The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, Can I Save Money on my Health Insurance Premiums in the Marketplace? You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income. Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace? Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit. 1 Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis. How Can I Get More Information? The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area. 1 An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

36 PART B: Information About Health Coverage Offered by Your Employer This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application. 3. Employer name 4. Employer Identification Number (EIN) 5. Employer address 6. Employer phone number 7. City 8. State 9. ZIP code 10. Who can we contact at this job? 11. Phone number (if different from above) 12. address You are not eligible for health insurance coverage through this employer. You and your family may be able to obtain health coverage through the Marketplace, with a new kind of tax credit that lowers your monthly premiums and with assistance for outof-pocket costs.

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39 Health Reform Public Health Insurance Marketplaces/Exchanges

40 Please read this entire communication before distributing to ensure it matches your company s strategy.

41 Information About Health Insurance Marketplaces/Exchanges When key parts of the health reform law take effect January 1, 2014, you will have a new way to get health insurance. Public health insurance marketplace/exchange Compare available plan options based on price, benefits, and quality. Each state is required by the law to have a marketplace available for benefits coverage in If a state is not prepared to operate a marketplace by that date, the federal government intends to operate the marketplace for the state s residents <Insert optional text here regarding specific open enrollment and effective dates for the marketplace in the relevant state(s)> 3

42 Potential Financial Assistance in the Marketplace Financial assistance in the form of advance tax credits may be available (to purchase a health plan) If household income is >100 percent, but <400 percent of federal poverty level, and you meet other requirements, you might be eligible for a tax credit Tax credit amounts vary based on household income. If your income is at or below 133 percent of the federal poverty level, you might be eligible for Medicaid. Cost-sharing subsidies may also be available to you Financial assistance in paying out-of-pocket plan costs like deductibles, copayments, etc. More information about tax credits and subsidies: 4

43 <Optional Text> Employers that will offer NO coverage After careful consideration, <COMPANY NAME> has decided not to offer health insurance. A premium tax credit may be available to you through the insurance marketplace serving your state. Enter your information into the subsidy calculator to determine if you are eligible for a subsidy. Employers that WILL offer coverage <COMPANY NAME> will offer health insurance to all employees working 30 or more hours per week. In compliance with the health reform law, the <COMPANY NAME> medical plan(s) are considered both qualifying and affordable to you, which means you will not qualify for a tax credit to help you purchase health insurance through the marketplace. Thus, if you purchase coverage through the marketplace, you will have to pay the full cost of the coverage yourself. Employers that offer coverage but want to mention the marketplace <COMPANY NAME> will offer health insurance to all employees working 30 or more hours per week. You also have the option to purchase insurance through the health insurance marketplace, and you may be eligible for a tax credit if our coverage requires you to spend more than 9.5 percent of your household income for employee-only coverage, or is not considered adequately robust under the health reform law (note, however, that we believe our employee-only coverage rate does not require you to pay more than 9.5 percent of your household income, and is considered adequate under the health reform law). Please visit for more information. 5

44 <Optional Text> Could apply to any employer <COMPANY NAME> provides you the option to pay for your health insurance on a pre-tax basis, which in turn lowers your taxable income. Please be aware that coverage purchased through the marketplace is paid for on a post-tax basis. Non-calendar plan year employers who will allow one-time, mid-year changes to a health insurance marketplace <COMPANY NAME> will provide you with a one-time opportunity to drop coverage through our health plan and elect coverage through the health insurance marketplace, if you choose to do that. Your next opportunity to elect coverage through the health insurance marketplace will be during an open enrollment period. <OPTIONAL TEXT FOR CLOSING> We realize that selecting the right health insurance is a complex decision, and we will continue to update you with more information about the marketplace as it becomes available. If you have questions about your benefit options or the health reform law, please contact Human Resources or visit 6

