Life & Health Options can assist Louisiana residents with enrolling in a plan on or off the Health Insurance Marketplace. Contact us via email at firstname.lastname@example.org or by phone 225-772-2794. Let us know if you have questions or would like to enroll.
The Affordable Care Act (ACA), sometimes known as “Obamacare”, was signed March 23, 2010. Beginning in 2014, the individual shared responsibility provision of the Affordable Care Act requires each individual to:
• Maintain a minimum level of health care coverage – known as minimum essential coverage, or
• Qualify for an exemption, or
• Make an individual shared responsibility payment when filing their federal income tax return
• Health insurance plans are available on the Health Insurance Marketplace (www.healthcare.gov) and off the Marketplace.
• Enrollment Periods:
-Open Enrollment Period – November 1 – December 15
-Special Enrollment Period During the Year – available in certain circumstances
• Premium assistance in the form of tax credits (subsidy) is available to those with household income 100% – 400% of the federal poverty level (FPL) (or below 100% FPL for lawfully present non-citizens who are ineligible for Medicaid by reason of immigration status). Subsidy is based on household income and family size. Premium assistance, if applicable, is only available for plans on the Marketplace. https://www.healthcare.gov/will-i-qualify-to-save-on-monthly-premiums/
• What if I Have Job Based Health Insurance
• Reporting Income and Household Changes
Once you have Marketplace health insurance, you must report changes to your income, household, address and health coverage eligibility as soon as possible. You can report any life changes to the Marketplace online or by phone (1-800-318-2596) . It is important to keep your profile up-to-date to avoid any issues with coverage.
• One-Page Guide to the Health Insurance Marketplace
• Marketplace Application Checklist
• Things to Think About When Choosing a Health Plan
• Effective January 1, 2014, insurers must accept all applicants (guarantee issue). No rate-ups (higher premium) due to health conditions. No pre-existing condition exclusion period. Rating based on gender is not allowed. The ACA allows only limited rating factors due to geographic location, age (limited 3 to 1), family composition and tobacco use.
• Effective January 1, 2014, non-grandfathered policies in the individual and small group market must meet new minimum standards under the ACA and cover ten essential health benefits: ambulatory patient services (for example, doctor visits), emergency services, hospitalization, laboratory services, maternity and newborn care, mental health and substance abuse, pediatric vision and dental, prescription drugs, preventive and wellness services and chronic disease management, rehabilitative and habilitative services and devices.
• Plans available for an effective date on and after January 1, 2014*:
1) Bronze – 60% actuarial value
2) Silver – 70% actuarial value
3) Gold – 80% actuarial value
4) Platinum – 90% actuarial value
5) Catastrophic Plan (an additional option for young adults under 30 years of
age and for those who cannot afford coverage and obtain a hardship waiver from
* Allows for range of +/- 2% points
• The ACA allows individuals and employer groups to keep a grandfathered plan. Grandfathered plans are those that were in existence on March 23, 2010 and have stayed basically the same. But they can enroll people after that date and still maintain their grandfathered status. In other words, even if you joined a grandfathered plan after March 23, 2010, the plan may still be grandfathered. The status depends on when the plan was created, not when you joined it. If you are unsure if your current plan is grandfathered, ask your health coverage provider. For additional information, refer to www.healthcare.gov.
How the ACA Affects Employers
• In accordance with the ACA, employers with 50+ full-time employees (including full-time equivalent employees) must offer qualified, affordable health insurance to full-time employees or pay a penalty (Employer Shared Responsibility Payment). https://www.healthcare.gov/what-is-the-employer-shared-responsibility-payment/ (see update below). Determining large employer status: Threshold for “large employer” = 50 full-time equivalent employees (FTE). Full-time employees = employees working 30 hours per week, on average. All employees of the controlled group are taken into account when determining whether the 50 full-time employee threshold is reached. # Full-time employees + Aggregate # hours worked by part-time employees divided by 120 = # Full-time equivalent employees. FTEs are used solely to determine large employer status. Special rules apply for seasonal workers. (refer to www.irs.gov and www.healthcare.gov for additional guidance)
Please note: On February 10, 2014, The U.S. Department of the Treasury and Internal Revenue Service (IRS) issued final regulations implementing the employer responsibility provisions under the Affordable Care Act (ACA) that take effect in 2015.
Small Businesses with fewer than 50 employees: Under the Affordable Care Act, companies that have fewer than 50 employees are not required to provide coverage or fill out any forms in 2015, or in any year.
Employers with 50 to 99 employees: Companies with 50-99 employees that do not yet provide quality, affordable health insurance to their full-time workers will report on their workers and coverage in 2015, but have until 2016 before any employer responsibility payments could apply.
Larger employers with 100 or more employees: The new rules phase in the percentage of full-time workers that employers need to offer coverage to from 70 percent in 2015 to 95 percent in 2016 and beyond. Employers in this category that do not meet these standards will make an employer responsibility payment for 2015.
• FACT SHEET: Final Regulations Implementing Information Reporting for Employers and Insurers under the Affordable Care Act (ACA) 3/5/2014
• How Do I Enroll in Coverage Through the Small Business Health Options Program (SHOP) Marketplace
Model Notice for Employers to Share with Employees on Exchanges
(Health Insurance Marketplace)
On May 8, 2013, the Department of Labor (DOL) issued Technical Release 2013-02 which provides temporary guidance for employers regarding the requirement to notify employees of coverage options available through the Health Insurance Marketplace. Employers must provide notice to current full-time and part-time employees by October 1, 2013. Employers are required to provide the notice to each new employee at the time of hiring, beginning October 1, 2013. For 2014, the DOL will consider a notice to be provided at the time of hiring if the notice is provided within 14 days of an employee’s start date. There are two model notices. Both forms require the employer to enter specific information before distributing to employees.
Employers Subject to the Notice Requirement
The Fair Labor Standards Act (FLSA) section 18B requirement to provide a notice to employees of coverage options applies to employers to which the FLSA applies. In general, the FLSA applies to employers that employ one or more employees who are engaged in, or produce goods for, interstate commerce. For most firms, a test of not less than $500,000 in annual dollar volume of business applies.(4)
The FLSA also specifically covers the following entities: hospitals; institutions primarily engaged in the care of the sick, the aged, mentally ill, or disabled who reside on the premises; schools for children who are mentally or physically disabled or gifted; preschools, elementary and secondary schools, and institutions of higher education; and federal, state and local government agencies.(5)
The Department’s Wage and Hour Division provides guidance relating to the applicability of the FLSA in general including an internet compliance assistance tool to determine applicability of the FLSA. See www.dol.gov/elaws/esa/flsa/scope/screen24.asp
DOL Technical Release 2013-02:
Model Notice for Employers Who Offer a Health Plan:
Model Notice for Employers Who Do Not Offer a Health Plan:
Disclaimer: External links open in new windows to websites not controlled by Life & Health Options. This information has been compiled from a variety of sources. Please note that interpretations may vary, and you should consult your attorney and/or tax adviser for more specific information. New and existing state laws may impact many of these provisions as well as future federal and state regulations.