Healthcare Reform and You: Key Provisions

Healthcare Reform and You
The healthcare reform law, officially known as the Patient Protection and Affordable Care Act (Affordable Care Act), was
signed by President Obama in March 2010. The law is intended to expand access to affordable, quality healthcare for
Americans.
The law will be implemented over a 10-year period. Several major provisions, or rules of the law, took effect in 2014. Some
things may affect you and your family while others may not.
Key Provisions:
Children Covered to Age 26: Dependent children up to age 26 can be covered under your medical plan, even if they
are married, not living with you or not financially dependent on you.
Summary of Benefits and Coverage: During each years enrollment, you will receive a Summary of Benefits and
Coverage in paper or electronic form with information about our plan in a standard format so you can compare our
plan to other coverage, such as your spouses plan.
W-2 Reporting: Each January, we will report the total value of your medical plan for the previous year on your W-2
tax form. This is for your information only and does not affect your income or taxes
No Lifetime Maximum: There is no lifetime dollar limit on the amount your medical plan will pay for essential health
benefits. This refers to a set of benefits that includes the 10 general categories listed below. All plans may or may not
cover all of these categories. However, for items that are included, the plan cannot place lifetime dollar limits on
those benefits.
Additional Medicare Taxes: Individuals earning more than $200,000 and couples earning more than $250,000 began
paying additional Medicare taxes in 2013.
Preventive Care: Preventive care services, such as annual physicals and immunizations, are covered at no additional
cost to you. Effective August 1, 2012, non-grandfathered plans were required to cover additional womens
preventive services with no co-insurance, copays or deductibles, including certain health screenings, breastfeeding
equipment and supplies, and contraceptives.
Doctor Choice: If your plan requires you to choose a primary care doctor, you can select a general practitioner,
family practitioner, internal medicine specialist or pediatrician. Women can also visit an obstetrician/gynecologist
without a referral.
Emergency Care: Emergency room services from any hospital are paid at the in-network level, even if the hospital
isnt in our plans network.
Prescriptions for OTC Drugs: You must have a prescription to pay for most over-the-counter drugs from an HSA, FSA
or health reimbursement account (HRA).
Health Savings Account Penalty: If you use your HSA for purchases not listed as eligible healthcare expenses under
the federal tax code, you will pay a 20-percent penalty on those purchases.
The Individual Mandate: A new requirement called the individual mandate took effect on January 1, 2014. All U.S.
citizens and legal residents, with a few exceptions, are required to have minimum essential coverage. Coverage
under one of our medical plans will satisfy this requirement. Other types of coverage that meet the individual
mandate include plans provided by another employer, Medicare, Medicaid or individual health insurance.
Healthcare Reform: Health Insurance Marketplace FAQs

What Is the New Health Insurance Marketplace (or Exchange), and When Will It Be Available?
The Health Insurance Marketplace is an online marketplace that was established with the intent of making it easier and
more affordable to buy health coverage. Whether or not this goal will be achieved is yet to be determined. The marketplace
allows individuals and small businesses to compare health plans and determine if they are eligible for tax credits for private
insurance or other health programs (e.g., CHIP) and enroll in a health plan that meets their needs.
Is the Marketplace Relevant for People Who Have Coverage Through Their Employers?
Probably not. Although employers can purchase their coverage through the marketplace, most employers are expected to
maintain their plans outside of the marketplace based upon the projected pricing and plan options. If your employer does
not purchase coverage through the marketplace, it is unlikely that the marketplace will be a viable option for you because
you would be forfeiting your employers contribution toward your benefit premiums if you waive coverage from your
employers plan and enroll in the marketplace plan.
When Will I Be Able to Enroll in a Health Plan Through the New Marketplace?
The initial enrollment period for the marketplace began on October 1, 2013. You are now able to get information from the
marketplace about the plans in your state. You may enroll directly through the website or by calling a toll-free hotline. If you
are having difficulty finding a plan that meets your needs and budget, assistance is available.
What Types of Health Plans Are Available Through the Marketplace?
The health plans are similar to the plan(s) you receive from your employer. All health plans offered through the marketplace
have limits on cost-sharing and cover a comprehensive package of items and services, which is known as the essential
health benefits package. In general, the marketplace offers four levels of coverage for consumers.
How Much Does a Health Plan Cost Through the Marketplace?
The premiums for health plans offered through the marketplace vary by type of plan and location, but the total premiums
are very similar to the total premiums under your current employer plan. The big difference, however, is that you are
receiving a company contribution under your current company-sponsored plan, but you will lose that contribution if you
drop your employer coverage to join a marketplace plan. Different financial assistance programs are linked to the
marketplace, such as Medicaid and CHIP. Some individuals may be eligible for a new premium tax credit that they can use
right away to lower their monthly health plan premiums.
Who Is Eligible for the Marketplaces Premium Tax Credit?
Eligibility for the tax credit depends on your income and family size, as well as your eligibility for minimum essential
coverage through your employers plan. To be eligible for the tax credit, you must enroll in a health plan through the
marketplace and:
You must have household income for the year between 100 percent and 400 percent of the federal poverty line for your
family size.
You may not be claimed as a tax dependent of another taxpayer.
You must file a joint return, if married.
You cannot be eligible for minimum essential coverage under an employer health plan.
If you are eligible to enroll in an employer health plan that meets certain standards, you are eligible for minimum essential
coverage. This would make you ineligible for the premium tax credit. An employers plan does not provide minimum
essential coverage if the cost for employee-only coverage is more than 9.5 percent of your income for the year.
How Can I Access Information About the Marketplace in My State and Get a Price & Coverage Quote?
The federal government has established a tool to walk you through a process to direct to you to the correct marketplace
based upon the state in which you live. To use this tool, visit www.healthcare.gov.
2
New Health Insurance Marketplace Coverage

