Affordable Care Act Toolkit

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1 Affordable Care Act Toolkit for Businesses with less than 50 employees Choose coverage that fits. Form No (07-14)

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3 Small Groups The Affordable Care Act Blue Cross of Idaho prepared this toolkit to help you define where your business fits in the Affordable Care Act (ACA) and understand how the law will impact the coverage you offer your employees. What does it mean for you? The ACA is the final version of healthcare reform legislation passed by Congress and signed into law in Some of these regulations took effect immediately, while others were rolled out over the last few years. The individual mandate took effect on January 1, 2014, and we expect regulations that impact employers to take effect over the next few years. Blue Cross of Idaho will continue to implement ACA changes and provide you with information about the new regulations and their impact on your health insurance. Impacts of the ACA At its core, the federal government is trying to do three primary things through the ACA: IMPACTS OF THE Affordable Care Act The information in this toolkit is a general overview of the rules, regulations and consequences of the ACA. It may not address every aspect of the ACA that affects employers and their insurance and is not intended to be legal or tax advice. Ensure more people have access to and get health insurance coverage Set coverage standards for health insurance benefits Lower premium and out-of-pocket costs through subsidies Choose coverage that fits bcidaho.com 3

4 Understanding the ACA s Impact on Your Business Employers face the difficult task of determining whether or not it makes better financial sense to offer group health insurance to employees or leave it to employees to purchase individual coverage. If you determine that you have the equivalent of 50 or more full-time employees, please refer to our large-group toolkit for more information. With your specific employee and business information, we can create a strategic impact report that can help you see how the ACA affects your employees and your bottom line now and in the future. This report gives you: Premium and cost sharing estimates for employer-based plans vs. individual plans, Anticipated tax credits if you have less than 25 employees, Estimated impact on premium rates if you have less than 50 employees, Estimates of ACA eligibility and affordability for employees, Estimates on employee compensation needed to replace the value of the health plan, Pre- and post-tax implications of terminating current coverage, Your projected cadillac tax risk. To complete a study, you simply provide Blue Cross of Idaho with information about your employees and business and we do the rest. We can provide you a preformatted Excel file for you to easily enter the information we need. We can also help your broker enter the information if you would like. To get started, we need to know the following information: Your Business: Local income tax rate Workforce category (white or blue collar) For all of your employees: Salary/hourly wage Average weekly hours Premium contribution (employee and employer) HRA/HSA employer funding levels 4 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Small Groups

5 Small Groups For employees not currently covered by Blue Cross of Idaho we also need: Date of birth Zip code of residence Gender Marital status Number of children Grandfathered status If your plan was effective prior to March 23, 2010, it may be grandfathered under the ACA. If you have a grandfathered plan, you can continue offering your current coverage and avoiding some of the impacts of the ACA. However, changes you make to your existing health plan can affect its grandfathered status. In general, if you decrease coverage and/ or increase your employees cost-sharing responsibilities, your plan may lose its grandfathered status. If you are not grandfathered Small businesses with health insurance effective after March 23, 2010, but before January 1, 2014, are non-grandfathered under the ACA. Non-grandfathered plans were scheduled to end in 2014, but the federal government has decided to extend these plans through Blue Cross of Idaho will keep our small groups updated on the latest changes to this part of the ACA. For questions about grandfathered coverage, call your account manager, one of our statewide offices at or your health insurance agent. If you re interested in receiving a Blue Cross of Idaho analysis to assess the ACA s impact on your employees, contact your insurance broker or local Blue Cross of Idaho district office at Choose coverage that fits bcidaho.com 5

6 Get a Break on Costs Employer tax credit If you are a small or medium sized employer with up to 25 full-time equivalent employees (See Determining Your Group Size on page 4 to calculate your full-time equivalent employees.) you may be eligible for a tax credit to partially offset the cost of providing health insurance coverage for employees. If the average annual pay of your employees is less than $50,000 and you pay 50 percent or more of the cost of health insurance, your tax credit can be as much as 50 percent of what your company pays for health benefits today. 6 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Small Groups

