The Patient Protection and Affordable Care Act (ACA) was signed into law on March 23, 2010. The law has had various segments of implementation based on a required timeline. The law has been amended several time since the bill was first passed.
Beginning in 2015, employers with 50+ full-time employees or full-time equivalents must offer medical coverage that is “affordable” and provides minimum value to full-time employees and their children up to age 26 or face penalties.
Coverage is “affordable” if employee only contributions are less than 9.5% of:
A plan must pay 60% of the cost of covered health services to provide "minimum value."
Although states are given some flexibility, the essential health benefits package must include items and services from the following ten categories:
Many essential benefits vary state to state: i.e. acupuncture, autism, wigs, TMJ, infertility, bariatric surgery, chiropractic care, hearing aids. For large group you will need to decide the contract/situs state.
As of 1/1/2014, or your plan year anniversary In-network out-of-pocket (OOP) maximums in non-Grandfathered plans cannot exceed $6,350 for Individual, or $12,700 for Family.
Out of Pocket include all: Co-pays, deductibles, and co-insurance.
Beginning in 2015, the OOP family maximum cannot be more than twice the individual maximum
There are 17 states that have their own exchanges. The link below directs you to the page were you can select a state at the bottom of the webpage and determine if the particular state has their own exchange or are in the federal exchange. healthcare.gov/what-is-the-health-insurance-marketplace
Exchanges will offer individuals a choice of health plans that meet certain benefit and cost standards. The Department of Health and Human Services (HHS) administers the requirements for the Exchanges and the health plans they offer.
Health Insurance Premium Tax Credit -Starting in 2014, individuals and families can take a new premium tax credit to help them afford health insurance coverage purchased through an Affordable Insurance Exchange. Exchanges will operate in every state and the District of Columbia. The premium tax credit is refundable so taxpayers who have little or no income tax liability can still benefit. The credit also can be paid in advance to a taxpayer’s insurance company to help cover the cost of premiums.
Some consumers are not eligible for premium assistance if they have access to other government (e.g., Medi-Cal or Medicare) or employer sponsored “Minimum Essential Coverage” (MEC) that is affordable and offers minimum value.
Under health care reform law, all people must have minimum essential coverage beginning January 1, 2014
People have "minimum essential coverage" if they have a Government-sponsored plan, Employer-sponsored plan or Individual plan
People can choose to buy health insurance on or off state insurance exchanges that will be open to write business effective Jan 1, 2014. Some people can also get federal premium assistance on an exchange.
If a person cannot keep minimum essential coverage, the Internal Revenue Service will collect a tax penalty from him or her. The monthly tax penalty is described as 1/12th of the greater of:
For 2014: Greater of $95 per uninsured adult and $47.50 per child in the household (capped at $285 per household) or one percent of the household income over the filing threshold
For 2015: Greater of $325 per uninsured adult and $162.50 per child in the household (capped at $975 per household) or two percent of the household income over the filing threshold
For 2016: Greater of $695 per uninsured adult and $347.50 per child in the household (capped at $2,085 per household) or 2.5 percent of the household income over the filing threshold
The penalty is half of the amount for people under age 18.
You can find an interactive Subsidy Calculator tool that determines if a person would be eligible for a subsidy in the exchange/marketplace at kff.org/interactive/subsidy-calculator
There are a few exceptions to the penalty, including:
What is the fee for not having health insurance in 2016?
The fee is calculated 2 different ways – as a percentage of your household income, and per person. You’ll pay whichever is higher.
Percentage of income:
Paying the fee
There are a few exemptions to avoiding the tax penalty, but the employee would have to answer specific questions about their household to determine if they would be exempt from the fee. https://www.healthcare.gov/exemptions-tool/#/ .
Medicaid and CHIP coverage is considered qualified health care. Here is the link to see if the employee or their dependents may be able to qualify for Medicaid or CHIP. https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/
The information was obtained from https://www.healthcare.gov/fees/fee-for-not-being-covered/