Do businesses need to inform their employees of the state Exchange (also called Marketplace)?
Yes, employers need to inform their employees by Oct. 1, 2013. The Affordable Care Act originally placed a deadline of March 1, 2013, but extended this notice requirement.
If an employee gets a subsidy on the SHOP (Small Business Health Option Programs), does the employer pay the balance of that subsidy or does the employee pay it and get reimbursed?
There are no “subsidies” under SHOP. There are defined contribution payments. The SHOP regulations do not yet specifically address how these payments will be handled between the employee, employer and SHOP.
How does the ACA’s Safe Harbor work to determine affordability?
The IRS requires that the employee contribution toward the self-only premium for the employer's lowest cost coverage that provides minimum value (the employee contribution) not exceed 9.5 percent of the employee's Form W-2 wages for that calendar year.
Has small group been increased to <100 employees?
Based on Nebraska law, at this time small group is still 2-50.
It appears that HSA/HRA contributions are factored into the Actuarial Value calculation of a small group employer’s insurance plan. Is that correct?
Yes, under the proposed Essential Health Benefit regulations, employer contributions (not employee) may be (but are not required) to be taken into account in determining the Actuarial Value calculation of a small group plan. This poses some challenges for an insurer, however, because an insurer typically does not have any information regarding employer contributions to an HSA or HRA. BCBSNE is currently evaluating these provisions.
What is the definition for small group in Nebraska?
The definition for a “small group” under Nebraska law is currently 2-50. Is there a new rule about small businesses only being able to offer HSAs with a deductible up to $2,000/$4,000? For plan years beginning in 2014, the annual deductible imposed under non-grandfathered health insurance coverage offered in the small group market (including qualified health plans offered on the SHOP Exchange) cannot exceed $2,000 for self-only (individual) coverage or $4,000 for non-self-only (family) coverage.
Does health care reform change the way premium rates are calculated?
Health insurance companies may use specific factors as determined by the Affordable Care Act in calculating premium rates for coverage in the individual and small group market for plan or policy years beginning on or after Jan. 1, 2014. These factors include: individual vs. family coverage, rating area, age and tobacco.
These rules do not apply to the large group market at this time, nor do they apply to self-funded coverage.
What is the actuarial value of our plan?
The proposed Essential Health Benefit (EHB) regulations provide guidance pertaining to the calculation of minimum value (MV) for employer-sponsored health plans for the purposes of the premium tax credit and employer shared responsibility (pay or play) provisions. For this purpose, MV is expressed in the same general manner as Actuarial Value (AV), i.e. the plan’s share of the total allowed costs of benefits.
The proposed regulations provide that a group health plan may calculate MV using one the following methodologies: (a) a MV calculator that HHS and the IRS has made available; (b) any safe harbor method established by HHS and the IRS (yet to be determined); or (c) an actuarial certification by a member of the AAA, based on an analysis performed in accordance with generally accepted actuarial principals and methodologies.
Does an employer need to do anything on January 1, 2014, if its plan year isn’t up for renewal until later in the year?
All of the 2014 market reforms and essential health benefits are effective with the first plan year following 1-1-2014. If, for example, the group has a July plan year, the changes would need to be made by July 2014.
It was my understanding that in Nebraska (since we are part of the Federal Exchange) that groups less than 100 were community rated. Is that correct?
Nebraska has the option to define a small group as employers with up to 50 employees until 2016. The Nebraska Department of Insurance intends to exercise this option.
If an individual has a deductible higher than $2,000, will the deductible have to be reduced in 2014?
In 2014, the annual deductible for a health plan in the small group market may not exceed $2,000 for self-only coverage or $4,000 for family coverage. Individual market plans are not held to the same deductible limits but do have maximum out-of-pocket requirements.
Is the $2,000/$4,000/ maximum deductible for 2-50 sized groups, 50+ groups or both?
In 2014, the annual deductible for a health plan in the small group market may not exceed $2,000 for self-only coverage or $4,000 for family coverage. Small employers are defined as 2-50 in Nebraska until 2016, when the definition will change to 2-100.
What is cost share subsidy?
It affects individuals whose income places them between 100 percent and 250 percent of the Federal Poverty Level. In addition to being eligible for a premium subsidy, these individuals will also be eligible for a cost-sharing subsidy if they buy a Silver Plan on the Marketplace.
What happens if someone does not buy insurance during the open enrollment period? Will they be able to join the Marketplace whenever they want or will they have to wait until the next open enrollment period?
They will have to wait until the next open enrollment unless they have a qualifying event that would allow for mid-year entry.