Everyone will receive a notice about coverage options Q. I am not currently eligible for my employer’s health insurance or through another source (e.g. spouse). What should I look for in the mail and what do I need to do? A.Look for option 2 shown on the opposite page, which will be filled out by your employer. To avoid the individual mandate penalty, you will need to enroll in a plan through the New York State Marketplace during the open enrollment period beginning Oct. 1, 2013. Individual Marketplace Coverage The New York Health Benefit Marketplace will be ready to enroll people in health insurance plans beginning on Oct. 1, 2013, for coverage that will be effective starting on Jan. 1, 2014. The New York Health Benefit Marketplace is where uninsured or qualifying individuals and families will shop for, compare and buy health insurance coverage. It’s the only place to get tax credits that reduce the cost of coverage. IMPORTANT – If your employer provides you with affordable health coverage that provides “minimum value,” you are not eligible for premium tax credits to purchase coverage through the Marketplace and nothing more will be required of you as this satisfies the Individual Mandate under the law. Small Business Health Options Program (SHOP) Coverage Employers with 50 or fewer employees will be eligible to purchase a selection of health insurance options at a range of price points through the SHOP. If small employers offer employees health coverage through the SHOP, the employer may qualify for a Small Business Health Care Tax Credit of up to 50 percent (up to 35 percent for non-profits) of eligible premium expenses to offset the cost of insurance for employees. As of 2014, SHOP is the only place for small employers to be able to access this tax credit. Small employers are eligible for the tax credit if they: • Have 25 or fewer full-time employees (two half-time employees can count as one fulltime employee) • Pay employees an average of less than $50,000 per year • Contribute at least 50 percent toward employee premium cost (for an individual, not family) IMPORTANT – If health insurance coverage is established through collective bargaining, small employers have an obligation to continue the negotiated benefits in accordance with the agreement. However, now that plan options will soon be available through the New York state Benefit Marketplace, we anticipate that small employers may propose such plan options upon the contract’s expiration. Employer Shared Responsibility – Delayed Until January 1, 2015 Beginning Jan. 1, 2015, large employers (defined as 51 or more full-time equivalent employees) must provide insurance coverage to essentially all full-time employees and their dependents (children only, not spouses), or otherwise pay a penalty. The insurance coverage provided must offer minimum essential coverage that meets affordability and minimum value guidelines. NOTE – Small employers (50 or fewer full-time equivalent employees) are not subject to the Employer Shared Responsibility Requirement. What is Minimum Value and Affordability? Minimum Value is defined as a plan that has an actuarial value of 60 percent or more. In other words, the plan provides minimum value if it pays for 60 percent of the services and benefits that are covered by the plan, and covered participants pay no more than 40 percent of the total cost of benefits in deductibles, co-payments, coinsurance and other out-of-pocket expenses for covered benefits under the plan. Important – Virtually every employer plan negotiated by CSEA significantly exceeds a 60 percent actuarial value. Affordability of Coverage – If the amount the employee has to contribute for “single only” coverage of the employer’s lowest cost plan offered that provides minimum value exceeds 9.5 percent of their W-2 wages, the plan is considered unaffordable. If an employee is enrolled in a plan considered unaffordable (described above), the employee may be eligible to receive subsidized coverage (based on household income) through the Marketplace. IMPORTANT – Even if an employer plan is determined to be unaffordable (based on the 9.5 percent test) an employee can continue to be covered under their employer-sponsored plan, as opposed to obtaining coverage through the Marketplace which will most likely result in a benefit package that is not as comprehensive. Q.I already have insurance. What should I look for in the mail and do I need to do anything? A. Look for option 1, which will have information provided by your employer. You need not do anything unless your coverage does not meet ACA minimum value and affordability standards. Q. What if my current coverage the law? A. Look for Option 1 in the mail. notice will let you know whether or not your employer coverage meets the affordability standard. (See “Affordability of Coverage” in box above.) More information coming in future editions of The Work Force. is unaffordable according to Based on your income, the September 2013 The Work Force 15
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