Impending Deadline: Required Notices & The Health Insurance Marketplace

Key parts of the health care law will take effect in 2014 and others have been delayed to 2015. One part that has not been delayed is the October 1, 2013 deadline for all employers to provide employees with Notices addressing coverage options and the health insurance marketplace. Regardless of whether an employer offers a health plan, you must provide a Notice.

Which Notices Should Employers Be Using?

1. Click here to view the Notice for employers that do not offer an employer-sponsored health plan, and will also not be offering one in 2014.
2. Click here to view the Notice for employers who do offer an employer-sponsored health plan to some or all employees.
3. Click here to view the Notice for employers who provide COBRA continuation coverage.

What Should Employees & Employers Know About The Marketplace?

Designed to help individuals find health insurance that meets their needs while fitting their budget, the Marketplace will allow individuals to find and compare private health insurance options available to individuals, families, and small businesses. Open enrollment starts in October 2013 for coverage beginning as of January 1, 2014. Whether individuals are uninsured or would like to explore their options, you can start planning now to be ready for the open enrollment period.

Individuals & Families – What can you do now to prepare?

1. Begin reviewing the different types of health insurance available, including job-based, public and private coverage. By reviewing each type you will also increase your understanding of how insurance works, including reviewing deductibles and out-of-pocket expenses.
2. Find out about the coverage your employer offers, especially if you work for a small business. If your employer does not offer coverage which meets certain standards depending on household income you may be able to qualify for a new tax credit which lowers your premium.
3. Explore current options. Through existing programs that have taken effect from the health care law, you may already be eligible for insurance. This includes health insurance for adults up to age 26, children in families with limited income, and Medicare for individuals over 65 or those who have disabilities.

Small Businesses – What can you do now to prepare?

1. Confirm your understanding of how insurance works. For example, you will need to understand the difference between premiums and out-of-pocket costs, such as deductible and co-payments.
2. Set your budget. Through the Marketplace you will be able to choose a level of coverage which provides the benefits you need within a budget you can afford. Also consider when to begin coverage and begin gathering information about your business, such as a list of your employees and your tax ID number.
3. Ask questions. Whether meeting with your accountant to address reporting requirements or with your agent or broker to review options, you are not alone in making this decision.

Employer Health Coverage & Available Tax Credits

If your employer does not offer health insurance or offers health insurance that meets certain standards you will not be eligible for a credit through the Marketplace. If the health insurance offered is more than 9.5% of your household income for the year or if the coverage your employer provides does not meet the “minimum value” standard set by the Affordable Care Act you may be eligible for a tax credit.

The PCORI Fee

The Patient-Centered Outcomes Research Institute (PCORI) performs medical research. Funding is provided, in part, by the PCORI fee which is imposed on (a) issuers of certain health insurance policies and (b) plan sponsors of self-insured health plans, including health reimbursement arrangements and health flexible spending arrangements.

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