45 Frequently Asked Questions Who can purchase coverage through the marketplace? Anyone can purchase coverage through the marketplace. Who is eligible for a financial assistance to purchase coverage through the marketplace? Financial assistance may be available to people who are not offered qualifying and affordable coverage through their employers, and not enrolled in any employer-based plan. If your household income is between 100 and 400 percent of the federal poverty level, you might be eligible for financial assistance. Financial assistance amounts vary based on household income. If your income is at or below 133 percent of the federal poverty level, you might be eligible for Medicaid. What type of plans will be offered through the marketplace? Every health insurance plan in the marketplace will offer comprehensive coverage fulfilling the health reform law s individual mandate. 7

46 Frequently Asked Questions Is coverage through the marketplace free? No. Financial assistance in the form of tax credits may be available to people who are not offered qualifying and affordable coverage through their employer, are not enrolled in an employer-based health plan, and whose income is less than 400 percent of the federal poverty level. Individuals and families with incomes at or below 133 percent of the federal poverty level may be eligible for Medicaid, and won t qualify for financial assistance to purchase an insurance policy in a Marketplace. Health insurance plans purchased through the marketplace are paid for on a post-tax basis. How can I buy coverage through the marketplace? You can apply for and enroll in coverage online, in person, by phone, fax, or mail. My employer offers family coverage, and the employee-only tier of coverage is considered qualifying and affordable. Is my spouse eligible for financial assistance through the marketplace? Generally, no. If an employer offers family or employee-plus-spouse coverage, and the employee-only tier of coverage is considered both qualifying and affordable, your spouse does not qualify for financial assistance in the marketplace. This goes for other of your dependents (such as children) as well. 8

47 Did You Know? Here s Information About the Health Reform Law

48 PRST-STD U.S. POSTAGE PAID CITY, ST PERMIT NO. XXX When key parts of the health reform law take effect January 1, 2014, you will have a new way to get health insurance. You can shop for coverage through a public health insurance marketplace or exchange. Each state will have one, and this marketplace will help you compare available plan options, based on price, benefits, and quality. To learn more, ask our HR Department. <Contact Info>

49 Did You Know? When key parts of the health reform law take effect January 1, 2014, you will have a new way to get health insurance. You can shop for coverage through a public health insurance marketplace or exchange. Each state will have one, and this marketplace will help you compare available plan options, based on price, benefits, and quality. To learn more, ask our HR Department

50 Options to Purchase Health Insurance January 2014 On January 1, 2014, a key component of the health reform law will take effect: Everyone in the U.S. (with a few exceptions) will be required to have health insurance. [FOR EMPLOYER WITH QUALIFYING AND AFFORDABLE PLAN] <COMPANY NAME> will continue to offer health insurance for eligible employees. This coverage meets all of the health reform law requirements to satisfy your individual mandate under the reform law. We hope to keep offering this benefit as a valuable part of your total compensation. In 2014, you will also have other options to purchase health insurance, but because we offer you coverage that satisfies all the health reform requirements, you will not qualify for any federal assistance to purchase an individual or family policy on the open market. These other options include: Insurance policies via a public health insurance marketplace/exchange Private health insurance marketplaces/exchanges Insurance policies directly from health insurers and brokers Please see the details below. Options to Purchase Health Insurance Public health insurance marketplaces/exchanges You can shop for coverage in an online public health insurance marketplace/exchange and compare available policies based on price, benefits, and quality. Each state is required to have an online public marketplace available for health insurance coverage in 2014 (if a state does not establish one, the federal government will operate an exchange for the state s residents). Because <COMPANY NAME> offers you coverage that satisfies all requirements under the health reform law, you and your dependents will not qualify for federal financial assistance (premium tax credits) for any coverage you purchase on the public exchange. Private marketplaces/exchanges A variety of private exchanges will serve as marketplaces where you can compare health plans and buy coverage. For example, an insurance company might create a private exchange that serves some of the same functions as a public exchange, but cannot offer federal financial assistance to individuals purchasing coverage. In addition, some health insurance companies are opening retail stores where you can shop for a policy, check on claims and get oneon-one health education coaching ANY STREET WEST, TOWNSVILLE, ST 54321

