On May 8th the U.S. Department of Labor announced Technical Release No. 2013-02, which provides guidance regarding the employer notification about new coverage options through the health insurance exchange. The guidance requires all employers to provide notice of coverage options to each employee, regardless of plan enrollment status or of part-time or full-time status. Starting October 1, 2013 the employer must provide notice at the time of hiring. Current employees must be notified no later than October 1, 2013.

The notice is required to be provided automatically, free of charge. It can be provided in writing either by first-class mail, or electronically if the department’s electronic disclosure safe harbor requirements are met. To satisfy the content requirements for FLSA section 18B model language is available on the Department’s website www.dol.gov/ebsa/healthreform. There is one model for employers who do not offer a health plan and another model for employers who offer a health plan or some or all employees.

The guidance also provides updated rules regarding the election notice employers must provide to employees in regards to COBRA continuation coverage. The election notice must be provided within 14 days of the employer learning of a qualifying event, as well as a list 12 items that must be contained in the notice:


-The name of the plan and the name, address, and telephone number of the plan's COBRA administrator;

-Identification of the qualifying event;

-Identification of the qualified beneficiaries (by name or by status);

-An explanation of the qualified beneficiaries' right to elect continuation coverage;

-The date coverage will terminate (or has terminated) if continuation coverage is not elected;

-How to elect continuation coverage;

-What will happen if continuation coverage isn't elected or is waived;

-What continuation coverage is available, for how long, and (if it is for less than 36 months), how it can be extended for disability or second qualifying events;

-How continuation coverage might terminate early;

-Premium payment requirements, including due dates and grace periods;

-A statement of the importance of keeping the plan administrator informed of the addresses of qualified beneficiaries;

-A statement that the election notice does not fully describe COBRA or the plan and that more information is available from the plan administrator and in the plan’s summary plan description (SPD).

How will the new Health Insurance Exchanges work and what will my options be in 2014?

Starting January 1, 2014, the newest and largest phase of the Affordable Care Act (ACA) will emerge. We have put together the most common elements of this new law and also what we feel are the issues that the self employed might be the most concerned with.

The following is a guide of how the Exchanges will work and what you can expect:
Health Insurance Exchanges are expected to go online in the 4th Quarter of 2013. A Health Insurance Exchange is a way for all people to shop for the most competitive prices on health insurance through one source.

What are my options going to be in 2014?

Medicaid:
If you are at or below approximately $15,000 of annual income as an individual or $31,000 per year as a family of four, you will be eligible for Medicaid and you would not be required to pay a premium.

State or Federal Exchange (Public Exchange):
Depending on which State you live in, you will have access to an Exchange administered by your State. If your State does not offer an Exchange, you will fall back on the Federal Exchange option. Four different options, called “Metal Plans” (Bronze, Silver, Gold, and Platinum) will be offered through these Exchanges. Subsidies will be available based on your age, your income, and your geographic location. Subsidies will not be available for singles that make over approximately $47,000 per year and for families that make over $94,000 per year. All plans offered through the Exchange require some premium to be paid by the applicant. All Metal Plans will be ACA compliant and will include coverage for pre-existing conditions, Essential Health Benefits (EHB), and will be Qualified Health Plans (QHP), which simply means you will not be required to pay a tax penalty if you have a Metal Plan.

Private Exchange:
The private Exchanges work very much like the State and Federal (Public) Exchanges; however, they will offer more options outside of the “Metal” Plans. These plans will be required to have pre-existing condition coverage and Essential Health Benefits. They also must be QHP and ACA compliant. These plans do not have any subsidies available, but could potentially provide lower cost options than the State and Federal “Metal” plans. The Private Exchange's, more than likely, will be a better option for individuals and families that do not qualify for any premium subsidies. These plans are also QHP and you will not have to pay a tax penalty if you purchase one.

Non-Qualified Health Plans (NQHP's):
These plans are not major medical plans. They also are not ACA compliant and would require a tax penalty if you purchase one. However, the premiums could cost as much as 50% less and even more in some cases.

What is a Qualified Health Plan (QHP)?
A Qualified Health Plan is a plan that must include all ACA mandates, including coverage for pre-existing conditions and Essential Health Benefits (EHB). They additionally must contain both deductible and out of pocket maximums which are compliant with the Affordable Care Act (ACA). You are not subject to the tax penalty as long as you have a QHP compliant plan.

What are Essential Health Benefits (EHB)?
Essential Health Benefits are certain amounts of coverage that must be included in any ACA qualified plan (QHP) and must contain maternity benefits, substance abuse, and mental health coverage. We may see additional coverage mandates from the Federal government and also additional mandates from different States.

What is the tax penalty for not having QHP (Qualified Health Plan) insurance?
The tax penalty for an individual not having health insurance is 1% of your income in 2014, 1.5% in 2015, 2% in 2016, and 2.5% of your income in 2017.

