Small Group and the Affordable Care Act - Do I really need to comply? NO!!!

You know how things kind of ruminate in the back of your mind for awhile before you "suddenly" have a realization? That's what happened to me a last week.

If your company is less than 50 employees (combining Full Time and Full Time Equivalents), then you are considered a "Small Group" under the definition set out by the Affordable Care Act. While everyone is talking about 30 hours this, Bronze, Silver, Gold, Platinum medal plans that, penalties for not offering minimum coverage and cost, etc. The reality is that you will not be subjected to the employer mandate and therefore will not face any penalties if you do not comply with that mandate such as not offering coverage, not making it "affordable", or not offering compliant coverage (Note that there are other items which you must comply with such as providing a Summary of Benefits of Coverage to each employee).

To be straight, I'm not talking about plan designs or things outside of your control. I'm talking about changing the amount you contribute to your employee's premium, number of hours they are required to work before they are considered full time, etc.

You don't have to offer a plan that meets one of the Medal plans even though the probability of a plan being available that doesn't meet the guidelines is close to zero. You don't have to offer coverage to dependents (BTW, spouses are, by ACA definition, NOT dependents). Of course you may not be able to

You don't have to make sure that the employee only pays no more than 9.5% of their income towards employee only coverage on your lowest compliant plan to meet "Safe Harbor." As a matter of fact, it's probably NOT in your best interest to do this. You may harm your employees unknowingly. For example, if you do offer a "Bronze" level plan and meet the "Safe Harbor" of the above for the employee and offer coverage to their dependents, then your employee is NOT ELIGIBLE FOR A SUBSIDY. If you have lower income employees, this could be bad as a plan within the individual/family exchange may be less expensive and cover more than the plan you offer. For higher income employees who are close to or over the 400% Federal Poverty Level for income, this doesn't impact them much.

What does this mean? It means you have more flexibility that you know. If you have 5 or more employees (for Illinois at least - every state is different, in New York, only employers with over 50 employees are allowed to look at the following plans), and your workforce is younger and healthy, then you may want to explore a "level funded benefit" plan. This is partially self-funding. In the eyes of the government, it is considered self funded and not subject to some of the restrictions of the ACA. In the eyes of your employees, it looks and works exactly like a fully insured plan except with the possibility of receiving money back after your plan year if claims were less than expected.

Also, if your agent hasn't mentioned that you can do an early renewal (this means renewing this year, then renewing again on 12/1/2013) to push off the reforms (including changes in plan designs) until the end of 2014, call and ask them about it.

In general, work with your agent, roll up your sleeves and see what works best for your business first, then employees (understanding that without happy employees, your business will go down the drain).

Obama Administration simplifies, significantly shortens application for health insurance

Obama Administration simplifies, significantly shortens application for health insurance

By Larry Grudzien, Attorney-At-Law

April 30, 2013

 

The Centers for Medicare & Medicaid Services (CMS) today announced that the application for health coverage has been simplified and significantly shortened. The application for individuals without health insurance has been reduced from twenty-one to three pages, and the application for families is reduce by two-thirds. The consumer friendly forms are much shorter than industry standards for health insurance applications today.

In addition, for the first time consumers will be able to fill out one simple application and see their entire range of health insurance options, including plans in the Health Insurance Marketplace, Medicaid, the Children's Health Insurance Program (CHIP) and tax credits that will help pay for premiums.

The applications released today, which can be submitted starting on October 1, can be found here:

http://cciio.cms.gov/resources/other/index.html#hie

"Consumers will have a simple, easy-to-understand way to apply for health coverage later this year," said CMS Acting Administrator Marilyn Tavenner. "The application for individuals is now three

The online version of the application will be a dynamic experience that shortens the application process based on individuals' responses. The paper application was simplified and tailored to meet personal situations based on important feedback from consumer groups.

Consumers can apply online, by phone or paper when open enrollment begins October 1, 2013. There will be clear information provided about how to complete the application, and how to access help applying and enrolling in coverage.

This consumer-focused approach will facilitate the enrollment of millions of Americans into affordable, high quality coverage while minimizing the administrative burden on states, individuals and health plans.

For more information about the Health Insurance Marketplace, visit: www.HealthCare.gov pages, making it easier to use and significantly shorter than industry standards. This is another step complete as we get ready for a consumer-friendly marketplace that will be open for business later this year."

For More Information:

If you have any comments or questions regarding any of above information, please do not hesitate to contact me at 630-779-1144 or Larry at (708) 717-9638.