This Patient Protection & Affordable Care Act (PPACA) was signed into law by President Obama on March 23, 2010. Our agency has proactively worked to educate ourselves and our customers since day 1! The recent news coverage of the rollout of the "Healthcare Marketplace" shows the importance of having an agency that is up to date, and well educated on this law. Our Life & Health producers are Certified Healthcare Reform Specialists and continue to attend seminars, read daily updates from organizations like "HAFA - Health Agents for America" and provide customized education for our customers.

The overall impact this law has on both individuals and employers is just now becoming a reality.

First let's address the "Healthcare Marketplace" - these are the exchanges where individuals should be able to shop for insurance on themselves and family members and find out if they qualify for a subsidy. This rollout has been riddled with computer glitches, causing frustration for both individuals and agents.

The administration initially projected 7 million individuals would enroll by March 2014 - only 106k actually enrolled in the first month. This means to hit the 7 million projected enrollees - approximately 1.16 million individuals would need to enroll each month through the March deadline!

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There is also concern for the over 4 million people that have received cancellation notices on their current coverage. The administration is doing their best to address this, but it will require cooperation from the carriers & State Insurance Commissioners.

That takes us to our second concern - Employers. President Obama has stated that the fines for non-compliance in 2014 will be delayed to 2015 for groups larger than 100 and 2016 for groups between 50 and 100. This gives employers a little longer to determine what options they have for compliance in 2015.

Question - Am I an ALE (Applicable Large Employer)?

To determine if you are an ALE, you must consider all employees both Fulltime and Part-time, as well as controlled, affiliated and associated groups- if you have more than 50 FTE (Full Time Equivalents), you ARE an ALE.

Download our ALE Computation Tool

Answer- NO I am NOT an ALE!

Great! If you are not an ALE - you have no obligations to provide affordable and essential coverage- or health coverage of any kind! You are not subject to fines under 4980H. You must still be able to demonstrate your Non-ALE status to the Federal Government.

Answer - YES I am an ALE!

You have many new Federal Obligations. The fines for non-compliance have been delayed, but the mandates remain the same.

  • To avoid fines you must offer "affordable," "minimum value" health coverage to 95% of all benefit eligible employees. Coverage must also be offered to children under the age of 26 -no employer contribution to the premium for the dependent is required.
  • You Risk some fines if you offer coverage that fails one of the "affordable or minimum value" tests. Employers would be fined $250 per month per employee who "leaks" to the Individual Healthcare Marketplace.
  • You can opt to pay the fines and offer no coverage at all. If you choose this option, you would pay $2,000 per year per uncovered employee minus the first 30 lives.

What does "affordable and minimum value" mean?

  • The plan that is offered to your employees must be "affordable." There are 3 means of determining affordability.
  • Providing a "minimum value" plan requires that the coverage is "at least 60% actuarial value."

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