7 Small Groups Regulations that may impact you Exchange notice Employers should provide employees with information about their health insurance, the Health Insurance Exchange, and possible financial assistance with the cost of insurance. Employees should receive notice within 14 days of beginning work. Blue Cross of Idaho provided group administrators with a template of this notice. Please contact us if you want a copy. Employee waiting period Probationary periods for new employees cannot exceed 90 calendar days. This means if you hire a new employee on June 1, his/her health insurance must begin no later than August 30. However, you can include an orientation period of 30 days to meet your enrollment timeline. Pediatric dental coverage The ACA requires certain small groups that offer health insurance to their employees to include qualified pediatric dental coverage for members under 19. The dental plans we currently offer do not include Pediatric Dental, an Essential Health Benefit under the ACA. What does this mean for you? If you currently provide a Blue Cross of Idaho dental plan and your medical coverage is grandfathered, you can keep your plan without needing to make any changes. If you currently provide a Blue Cross of Idaho dental plan and your medical coverage is not grandfathered, your options include the following: You may keep your existing dental coverage for anyone age 19 and older and add a qualified dental plan for pediatric members, or You may replace your current group dental coverage with a new qualified group plan that covers all of your participating employees and dependents, or You may keep your current group dental coverage with the knowledge that the dental plans we currently offer do not include Pediatric Dental, an Essential Health Benefit under the ACA. You do not need to have Blue Cross of Idaho group medical coverage to purchase a separate dental plan for your employees and their dependents. Blue Cross of Idaho products and services bcidaho.com The Idaho Health Insurance Exchange yourhealthidaho.org Choose coverage that fits bcidaho.com 7

8 The effects on Your company s coverage and services The following is a summary of Blue Cross of Idaho s coverage and plan changes resulting from the ACA. The information below is general and intended to provide an overall view of the ACA regulations and how Blue Cross of Idaho is responding. G NG New and non-grandfathered groups G Grandfathered NG groups Dependent age G NG G We NG extended coverage for dependent adult children up to age 26, regardless of marital status, income, financial status, educational status or place of residence. Pre-existing waiting periods In 2010, we stopped requiring waiting periods for pre-existing conditions G NG G for NG members under age 19. Effective at your group renewal in 2014, we will remove waiting periods for pre-existing conditions for all members regardless of age. Preventive health services G NG We cover preventive care services at 100 percent, not subject to deductible or coinsurance, when provided by an in-network provider. We also expanded covered preventive services to include additional women s health services. G Preventive health services We NG cover preventive care services at 100 percent, not subject to deductible or coinsurance, when provided by an in-network provider. Annual maximum limit on essential health benefits G NG G We NG removed annual dollar maximums from essential health benefits, including prescription drug services. 8 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Small Groups

9 Small Groups G NG New and non-grandfathered groups Lifetime benefit limits G NG G NG We removed all lifetime dollar maximum limits. Summary of benefits & coverage (SBCs) G Grandfathered NG groups Blue Cross of Idaho provides individual members, employer groups and potential members access to a uniform overview of their health insurance G NG G coverage. NG These materials contain a short, easy-to-understand summary of benefits and coverage (SBC) and a list of definitions (called the uniform glossary) that explains terms commonly used in health insurance coverage such as deductible and copayment. G NG G Wellness program incentives Effective January 1, 2014 or at renewal NG The ACA allows employers who offer wellness programs to increase the incentive for participation to up to 30 percent of the premium contribution. Out-of-pocket maximums Effective January 1, 2014 or at renewal The ACA sets a maximum amount you have to pay out of your own pocket for services. Effective January 1, 2014, or when your plan renews, this limit G NG G is $6,350 NG for individuals and $12,700 for families. For 2015, the limits for grandfathered and non-grandfathered groups increase to $6,600 for individuals and $13,200 for families. This maximum amount includes all deductibles, coinsurance and copayments for medical services. This limit will vary each year based on federal guidelines. Essential health benefits Effective January 1, 2014 for new plans, or at plan renewal To ensure our status as a qualified health plan, all Blue Cross of Idaho plans include coverage for essential health benefits in the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity G NG G and NG newborn care; mental health and substance use 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. We removed annual dollar maximums for all essential health benefits. Patient Protections It s important to us that you receive timely information about your health insurance and understand your rights as a Blue Cross of Idaho member. Blue Cross of Idaho will: respond to urgent care requests for prior authorization within 72 hours of receipt. provide members with a description of the diagnosis and treatment codes and their corresponding meanings on request. provide unique, identifiable denial codes/reasons on all adverse benefit determinations and add a general definition of investigational and medical necessity to the explanation of benefits. Provide an external review process. provide translation of some forms into Spanish, Tagalog, Chinese and Navajo Indian (Dine) on request. Choose coverage that fits bcidaho.com 9

