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Employer Health Insurance Requirements

   Small Business (1 – 50) No health insurance requirements through 2016 Mid-Sized Company (50 – 99) No requirements in 2015 2016: Must offer minimum essential coverage to at least 95% of full time employees or be subject to a potential $2,000 per employee penalty (minus 1st 30 FT employees) More specific details regarding the penalty can be found here Business (100+) 2015: Must offer minimum essential coverage to at least 70% of full time employees 2015: Anticipated penalty is $2,000 per full time employee (minus the 1st 80 FT employees) 2016: Must offer minimum essential coverage to at least 95% of full time employees 2016: Anticipated penalty is $2,000 per full time employee (minus the 1st 30 FT employees) More specific details regarding the penalty can be...

2015 & 2016 Guidelines (100+)

Click here to review guidelines for groups with 50 – 99 employees. Employer Penalities for 2015 and 2016 “A” PENALTY 4980H (a) No offer of minimum essential coverage (MEC) Trigger: FT employee gets Premium Tax Credit (PTC) from Exchange – no penalty for Medicaid enrollment $2,000 x all FT employees 2015: minus first 80 FT employees 2016: minus first 30 FT employees NOTES: Must offer to “all” FT employees Regulators define “all” as 95% (all but greater of 5% or 5 FT) For 2015, lowered requirement to 70% In 2016, 95% applies “B” PENALTY 4980H (a) Coverage is not “affordable” or does not provide minimum value Trigger: FT employee gets Premium Tax Credit (PTC) from Exchange $3,000 x each FT employee who gets PTC from Exchange; never higher than employer would have received for “A” Penalty NOTES: A 100+ employer that avoids the “A” Penalty in 2015 could be subject to the “B” Penalty if FT employee (part of 30% not offered MEC) gets PTC from Exchange In 2016, 50+ employer that avoids “A” Penalty could be subject to “B” Penalty if FT employee (part of 5% or 5 FT not offered MEC) gets pTC from Exchange * EITHER PENALTY MAY APPLY BUT NOT...

2015 & 2016 Guidelines (50 – 99)

Click here to review potential penalties for 100+ sized groups. Employer Penalities for 2015 and 2016 “A” PENALTY 4980H (a) No offer of minimum essential coverage (MEC) Trigger: FT employee gets Premium Tax Credit (PTC) from Exchange – no penalty for Medicaid enrollment $2,000 x all FT employees minus first 30 FT employees NOTES: Must offer to “all” FT employees Regulators define “all” as 95% (all but greater of 5% or 5 FT) For 2015, no penalty Important to prepare in 2014 and 2015 for 2016 In 2016, 95% applies “B” PENALTY 4980H (a) Coverage is not “affordable” or does not provide minimum value Trigger: FT employee gets Premium Tax Credit (PTC) from Exchange – no penalty for Medicaid enrollment $3,000 x each FT employee who gets PTC from Exchange; never higher than employer would have received for “A” Penalty NOTES: For 2015, no penalty A 50+ employer that avoids the “A” Penalty could be subject to the “B” Penalty in 2016 if FT employee (part of 5% or 5 FT not offered MEC) gets PTC from Exchange * EITHER PENALTY MAY APPLY BUT NOT BOTH...

2015 HSA Limits Increased

Courtesy of Anthem – The Internal Revenue Service (IRS) has released the 2015 guidelines for Health Savings Account (HSA) plans. Here are the changes from 2014 to 2015: Contribution Limits Individual/ Employee Contribution Limit: increases $50 from $3,300 in 2014 to $3,350 in 2015 Individual/Employee + dependent(s) Contribution Limit: increases $100 from $6,550 in 2014 to $6,650 in 2015 Annual Deductible Amounts Individual/ Employee  Minimum Deductible: increases $50 from $1,250 in 2014 to $1,300 in 2015 Individual/Employee + dependent(s) Minimum Deductible: increases $100 from $2,500 in 2014 to $2,600 in 2015 Out-of-Pocket (OOP) Maximum Amounts Individual/ Employee OOP Maximum: increases $100 from $6,350 in 2014 to $6,450 for HDHP that have deductibles of at least $1300 in 2015. Individual/Employee + dependent(s) OOP Maximum: increases $200 from $12,700 in 2014 to $12,900 for HDHP that have deductibles of at least $2,600 in 2015 High Deductible Health Plans  Unlike 2014, when high deductible health plan limits on out-of-pocket expenses and the maximum out-of-pocket limits under the Affordable Care Act (ACA, health care reform law) were the same, these amounts are different for 2015.  The maximum out-of-pocket limits for 2015 are $6,600 coverage for an Individual or employee only and $13,200  coverage for an individual or employee +dependent(s) for traditional plans. For more details, you can read the IRS notice for 2015 and this chart showing HSA limits by...

Blue Shield Reduces Participation

From May 1, 2014 through July 1, 2014, Blue Shield of California is relaxing the participation requirement for groups with five or more enrolled employees to 25%. This is less than Blue Shield’s already low requirement of 65%, and among the lowest in the industry. Although most businesses often want to purchase two plans – an HMO from one carrier and a PPO from another – relatively smaller businesses typically can’t meet minimum participation requirements. This limited-time promotion lets your clients purchase a PPO plan from Blue Shield alongside another carrier’s HMO. With the relaxed participation requirement, you can deliver to your clients what they want – flexibility and choice. The relaxed participation requirements are available for new medical small business clients with effective dates of May 1, 2014 through July 1, 2014*. The promotion applies to off-exchange plans only. New groups with fewer than five employees enrolling with Blue Shield do not qualify. Groups must meet the definition of a qualified small employer group. All normal eligibility and enrollment documents are required. Refusals are required for all eligible employees not enrolling in the Blue Shield plan(s). Be on the lookout for information about our specialty products promotion coming soon. *Blue Shield reserves the right to cancel this program at any...

ACA Impact on Group Dental

The Affordable Care Act (ACA) has brought with it sweeping changes to benefits for small employers with 50 or fewer lives. One of the lesser highlighted changes made includes mandated requirements dental insurance. Essential Health Benefits (EHB) must include pediatric services, including oral and vision. “Qualified” health plans for small groups must include 10 Essential Benefits in order to be deemed compliant. One of the Essential Health benefits includes pediatric oral care for children up to age 19. The pediatric oral care EHB requirement can be fulfilled on and off exchange by a stand-alone dental plan. EHB requirements for pediatric oral care include: Separate, “reasonable” OOP maximum per child for stand-alone dental plans (federal is set at $700) Must include medically necessary orthodontia Medical carriers can exclude pediatric oral care from the list of EHBs, as long as there is an exchange-certified dental plan covering the requirements....
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