Does your business have over 50 Employees?
If so, you must provide coverage to at least 95% of your employees (not dependents) or you must face a penalty or tax of $2,000 per employee (the first 30 employees are exempt). In order to achieve a 95% “take rate”, you would more than likely have to pay all or the majority of the employees’ premiums.

What if I own more than one business?
Unfortunately common ownership is taken into consideration as well. So if you own three businesses (and you are sole owner or one of the owners) and the total employees from all three companies is over 50 full-time employees, you are subject to the mandate and you must provide benefits or face the tax.

Do part-time employees count?
Yes. To determine this, you must take into consideration the hours all of your part-time employees work. When any number of employees’ combined hours equal 30 hours, it will count as one full-time employee. IE: (2) employees working 15 hours each (total of 30 hours) count as 1 full-time employee; (3) employees working 10 hours each (total of 30 hours) count as 1 full-time employee, etc.

What determines whether or not I will receive a premium tax subsidy?
Several factors are taken into consideration including age, geographic area of the US, tobacco use, and income.

What figure do I use for my income to determine if I qualify for a subsidy?
Start with your gross income which includes wages, unemployment, pensions, Social Security, retirement accounts, capital gains, rental income, dividends, interest, and several other factors. You may then take some deductions like alimony, student loan interest, car or truck expenses, insurance, depreciation, employee wages, contract labor, repairs and maintenance, commission taxes and licensing. ***This list is not all inclusive and other provisions may apply**

Will the tax subsidies be paid to me or the insurance company?
If you qualify for a premium tax subsidy, the amount the government pays will be paid directly to the insurance carrier you are enrolled with.

Will I be able to deduct the premium I have to pay?
If you are self-employed, you can deduct premiums from income for Federal and State tax (not FICA) each year on Page 1 of 1040. You may be able to use an IRS Section 105 Plan (HRA) if you have a spouse or at least one full-time employee. This will then enable you to take a Federal, State, and FICA deductions. If you are not self-employed, it does not appear you will be able to deduct premiums at this time and premiums must be paid with after tax dollars.

How do I go about applying for coverage?
You may visit JLBGHealth.com for information and rates for the Private (available now and rate lock until the end of 2014) and Non QHP plans (available now). Public plans are not yet available.

What will premiums look like with and without Government Tax Credits beginning January of 2014 through the Public Exchange (AKA State or Federal Exchanges)?

Example #1:
Single person, age 45, living in a medium regional cost zone, making $45,000 per year
Government Tax Credit: $111.66 per month
Remaining premium due by insured: $356.25 per month

Example #2:
Single, age 55, living in a higher regional cost zone, making anything over $47,000 per year
Government Tax Credit: None
Full premium due by insured: $849.41 per month

Example #3:
Family age 45, living in a medium regional cost zone, making $85,000 per year
Government Tax Credit: $514.17 per month
Remaining premium due by insured: $672.91 per month

Example #4
Family age 55, living in a higher regional cost zone, making $85,000 per year
Government Tax Credit: $672 per month
Remaining premium due by insured: $1,302.00 per month

Example #5
Family age 45, living in medium cost zone, making anything over $94,000 per year
Government Tax Credit: None
Full Premium due by insured: $1,424.00 per month

Example #6
Family age 55, living in higher regional cost zone, making anything over $94,000 per year
Government Tax Credit: None
Full Premium due by insured: $1,975.00 per month

** Family rates assume two adults (the same age with no tobacco use) having 2 children
** Tobacco usage rates are 50% higher than prices above**
***Costs are factored using the Silver plan option which is based on current Congressional Budget Office (CBO) estimates
***Source: Kaiser Family Foundation Health Reform Subsidy Calculator

Many aspects of the Affordable Care Act (ACA) are still being determined at this time. The Department of Health and Human Services (HHS) continues to release updates on the ACA, sometimes on a daily basis. The “Insert Affiliate Name” posts these updates on the website below. “Insert Affiliate” members in 2014 will be able to access all four of the options that are listed above through the “Insert Affiliate” Health Insurance Exchange.

How can I avoid the Health Care Cliff and higher premiums coming in Jan 2014?
Beginning now and lasting through December of this year (2013), members can purchase a health insurance plan and lock in both the plan and the rate until the end December of 2014. In other words you can avoid these higher premiums and mandated plans by purchasing early and not having to worry about it for at least a year and in many cases well over a year. By locking your plan today, you could save thousands in 2014.
For more information on Health Care Reform, to lock in your plan and rate until the end of 2014, to see which option(s) might be best for you, to see if you qualify for any premium tax subsidies or for any additional questions, please visit: JLBGHealth.com or call 1-800-800-5735

Health Care Law Changes Year By Year

2010:

- SMALL BUSINESSES: Tax credits start flowing to businesses with fewer than 50 employees, covering 35% of premiums, to help them afford coverage. By 2014, that will rise to 50%.
UPDATED 3/26/10: The only businesses that get the full 35% have to employ 10 or less and pay them an average wage of $25,000 or less (the wage limitations are not indexed for inflation in the first three years). The credit is reduced for each employee over 10 up to 25 (where you get 0 credit) and $50,000 in average wages (where you get 0 credit). But since the two work together the credit is reduced twice, making it worth even less. The credit expires after the sixth year (or 2010-2013, then you get an additional 2 years if you go into the exchange in 2014), so once the individual mandates and other requirements kick in the credit is gone.