10 Questions and answers What is healthcare reform? The Affordable Care Act (ACA) was passed by Congress and signed into law in Some regulations and laws are already in place and may have impacted your insurance coverage. The primary regulations were effective January 1, Does the ACA require that I offer insurance to my employees? The ACA does not require businesses with the equivalent of less than 50 full-time employees to offer insurance to employees. I heard that the government delayed some parts of the ACA for a year. What was delayed and what does that mean for my business? The ACA requires employers with 50 or more full-time employees to offer qualified health insurance that provides adequate coverage at an affordable price or pay an IRS tax penalty. This rule was supposed to take effect in However, the federal government delayed the IRS reporting mandate for employers until 2015, giving large businesses extra time to meet the requirements of the new healthcare law. The delay in the employer reporting mandate did not delay the individual mandate, which required all legal US residents to have health insurance by January 1, Can I continue offering my current insurance plan to my employees? If your current health plan was effective prior to March 23, 2010, your plan may be grandfathered, allowing you to continue offering your current coverage. See the grandfathered section on page 5 of this toolkit for more information. How will my coverage change? Depending on the plan you currently have, it may change quite a bit, or very little. All ACA-qualified plans must cover essential health benefits without dollar limits. Will it cost me more to offer insurance to my employees? The impact of the ACA on your rates will depend largely on the changes you have to make to your existing insurance coverage. Depending on your benefit plan, the ACA may not have much effect on your rates; if you make significant changes to your current plan to comply with the ACA, it may increase your costs. Does the ACA put a limit on enrollment waiting periods? As of 2014, the waiting period for health insurance enrollment can t be longer than 90 days. You may include a bona fide orientation period no greater than 30 days in order to meet enrollment timeline needs. Will I be able to buy health insurance from Blue Cross of Idaho? Blue Cross of Idaho will continue to offer insurance to our small group clients. If I offer qualifying insurance to my employees, can they choose not to take it and qualify for subsidized insurance through the new marketplace? No. Employees and their dependents with access to an employeesponsored, qualified health plan are not eligible for subsidies through the marketplace. 10 Affordable Care Act Toolkit from BLUE CROSS OF IDAHO Small Groups

11 Small Groups Choose coverage that fits bcidaho.com 11

12 P.O. Box 7408 Boise, ID GO CROSS ( ) bcidaho.com Street Address 3000 East Pine Avenue Meridian, ID Meridian Mailing Address P.O. Box 7408 Boise, ID Claims Inquiries (208) (800) Coeur d Alene 1450 Northwest Boulevard, Suite 106 Coeur d Alene, ID Street Address 1910 Channing Way Idaho Falls, ID Idaho Falls Mailing Address P.O. Box 2287 Idaho Falls, ID Street Address th Street Lewiston, ID Street Address 275 South 5th Avenue Suite 150 Pocatello, ID Street Address 1431 North Fillmore Street Suite 200 Twin Falls, ID Lewiston Pocatello Twin Falls Mailing Address P.O. Box 1468 Lewiston, ID Mailing Address P.O. Box 2578 Pocatello, ID Mailing Address P.O. Box 5025 Twin Falls, ID by Blue Cross of Idaho, an independent licensee of the Blue Cross and Blue Shield Association (Rev )

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