Options and Your Health Coverage
PART A: General Information
As a result of the healthcare law, the Health Insurance Marketplace is now available as a new option to purchase health
insurance. To assist you as you evaluate options for you and your family, this notice provides some basic information about
the marketplace and employment based health coverage offered by your employer.
What Is the Health Insurance Marketplace?
The marketplace is designed to help you find health insurance that meets your needs and fits your budget. The marketplace
serves as a one-stop shop for finding and comparing private health insurance options. You may also
be eligible for a new tax credit that lowers your monthly premium immediately. Open enrollment for health insurance
coverage through the marketplace is now available.
Can I Save Money on My Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer either does not offer coverage
or offers coverage that doesn't meet certain standards. The amount of savings on your premium for which you are eligible
depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings Through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a
tax credit through the marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for
a tax credit that lowers your monthly premium or for a reduction in certain cost-sharing amounts if your employer does not
offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your
employer that would cover you (and no other members of your family) is more than 9.5 percent 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.
Note: If you purchase a health plan through the marketplace instead of accepting health coverage offered by your
employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, the employer
contributionas well as your employee contribution to employer-offered coverageis often excluded from income for
federal and state income tax purposes. Your payments for coverage through the marketplace are made on an after-tax
basis.
How Can I Get More Information?
For more information about the coverage offered by your employer, please check your summary plan description or contact
the Melita Group Benefits Help Desk at [email protected] or 800.986.6660.
The marketplace can help you evaluate your coverage options, including your eligibility for coverage through the
marketplace and its cost. Please visit www.healthcare.gov for more information, including an online application for health
insurance coverage and contact information for the Health Insurance Marketplace in your area.
PART B: Information About Health Coverage Offered by Your Employer

This section contains information about any health coverage offered by your employer. If you decide to complete an
application for coverage in the marketplace, you will be asked to provide this information. This information is numbered to
correspond to the marketplace application.
Employer Name
Sarens USA, Inc.
Employer ID Number (EIN)

94-1691525
Employer Address
5000 Executive Pkwy, Ste. 230
Employer Phone Number

(925) 359-6000
City
State
San Ramon
CA
Who Can We Contact About Employee Health Coverage at This Job?
Isabel Granados
Zip
94583
Phone Number (If Different)

(510) 865-2400
Email Address
[email protected]
Basic Information About Health Coverage Offered by This Employer:

As your employer, we offer a health plan to:
All employees
Some employees. Eligible employees are: Full time employees working at least 30 hours per week
With respect to dependents:
We do offer coverage. Eligible dependents are: Spouse, Domestic Partner, and Children up to age 26
We do not offer coverage
If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is intended to be
affordable based on employee wages.
Note: Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount
through the marketplace. The marketplace will use your household income, along with other factors, to determine
whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (e.g., you are
an hourly employee or you work on a commission basis), you are newly employed mid-year, or you have other income
losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the marketplace, www.healthcare.gov will guide you through the process. Below is the
employer information you'll enter when you visit www.healthcare.gov to find out if you can get a tax credit to lower your
monthly premiums.
The following information corresponds with the Marketplace Employer Coverage Tool. Completing this section is optional
for employers but will help ensure employees understand their coverage choices.
1. Is the Employee Currently Eligible for Coverage Offered by This Employer, or Will the Employee Be Eligible in
the Next 3 Months?
Yes (Continue)
Yes (Continue)
1.a. If the Employee Is Not Eligible Today, Including as a Result of a Waiting or Probationary Period, When Is the
Employee Eligible for Coverage?
(MM/DD/YYYY) (Continue)
No (STOP and return this form to employee)
4
2. Does the Employer Offer a Health Plan That Meets the Minimum Value Standard*?
Yes (Go to question 3)
No (STOP and return form to employee)
3. For the Lowest-Cost Plan That Meets the Minimum Value Standard* Offered Only to the Employee (Do Not
Include Family Plans): If the Employer Has Wellness Programs, Provide the Premium That the Employee Would
Pay if He/She Received the Maximum Discount for Any Tobacco Cessation Programs and Didnt Receive Any
Other Discounts Based on Wellness Programs.
a. How much would the employee have to pay in premiums for this plan? $__________
b. How often?
Weekly
Every 2 weeks
Twice per month
Monthly
Quarterly
Yearly
If the plan year will end soon and you know that the health plans offered will change, proceed to question #4. If
you don't know, STOP and return this form to the employee.
4. What Change Will the Employer Make for the New Plan Year?
Employer won't offer health coverage
Employer will start offering health coverage to employees or change the premium for the lowest-cost plan
available only to the employee that meets the minimum value standard.* (Premium should reflect the discount
for wellness programs. See question 3.)
a. How much will the employee have to pay in premiums for that plan? $__________
b. How often?
Weekly
Every 2 weeks
Twice per month Monthly
Quarterly
Yearly
Date of change (MM/DD/YYYY):
*An employer-sponsored health plan meets the minimum value standard if the plan's share of the total allowed
benefit costs covered by the plan is no less than 60 percent of such costs (Section 36B(c) (2) (C) (ii) of the Internal
Revenue Code of 1986).

Healthcare Reform and You: Key Provisions

Uploaded by

Copyright:

Available Formats

Healthcare Reform and You: Key Provisions

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Healthcare Reform and You: Key Provisions

Uploaded by

Copyright:

Available Formats

Healthcare Reform and You

Healthcare Reform: Health Insurance Marketplace FAQs

New Health Insurance Marketplace Coverage

PART B: Information About Health Coverage Offered by Your Employer

Employer ID Number (EIN)

Employer Phone Number

Phone Number (If Different)

Basic Information About Health Coverage Offered by This Employer:

You might also like