Bmono2aron & Associates, Inc.

  • Employee Benefits" data-mosaic-order-date="2012-09-12 00:50:19">
    We offer a diverse range of services to both small and large businesses.  We provide consulting and marketing services for your group medical, dental, life and disability programs as well
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    Employee Benefits

  • Individual Insurance" data-mosaic-order-date="2012-09-12 00:50:19">
    Individual and family health insurance is available through private insurance companies as well as State and Federal marketplaces.  Given the option, most people would prefer to have their employer provide
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    Individual Insurance

  • Life Insurance" data-mosaic-order-date="2012-09-12 00:50:19">
    Life insurance is a form of insurance that pays monetary proceeds upon the death of the insured covered in the policy.  Essentially, a life insurance policy is a contract between
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    Life Insurance

  • Senior Products" data-mosaic-order-date="2012-09-12 00:50:19">
    Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis
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    Senior Products

 

Marketplaces – Online Insurance Marketplace

 

Marketplaces are intended to help individuals and small groups shop for, select and enroll in high quality, affordable private health plans that fit their needs at competitive prices.

 

Public Marketplace

 

The ACA requires Marketplaces to be established in each state by Jan. 1, 2014. If a state does not establish an Marketplace, the federal government will step in and operate the Marketplace. Between 2014 through 2016, only individuals and employers in the small group market are eligible to participate in a Marketplace. In 2017, states may permit employers in the large group market to participate. Marketplaces will open for business beginning Oct. 1, 2013, offering coverage beginning Jan. 1, 2014. Markeplaces may be operated by the state or federal government or as a partnership between a state and the federal government. In 2014, small groups will be defined as businesses with up to 100 employees, although until 2016 a state may choose to limit the definition to businesses of up to 50 employees. The definition for large groups will remain as businesses with more than 100 employees.  In late summer or fall (future guidance is expected on complying with this notice requirement), employers must provide written notice to current employees and going forward, new employees, to inform them of the Marketplaces and the circumstances under which an employee may be eligible for health insurance subsidies.  Employees meeting certain requirements who cannot afford the coverage provided by their employer may purchase a plan in the Marketplace.  Employers with at least 50 full-time employees who decide not to offer a health benefit plan to their employees, and instead leverage the Exchange, are subject to penalties referred to as the employer mandate 

 

Private Marketplace

 

Private Marketplaces are being established by a variety of different entities such as consulting firms and cooperatives. Private Marketplaces are available to all business segments and fully insured or self-funded groups of all sizes. Because private marketplaces are operated by private entities, subsidies are not available to those purchasing health care insurance through a private marketplace. 

 

 

 

 

 

5 Critical Factors every employer needs to understand

 

 1. Business Size and Employer Mandate Applicability

Many PPACA provisions apply based on the size of an employer’s workforce. This section will explain how to determine if the employer is an applicable large employer for purposes of the shared responsibility provisions.  It will discuss the role of the “look back” period and how controlled groups factor in determining business size and the applicability of the Employer Mandate.

 

2. Small Business Tax Credits

PPACA provides significant tax credits to certain small employers. The law has different size requirements for not-for-profit and for-profit small employers.  This section will discuss what small employers must do to qualify for the tax credit.

 

3. Plan Affordability

Applicable large employers must meet two major thresholds to avoid paying a significant tax penalty for offering health benefit coverage that does meet the requirements of the law.  The first threshold is plan “Affordability.”  This section will explain how an employer can compute the affordability of the health benefit plan and avoid an employee going to a health benefits exchange to obtain an individual health insurance policy that has a federal premium subsidy.  As with the “Minimum Value” threshold (as discussed below), failing to meet this requirement can result in substantial tax penalty liabilities for a large employer.

 

4. Plan Value

Secondly, to avoid a tax penalty, the plan offered by the applicable large employer must provide “Minimum Value” to the employee.  Failure to understand and address this threshold proactively could expose an applicable large employer to liability; for example, if a full-time employee receives a federal premium subsidy because the benefits offered by the employer were of inadequate value, the employer would be forced to pay a tax/penalty. As with the Affordability threshold, failing to meet this requirement can result in substantial tax penalty liabilities for large employers.

 

5. New Reporting Requirements

PPACA places substantial reporting requirements on employers of all sizes. Employers need to understand these requirements and take a proactive approach to fulfilling them.  This section will explain the major reporting requirement being imposed on all employer groups.