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Noticeabout theHealth InsuranceMarketplace
Employers subject to the Fair Labor Standards Act are required to notify employees of the
Health InsuranceMarketplace andpotential eligibility for premium credits. Aflac has created
the “HealthCareReformCommunications Toolkit” to helpbusinesses to complywith this
communications requirement. Available at
, these tools can be
customizedwith a company’s logo and usedwithworkers.
Small BusinessHealthOptionsProgram (SHOP) and Individual Health Insurance
Marketplace
Effective 2014, small businesses and individualswill have the opportunity toparticipate in the
federal and state facilitatedHealth InsuranceMarketplace.
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Specific information by state can
be found at
.
Required contribution to the temporary reinsuranceprogram
During the first three years of insurancemarket reforms (2014–2016), a temporary reinsurance
program for the individual insurancemarket will be fundedby a required contribution from all
groupmajormedical plans. The per capita amount is paid for each enrollee by the insurer or
the self-fundedplan. For 2014, the annual per capita amount is set at $63per enrollee.
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Small business tax credit changes
Small business tax creditswill expand to 50percent of a small business’s premium costs
for two consecutive years. These credits are available tobusinesseswith averagewages of
less than $50,000 and 25 or fewer full-time equivalent employees that offer health insurance
through theSmall BusinessHealthOptions Program (SHOP) Marketplace.
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Firm size: Aqualifyingemployermust have25or fewer full-timeequivalent (FTE) workers. Employerswithmore than
24workersmaybeeligible if they still have fewer than24FTEs. For example, if a firmhas40employeeswhowork
part-time, the firmmay count 20as FTEs and, therefore, the firmwouldqualify in thisgroup. Note: ThePPACA says that
employerswith25or fewer FTEsmayqualify for thecredit; thecredit amount isphaseddown to zero for anemployer
with25FTEs. The IRSwebsite, asof Sept. 20, 2013, says that employerswith fewer than25FTEs areeligible for the
credit. Formore information, see
.
SecondwaveofHealth InsuranceReforms
In addition to thesemilestones, therewill be a secondwave of Health InsuranceReforms that
are effective for group health plans, including:
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•Pre-existing condition exclusionswill no longer be permitted.
• Therewill be no annual dollar limits on benefits.
•Small group fully insuredplanswill be required tooffer essential health benefits and
have limits on deductibles (does not apply to grandfatheredplans).
• Limitswill be placed on out-of-pocket expenses (does not apply to grandfathered
plans).
•Health insurerswill be subject tomodified community ratings and guaranteed-issue
requirements.
•Waitingperiods in excess of 90dayswill be prohibited.
ImportantDate 1:
October 1, 2013
ImportantDate2:
January 1, 2014