UPDATED 4/6/10: SMALL BUSINESS TAX CREDIT CALCULATOR

Having a hard time trying to figure out what, if any, tax credit you can get for your small business? No problem just click here: HEALTH INSURANCE TAX CREDIT CALCULATOR



- SENIORS: They get a $250 rebate to help fill the "doughnut hole" in Medicare drug coverage.

- YOUNG ADULTS: Children permitted to stay on their parents' insurance policies until their 27th birthday. NOTE: children must be on their parents plan by age 19 (they cannot be added later) and they must be a dependent (not married).

- PRE-EXISTING CONDITIONS: Insurance companies barred from denying benefits to children with pre-existing illness that they make an offer of coverage to.** See Update below**
NOTE:the current law reads that children can still be denied a new policy and therefore would have to go in the state risk pool. Adults are not covered for all pre-existing conditions until 2014.
UPDATED 3/30/10- Although the law is written that insures can still DECLINE to offer coverage on a child if they are sick the health insurance industry has agreed not to decline any child effective in Sept 2010.

- NO LIMITS ON COVERAGE: Insurers can't place lifetime caps on benefits any longer.

- PREVENTIVE CARE: New private plans will have to cover checkups and other preventive services with no co-pays. By 2018, all plans must comply.

- NO MORE RESCISSIONS. Effective immediately, you can't lose your insurance because you get sick. However, you can still be canceled for a material misrepresentation on your application.

2011:

- HEALTH CARE COMPANIES KICK IN: Drugmakers pony up new fees, starting at $2.7 billion. Insurance and medical-device providers follow in 2013.

2013:

- TAXES: Medicare payroll taxes increase - from a rate of 1.45% to 2.35% - for singles earning more than $200,000 a year and families above $250,000.

2014:

This is when all Americans will feel the bill's impact - in their wallets, if not elsewhere.

- INDIVIDUAL MANDATE: Almost everyone will be required to get insurance or face a fine - $95 in 2014, $325 in 2015 and $695 in 2016 (with a maximum of $2,250 for a family). There is an exemption for low-income people.

- EMPLOYER MANDATE: Businesses with 50 or more employees must offer insurance or pay a $2,000-per-worker penalty.

- HEALTH CARE EXCHANGES: These new state-based marketplaces should be open for business, giving individuals and small businesses a place to shop for affordable insurance .

- SUBSIDIES: To help pay for insurance, the feds will offer subsidies to families making as much as $88,000 a year. Out-of-pocket spending will be tied to a person's income and kept as low as $1,000.

2018:

- TAX ON HIGH-COST HEALTH PLANS: A 40% excise tax will be slapped on high-cost "Cadillac" plans starting in 2018.

2020:

- Benefits that began to close Medicare's "doughnut hole" for prescription drugs in 2010 will finally complete the job in 2020.

A majority of New Yorkers are unhappy with anti-tobacco cuts in the state, and many want more to be done to curb its use, according to a poll completed jointly by the American Heart Association, Campaign for Tobacco-Free Kids and several other organizations.

In total, 71 percent of consumers want some of tobacco taxes to go toward smoking prevention programs in the Empire State, according to the poll. Nearly 80 percent explained that it was important for the state to take action to use the available tobacco funds to pay for these types of programs.

"We can spend a little now or a lot later," said Julianne Hart, New York State government relations director for the American Heart Association. "Even in these difficult budget times, voters recognize that tobacco prevention is a smart investment for New York that protects kids, saves lives and saves money by reducing tobacco-related health care costs."

Consumers who are looking for a plan to benefit their healthy living practices may want to consider comparing affordable health insurance rates online. There are many health insurance quotes available that may fit their needs.

The Safety Net Hospital Alliance of Florida warned consumers that legislation in the Senate and House of Representatives could hurt the state's chances of taking care of ill children.

There are 14 hospitals in the Sunshine state specifically used for children, but Medicaid cuts could hurt these venues from helping many of the state's youth, according to the report.

Approximately two-thirds of children in Florida are covered by Medicare, and more than 60 percent hospital days are provided by these children's hospitals in the state. The Senate would cut nearly two-thirds of funding, while the House's proposal would cut 56 percent of funding.

"We are deeply concerned that Senate and House leaders may mistakenly believe children's hospital programs are not harmed by proposed Medicaid cuts, when in fact pediatric programs at children's hospitals across the state are facing devastating cuts," said Lindy Kennedy, a senior vice president at the Safety Net Hospital Alliance of Florida.

Consumers who want to make sure their family is covered may want to compare health insurance quotes, as there are many affordable health insurance rates available.