51 Health insurers and brokers Health insurance companies will sell plans directly to you through their own websites and call centers. In addition, even though you will be able to shop for yourself through the exchanges, you can enlist the assistance of an insurance agent or broker. OR [FOR EMPLOYER WITHOUT PLAN] You will have many options for finding and enrolling in the right coverage, but the law does not require you to get health insurance coverage differently than you do today. For example, if you currently have coverage as a dependent on your spouse s or parent s employer s plan, the regulations do not require you to make any changes. As long as you have minimum essential coverage <link to that document> to meet regulation requirements, you will not be subject to the individual mandate penalty. In 2014 you will have the following options to purchase health insurance: Public health insurance marketplace/exchange Private health insurance marketplace/exchange Insurance policies directly from health insurers and brokers Please see the details below. Options to Purchase Health Insurance Public health insurance marketplaces/exchanges You can shop for coverage in an online public health insurance marketplace/exchange and compare available policies based on price, benefits, and quality. Each state is required to have an online public marketplace available for health insurance coverage in 2014 (if a state does not establish one, the federal government will operate an exchange for the state s residents). Private marketplaces/exchanges A variety of private exchanges will serve as marketplaces where you can compare health plans and buy coverage. For example, an insurance company might create a private exchange that serves some of the same functions as a public exchange, but cannot offer federal financial assistance to individuals purchasing coverage. In addition, some health insurance companies are opening retail stores where you can shop for a policy, check on claims and get oneon-one health education coaching. Health insurers and brokers Health insurance companies will sell plans directly to you through their own websites and call centers. In addition, even though you will be able to shop for yourself through the exchanges, you can enlist the assistance of an insurance agent or broker ANY STREET WEST, TOWNSVILLE, ST 54321

52 Health Reform Options to Purchase Health Insurance January 2014

53 Please read this entire communication before distributing to determine which choice matches your company s strategy.

54 For Employer With Qualifying and Affordable Plan <COMPANY NAME> will continue to offer health insurance for eligible employees. Satisfies your individual mandate under the reform law. In 2014 you will have other options to purchase health insurance No federal assistance to purchase an individual or family policy on the open market 3

55 For Employer With Qualifying and Affordable Plan Other options include: Public health insurance marketplace/exchange Compare available policies based on price, benefits, and quality Each state is required to have an online public marketplace available in 2014 If a state does not establish one, the federal government will operate an exchange for the state s residents Because <COMPANY NAME> offers you coverage that satisfies all requirements under the health reform law, you and your dependents will not qualify for federal financial assistance (premium tax credits) for any coverage you purchase on the public exchange Private health insurance marketplaces/exchanges A variety of private exchanges will serve as marketplaces where you can compare health plans and buy coverage Directly from health insurers and brokers Health insurance companies will sell plans directly to you You can also enlist the assistance of an insurance agent or broker 4

56 ---OR---For Employer Without Plan You will have many options for finding and enrolling in the right coverage Law does not require you to get health insurance coverage differently than you do today For example, if you currently have coverage as a dependent on your spouse s or parent s employer s plan, the regulations do not require you to make any changes As long as you have minimum essential coverage <link to that document> to meet regulation requirements, no individual mandate penalty 5

57 For Employer Without Plan Options to purchase health insurance in 2014 Public health insurance marketplace/exchange Compare available policies based on price, benefits, and quality Each state is required to have an online public marketplace available in 2014 If a state does not establish one, the federal government will operate an exchange for the state s residents Private health insurance marketplaces/exchanges A variety of private exchanges will serve as marketplaces where you can compare health plans and buy coverage Directly from health insurers and brokers Health insurance companies will sell plans directly to you You can also enlist the assistance of an insurance agent or broker 6

