HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal)

Transcription

1 Group Health Insurance Q & A HEALTH CARE REFORM: FREQUENTLY ASKED QUESTIONS (Group, Individual, Seasonal) 1. Will small employers continue to have 12 month rates as they exist today? a. Yes. Employer groups will continue to have 12 month anniversary rates. 2. Will small employer rates continue being filed quarterly? a. Small businesses will still be able to file rates quarterly. 3. If a full time employee in a large group goes to the Exchange because coverage is unaffordable, and the employer is penalized $3000 but the employee is only employed for part of the year, is the penalty prorated? a. Yes, the penalty is pro-rated. 4. Is COBRA affected by the ACA (Affordable Care Act)? a. No. 5. How are controlled groups (same or similar ownership among multiple business entities) treated and how is group size calculated? a. The ACA states all employees of a controlled group of entities under section 414(b) or (c), an affiliated service group under section 414(m), or under section 414(o) are taken into account in determining whether the members of the controlled group or affiliated service group together are an applicable large employer. 6. What are the rules for discrimination testing under the ACA? a. The ACA s non-discrimination in favor of highly compensated employees is not yet published or enforced. 7. Do Union employees that fall under a Union health plan count as full time employees under the ACA in determining group size? How about contracted employees? a. Yes, union employees count toward determining employer size for the employer mandate. Contracted employees, sole proprietors, partners in a partnership, or a 2% S Corporation shareholder are not considered employees. 8. How are metallic levels and Essential Health Benefits determined and reported so that employer plans are actuarially sound? a. Non-grandfathered health plans will need to be on metallic level products by January 1, Carriers are developing transition processes for affected groups which are estimated to be a very small percentage of employer groups. 9. Does the employer HSA contribution factor into determination of metallic level?

2 a. Yes, the calculators used incorporate HSA and HRA contributions that are integrated with group health plans if the amounts may only be used for cost-sharing. 10. If a business offers two plans, how is affordable measured? Do both plans need to be affordable? a. If a business offers two health plans, only one needs to be considered affordable by the ACA standards for the employer to be in compliance. 11. How is the penalty determined for groups with more than 50 full time equivalent employees? a. The penalty is assessed at $2000 per full time employee excluding the first 30 full time employees. This penalty per full time employee is increased each year by the growth in health insurance premiums. 12. If a group is over 50 full time equivalent employees and decides not to offer a health plan, are full time Medicare eligible employees counted for the purpose or determining the penalty? a. Yes, Medicare eligible employees are counted for the purpose of the penalty.

3 Individual Health Insurance Q & A 1. What are the key provisions of the Affordable Care Act? a. The affordable care act is made up of three main parts. i. Individuals will be required to purchase qualifying health insurance, either through their work or on their State Exchange. ii. Individuals and families that fall below certain income levels will receive a tax credit to purchase insurance on the Exchange. iii. Insurance companies must comply with federal rules regarding pre-existing conditions, how dependants are covered, and preventative services and coverage. 2. I currently have an individual/family plan. Will I be forced to purchase a product through the exchange? a. Individuals and families with a current health plan will be able to keep their plan. 3. When will State Exchanges start offering health plans? a. Exchanges will start operations on January 1 st, How can I get help with choosing a plan in the Exchange? a. The federal government is setting up a system of Navigators who will help individuals find coverage that meets their needs inside of the exchange. 5. Can I still work with an agent to obtain health insurance coverage? a. Yes, Individuals will still be able to work with agents to obtain proper coverage. The rates for identical plans must be the same whether purchased through the exchange or through an agent. 6. What are the different levels of the income requirement? a. A family of four that does not have access to affordable employer coverage will be able to get tax credits up to approximately $88,000 in This amount is determined by the federal poverty line. 7. How is household income determined? a. The proposed regulations define a taxpayer s family as the individuals for whom the taxpayer claims a deduction for a personal exemption which may include the taxpayer, their spouse, and dependants. 8. What happens if I lose my job and my coverage? Will I be able to enroll in the exchange? a. People who lose coverage due to termination of employment will qualify for special enrollment under the Exchange. 9. Will individuals receiving a subsidy have to pay the full premium each month and get a tax credit on their taxes each year?

4 a. No. Subsidy dollars will come from the Exchange via a monthly electronic transactions and the individual will be billed the remainder, if any. Any under or over charging will be reconciled in their tax filing. 10. Is COBRA affected by the ACA? a. No, COBRA is not affected by the ACA. 11. How does the ACA affect IHS groups? a. Certain American Indians and Alaska Natives who purchase health insurance through the Exchange do not have to pay co-pays or other cost-sharing if their income is under 300 percent of the federal poverty level.

5 Seasonal Workers Q & A 1. How are seasonal workers counted to determine whether a business is a small business or a large business? a. There is a statutory exception to the large employer definition for employers utilizing seasonal workers. Under the exception, employers having a large number of seasonal workers might be able to avoid the large employer label and associated penalties even if its average full time equivalent employees is greater than How can a business determine whether it is eligible for this exemption? a. The exemption applies if, during the prior calendar year, an employer s full time employee workforce exceeded 50 employees for 120 or fewer days due to the addition of seasonal workers during the busy season. 3. If a business does not qualify for the seasonal worker exemption how will seasonal workers be classified? a. Businesses that are unable to qualify for the seasonal worker exemption may still be able to classify its seasonal workers as part time based on the IRS safe harbor rules. An employer may track seasonal worker hours during a measurement period of up to 12 months. If an employee averaged less than 30 hours per week during the measurement period, the employee can be treated as part time. 4. What are the issues associated with offering health insurance to a seasonal employee for the season in which they are employed? a. Employers that wish to cover seasonal employees for the season in which they are working may impose up to a 90 day waiting period. Once seasonal workers satisfy the 90 day period, he or she would be eligible for the remainder of their employment. If the employer is subject to COBRA rules, the termination of employment (and therefore group coverage) could trigger a COBRA obligation for the employer.