The 2015 Affordable Care Act

Health Insurance Updates for Employers and Employees

Putting politics and rhetoric aside, tis the season to prepare for the new 2015 Affordable Care Act requirements.

For Employers

On January 1, 2015, employers with 100 or more full-time equivalent employees will be required to provide qualified health care. Businesses within this size category must offer benefits to at least 70% of employees by 2015 and to at least 95% of employees by 2016.

Companies with between 50 and 99 full-time equivalent employees are encouraged to meet the 2015 requirements of the Affordable Care Act, but compliance for companies that fall within this employee range will not be mandatory until 2016.

Employers have specific fiduciary health care responsibilities to their employees. The cost of affordable care can be no more than 9.5% of an employee’s yearly household income. Health plans meet the minimum qualifying value if its benefits cover at least 60% of medical services. Noncompliance results in a $2,000 fee per employee (with the first 30 employees fee exempt).

A press release fact sheet from the U.S. Treasury Department offers information to assist companies with the transition to the new health care requirements. Some highlights of the document are:

• To determine employee count, employers can reference a period of six consecutive months in 2014, rather than the full year.
• Employers with health benefit plan years that do not start on January 1 can begin compliance on the date their 2015 plan begins.
• If employers do not currently offer any coverage to dependents, the general requirements for their company size can be arranged in 2015 with an effective date of 2016.

For more details, click here to read the complete fact sheet.

For Employees and Individuals

The Affordable Care Act provides protection for covered individuals and their dependents. Employers need to be aware of these requirements, and employees should understand their entitlements. Items covered in the Patient Bill of Rights are:

• Coverage for children cannot be excluded for pre-existing conditions.
• Unmarried, adult children may be covered by their parents until they reach age 26.
• Arbitrary withdrawal of coverage is not permitted.
• The patient is guaranteed the right to appeal denial of payment.
• There are no lifetime limits on coverage.
• Insurance companies are required to publicly justify unreasonable premium increases.
• Plans must cover preventative care, including but not limited to recommended immunizations and screenings.

The 2015 individual coverage open enrollment period is November 15, 2014 through February 15, 2015. There are life-changing conditions that would allow enrollment changes after February 15, however those who do not qualify under the allowable conditions will not be able to obtain coverage until the next open enrollment period. Unemployed individuals who are currently enrolled in a COBRA plan have the opportunity to switch to a lower-cost plan. Plan costs available in the Marketplace vary based on household income.

Resources

Be cautious of your information sources. The following websites contributed to this post, and are valid resources for additional information.

www.healthcare.gov
www.hhs.gov
www.nystateofhealth.ny.gov
www.sba.gov/healthcare

Finally, we strongly recommend that you consult with your attorney and/or accountant to be sure you’re getting the correct information to meet your specific needs.