58 Did You Know? For Employer With Qualifying and Affordable Plan Here s Information About the Health Reform Law

59 PRST-STD U.S. POSTAGE PAID CITY, ST PERMIT NO. XXX On January 1, 2014, a key component of the health reform law will take effect: Everyone in the U.S. (with a few exceptions) will be required to have health insurance. We will continue to offer health insurance for eligible employees. You will also have other options to purchase health insurance, but because we offer you coverage that satisfies all the health reform requirements, you will not qualify for any federal assistance to purchase an individual or family policy on the open market. Your other options include: Insurance policies via a public health insurance marketplace/exchange Private health insurance marketplaces/exchanges Insurance policies directly from health insurers and brokers To learn more, ask our HR Department.<Contact Info>

60 Did You Know? For Employer Without Plan Here s Information About the Health Reform Law

61 PRST-STD U.S. POSTAGE PAID CITY, ST PERMIT NO. XXX In 2014, you will have many options for finding and enrolling in the right coverage, but the law does not require you to get health insurance coverage differently than you do today. For example, if you currently have coverage as a dependent on your spouse s or parent s employer s plan, the regulations do not require you to make any changes. You will have other options, which include: Insurance policies via a public health insurance marketplace/exchange Private health insurance marketplaces/exchanges Insurance policies directly from health insurers and brokers To learn more, ask our HR Department. <Contact Info>

62 Did You Know? For Employer With Qualifying and Affordable Plan On January 1, 2014, a key component of the health reform law will take effect: Everyone in the U.S. (with a few exceptions) will be required to have health insurance. We will continue to offer health insurance for eligible employees. You will also have other options to purchase health insurance, but because we offer you coverage that satisfies all the health reform requirements, you will not qualify for any federal assistance to purchase an individual or family policy on the open market. Your other options include: Insurance policies via a public health insurance marketplace/exchange Private health insurance marketplaces/exchanges Insurance policies directly from health insurers and brokers To learn more, ask our HR Department

63 For Employer Without Plan Did You Know? In 2014 you will have many options for finding and enrolling in the right coverage, but the law does not require you to get health insurance coverage differently than you do today. For example, if you currently have coverage as a dependent on your spouse s or parent s employer s plan, the regulations do not require you to make any changes. Your will have other options, which include: Insurance policies via a public health insurance marketplace/exchange Private health insurance marketplaces/exchanges Insurance policies directly from health insurers and brokers To learn more, ask our HR Department

64 What s Happening To The Current Plan? CHOOSE ONE OPTION ONE: <Company Name> will continue to offer a health plan to our employees. The health reform law is changing the healthcare landscape as we know it. You and your dependents are required to have health insurance beginning January 1, 2014, which will coincide with coverage availability through the public health insurance marketplaces/exchanges. Some of you may be worried that <Company Name> will force our employees to the marketplace/exchange, but let us assure you, we have no plans to terminate the <Company Name> health plan (but of course reserve the right to consider that later). We expect health plan costs to rise. With the requirements of health reform, we expect the cost of the health plan to increase. Included in the health reform law are fees, taxes, and mandates that have direct or indirect impacts on our overall plan costs. While we cannot say exactly what the increase will be, we predict a(n) <range of # to # percent>. OPTIONAL <Company Name> will share the additional costs with our employees. This may mean some changes to the health plan offering. In order to manage the expected cost increases, we may make adjustments to the health plan offering. We will supply you with information on any changes if they occur. OPTION TWO: <Company Name> may not offer a health plan to all employees (e.g., those working fewer than 30 hours). The health reform law is changing the healthcare landscape as we know it. You and your dependents are required to have health insurance beginning January 1, 2014, which will coincide with coverage availability through the public health insurance marketplaces/exchanges. <COMPANY NAME> will offer health insurance to eligible employees working 30 or more hours per week. You also have the option to purchase insurance through the public health insurance marketplace/exchange, and you may be eligible for federal financial assistance. Please visit for more details. We will also provide more information as it becomes available ANY STREET WEST, TOWNSVILLE, ST 54321

