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Presented by: Sandy Walters Executive Vice President & Senior Consultant Kelly & Associates Insurance Group - PowerPoint PPT Presentation


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How the Exchanges / Marketplace Will Effect Your Business & The Latest Updates of ACA. Presented by: Sandy Walters Executive Vice President & Senior Consultant Kelly & Associates Insurance Group. Two Employer Rules for Large Group. Avoid $2,000 penalty by offering any plan

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Presentation Transcript
slide1

How the Exchanges / Marketplace

Will Effect Your Business

&

The Latest Updates of ACA

Presented by:

Sandy Walters

Executive Vice President & Senior Consultant

Kelly & Associates Insurance Group

slide2

Two Employer Rules for Large Group

  • Avoid $2,000 penalty by offering any plan
  • Avoid $3,000 penalty by either
  • - Offering qualified and affordable plan
  • - Having employee take any plan
counting employees
Counting Employees

Variations in Counting:

  • If an employer fails to provide its full-time employees (and their dependents) the opportunity to enroll in “minimum essential coverage,” and
  • One or more full-time employees enrolls for coverage in an exchange and qualifies for a premium tax credit or cost-sharing reduction, then
  • Employer penalty = $2,000 for each of its full-time employees in the workforce
slide4

Employee Rules

  • Must have qualified coverage if affordable (less then 8% of family income )
  • Can only receive either subsidy if 
  • - Income under 400% poverty level
  • - Not offered qualified and affordable plan from any size employer 
  • - Does not participate in any other plan
  • - Not eligible for Medicaid
2013 poverty guidelines for 48 contiguous states and dc
2013 Poverty Guidelines for 48 Contiguous states and DC

For families/households with more then 8 persons, add 4,020 for each additional person

dc coverage assistance options in 2014
DC Coverage Assistance Options in 2014

400%

Approximate Income Levels as a Percent of Poverty

300%

250%

200%

133%

100%

slide10

Exchange: Pros & Cons

  • Pros SHOP
  • Tax Credit
  • Employee Choice
slide11

Tax Credit

  • Under 25 Employees
  • Under 50K Average Salary
  • Contribution must be at least 50%
  • Max Credit - Under 11 Employees & Under 25K Salary
slide13

Exchange: Pros & Cons

  • Cons SHOP
  • Work with Government Entity
  • Same Plans Outside the Exchange at Same Price
  • Limited Plans
  • Strict Participation Rules in Shop
  • Disclosure of Info to Government
  • Higher Probability of Data Theft
slide14

Exchange: Pros & Cons

  • Pros of Individual Coverage
  • Subsidy
slide15

Exchange: Pros of Individual Exchange

  • Subsidy
  • Family Income Under 400% Poverty Level
  • No Group Qualified Affordable Single Coverage Available
  • Family Income Under 250% Poverty Level
slide16

Exchange: Pros & Cons

  • Cons Individual
  • Lose Pretax Savings
  • Employers Contribution
dc residency requirements
DC Residency Requirements

Individuals & Families

  • Persons under age 19 or one who is homeless can self-attest to residency
  • Otherwise, documentation such as a lease , deed or letter from roommate can prove residency
  • Moving our of DC would cause loss of eligibility for DC Health Link plan
  • 30 days to inform DC Health Link of change in residency
    • Plan eligibility can continue until end of month following month of reported change.
    • Premium payment required for that month.

Small Businesses

  • No check on individual’s legal status or residency for small business enrollees
premium calculation
Premium Calculation
  • DC will not permit a surcharge for tobacco users
  • Each employee will have a different premium based on his/her age
  • Family premiums will be a total of each family member’s age rate
  • Family premium – tour premium plus spouse/partner’s premium + child(ren)’s premium
  • Up to 3 children under age 21 included in family premiums
employer contributions
Employer Contributions

DC Health Link will allow a small employer to select its contribution level

  • Select one plan to base contributions on, the “reference plan”
  • Select a Percentage to contribute for employees and dependents to enroll in reference plan
  • The contribution remains fixed based on the reference plan. Employees enrolling in any other allowed plan will pay the difference in premium to “buy-up” or “buy-down”
counting employees1
Counting Employees

To calculate the number of “full-time equivalent (FTE)” employees:

  • Count all employees who worked on average 30 hours per week or more
  • Count the number of hours worked on average by part-time employees and divide by 30, rounding up to the next higher number for any fractions
  • Add the two numbers together

Note: Count all employees, not just those that are eligible for health benefits.

For example: SmallCo has 20 full-time employees working 30 hours per week and 4 part-time employees working 15 hours per week

  • Full-time employees 20
  • Part time hours divided by 30 2
  • Total full-time equivalents 22
slide24

Sample On and Off Exchange

  • Individual Coverage 50% and 75% Paid by Employer
  • Annual Income $30,000
  • Monthly Income $2,500
  • Hourly Income $14.42
  • Individual Coverage
  • Monthly Premium $300