Martin Insurance Benefits

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WHAT'S NEW WITH HEALTH CARE REFORM?

IF YOU ARE AN INDIVIDUAL OR FAMILY...

Starting in October of 2013, every citizen who is not on Medicare or Medicaid, will have two big changes to their health insurance:

  • As part of the Affordable Care Act (ACA or health care reform law), starting January 2014, All Americans must have health insurance or be taxed by the government.
  • Colorado will have a health insurance exchange for people who don't get health insurance at work or can't afford health insurance where they can shop for health insurance coverage. The exchange is simply a new place to shop and buy insurance, although health insurance will still be available privately.

Approved healthcare plans will be offered in a tiered format (i.e Platinum, Gold, Silver and Bronze).. Each tier will have several plans to choose from and pricing will be based on the tier level. The law requires health insurance to be "Guarantee Issue." This means a person (or family) can't be denied coverage or charged more because of an existing health condition. Those who don't have access to affordable, minimum essential health coverage can buy from the exchange and receive a credit or subsidy of they meet income requirements, which range from 133% to 400% of federal poverty level.

These "newly qualified" health plans include "essential health benefits", including :

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity & newborn care
  • Mental health and substance use disorder services
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Pediatric services, including oral & vision care

"Qualified health plans" will replace the plans currently in existence. This means that every person individually covered will enroll in a new "Qualified Health Plan" with enrollment beginning October 1 and effective January 1, 2014. It may be possible to enroll during their anniversary month, but this has not been finalized by Human Health Services.

In 2014 legal U.S. citizens who do not have a minimum amount of health coverage will receive a penalty. This amount is based on a flat dollar amount or 1% of your income, whichever is greater. Each year the penalty will increase if the citizen fails to obtain health insurance.

IF YOU RECEIVE HEALTH INSURANCE THROUGH YOUR EMPLOYER...

If you receive your health insurance through your employer, your employer will make decisions relative to your insurance plan. Employers with 50 employees or more will be required to offer health insurance that meets the minimum coverage definition or be exposed to certain penalties.

Health Care Reform does NOT require employers to

  • Contribute to the premium. (Although if they do not, their plan may not be affordable, putting the employer at risk for penalties.)
  • Offer dependent coverage.

Employers with 49 employees or less can offer employer based insurance or may use an exchange to find insurance for their employees. These are called Smart Business Health Opion Programs, of SHOP's for short.

Options available to Small Employers Include:

  • Offer a fully insured plan through a SHOP exchange or the traditional market
  • Offer a self funded plan, if allowed by state law, where they are not subject health reform standards
  • Stop offering coverage and let employees buy an individual plan on or off the exchange

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