65 We expect health plan costs to rise. With the requirements of health reform, we expect the cost of the health plan to increase. Included in the health reform law are fees, taxes, and mandates that have direct or indirect impacts on our overall plan costs. While we cannot say exactly what the increase will be, we predict a(n) <range of # to # percent>. OPTIONAL <Company Name> will share the additional costs with our employees. This may mean some changes to the health plan offering. In order to manage the expected cost increases, we may make adjustments to the health plan offering. We will supply you with information on any changes if they occur. OPTION THREE: <Company Name> will not offer a health plan to our employees in The health reform law is changing the healthcare landscape as we know it. You and your dependents are required to have health insurance beginning January 1, 2014, which will coincide with coverage availability through the public health insurance marketplaces/exchanges. Based on the increase in projected cost, an employer-sponsored health plan will not be offered by <Company Name> in However, you have many options for obtaining healthcare. For example, you may be able to obtain coverage through a: Public health insurance marketplace/exchange Government program such as Medicare, Medicaid, Children s Health Insurance Program (CHIP), TRICARE, or veterans coverage Student health coverage Medicare Advantage plan State high-risk pool coverage Plan for non-u.s. citizens, provided by another country Refugee medical assistance provided by Administration for Children and Families Plan for AmeriCorps volunteers OPTIONAL <Company Name> will provide <these services> to help ensure you reach your personal insurance coverage goals ANY STREET WEST, TOWNSVILLE, ST 54321

66 Health Reform What s Happening to Our Current Health Plan?

67 Please choose the applicable verbiage.

68 Option One <Company Name> will continue to offer a health plan to our employees. The health reform law is changing the healthcare landscape. You and your dependents are required to have health insurance beginning January 1, Same time as availability of public health insurance marketplaces/exchanges. We have no plans to terminate the <Company Name> health plan (but reserve the right to consider that later). We expect health plan costs to rise. With the requirements of health reform, we expect the cost of the health plan to increase. Included in the law are fees, taxes, and mandates. We predict a(n) <range of # to # percent> increase. OPTIONAL <Company Name> will share the additional costs with our employees. This may mean some changes to the health plan offering. We may make adjustments to the health plan offering. We will supply you with information on any changes, if they occur. 3

69 Option Two <Company Name> may not offer a health plan to all employees (e.g., those working fewer than 30 hours). The health reform law is changing the healthcare landscape. You and your dependents are required to have health insurance beginning January 1, <COMPANY NAME> will offer health insurance to eligible employees working 30 or more hours per week. You also have the option to purchase insurance through the public health insurance marketplace/exchange. You may be eligible for federal financial assistance. Please visit for more details. We will also provide more information as it becomes available. We expect health plan costs to rise. With the requirements of health reform, we expect the cost of the health plan to increase. Included in the law are fees, taxes, and mandates. We predict a(n) <range of # to # percent> increase. OPTIONAL <Company Name> will share the additional costs with our employees. This may mean some changes to the health plan offering. We may make adjustments to the health plan offering. We will supply you with information on any changes, if they occur. 4

70 Option Three <Company Name> will not offer a health plan to our employees in 2014 based on the increase projected. The health reform law is changing the healthcare landscape. You and your dependents are required to have health insurance beginning January 1, Same time as coverage availability through public health insurance marketplaces/ exchanges. Many options for obtaining healthcare. Public health insurance marketplace/exchange. Government program such as Medicare, Medicaid, Children s Health Insurance Program (CHIP), TRICARE, or the VA. Student health coverage. Medicare Advantage plan. State high-risk pool coverage. Plan for non-u.s. citizens, provided by another country. Refugee medical assistance provided by Administration for Children and Families. Plan for AmeriCorps volunteers. OPTIONAL <Company Name> will provide <these services> to help ensure you reach your personal insurance coverage goals. 5

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