!
To compare individual health insurance quotes, or to request quotes for health, life, disability, dental, workers’ comp, professional liability,
business owners package, home, auto, personal umbrella, and more go to
www.3000ig.com.
FREQUENTLY ASKED QUESTIONS:
What is an exchange? An exchange, also referred to as a marketplace, is a portal through which individuals can purchase insurance. There are private exchanges, state exchanges and a federal exchange. Oklahoma does not have a state exchange. The ODA has a private exchange at
3000ig.com. What penalty applies for an individual who does not comply with the Individual Mandate? The penalty fee for not having health coverage is calculated one of two ways: either a flat fee or a percentage of your household income that falls above the tax filing threshold, whichever is higher. In 2015 the flat fee penalty is calculated as $325 per adult and $162.50 per child under age 18, subject to a maximum of $975. In 2015 the percentage penalty is 2% of household income, subject to a maximum equal to the national average premium for a bronze plan. In 2016, the fee increases.
Does my employer have to offer health insurance coverage to me? At this time, there is no coverage mandate for small employers with fewer than 50 full-time equivalent employees (FTEEs). Employers with 50-99 FTEEs will be required to provide coverage beginning 1-1-2015, though new provisions were recently released suggesting some employers in this category may qualify for a delay to 1-1-2016. Employers with 100 or more FTEEs must offer coverage beginning 1-1-2015.
How do I know if I am eligible for a premium subsidy, and how much my premium subsidy would be? You may qualify for a premium subsidy if your household income falls between 100%-400% of the Federal Poverty Level, and your employer does not provide affordable coverage that includes minimum essential health benefits, and you are not eligible for Medicare or Medicaid. Here is a link to a calculator to help with determining eligibility
http://kff.org/interactive/subsidy-calculator/
How do I obtain the premium subsidy? If you qualify for a subsidy, you must purchase coverage from the Federally Facilitated Marketplace (FFM) at
healthcare.gov in order to receive the premium subsidy. Depending on information you provide and options you choose when enrolling in a qualifying health plan on the FFE, it will be in the form of an Advanced Premium Payment paid directly to your insurance company, or a tax credit applied when you file your 2014 Tax Return.
What is considered Affordable Coverage? Employer coverage is considered affordable if the employee’s share of the annual premium for self-only coverage is no greater than 9.5% of annual household income.
Do I have to register with or purchase coverage through
healthcare.gov? If you are not seeking a premium or cost-sharing subsidy, then there is no need to register with or purchase insurance through
healthcare.gov. Whether you purchase your next plan on or off the exchange, we can help you.
Can I keep and make contributions to my Health Savings Account (HSA) in 2015. Yes, you may keep your HSA because there will be ACA-compliant HSA qualifying health plans available in 2015. 2015 HSA Contribution Limits: • Annual contribution for self-only coverage under a high deductible health plan is $3,350. • Annual contribution for an individual with family coverage under a high deductible health plan is $6,650. • Catch-up contributions of up to $1,000 can be made for account holders age 55 or older.
50. TIMELINE:
The following changes have occurred to health insurance as a result of health care reform: • Guaranteed Issue coverage for all ages • No pre-existing conditions imposed on anyone • Dependents can be covered up to age 26 on their parents’ health plan • No annual or lifetime limits on essential benefits • Preventive care covered 100% in-network • Insurer Fee, Transitional Reinsurance Fee, Risk Adjustment Fee: fees payable by insurance companies and passed on to consumers, sometimes as a separate line item on your health insurance bills.
• Individual mandate: individuals must purchase a Minimum Essential Coverage (MEC) plan, enroll in Medicaid, enroll in Medicare, or enroll in an employer plan, or face a fee/penalty.
• Community Rating, i.e. rates can no longer differ based on gender, health history or claims. Rates are based on geographic location, age and tobacco use. Age factors are subject to a 1:3 maximum premium ratio, with 3 age bands: under 21, 21-63, and 64+
• Minimum Loss Ratio (MLR): carrier requirement to spend 80-85% of premium dollars on healthcare. Carriers must provide a rebate or premium credit to customers if they did not meet the MLR.
• Premium and cost-sharing subsidies available to eligible individuals • Expanded Medicaid eligibility in some states [Note: Oklahoma and many other states have not expanded Medicaid at this time – current income guidelines for OK Medicaid can be found at:
http://www.okhca.org/individuals.aspx?id=10328]. • Plans must include coverage for 10 Essential Health Benefits
Note: This information is not intended to provide legal or tax advice. Please consult a CPA and/or attorney for matters concerning tax planning and employment-related practices.
December 2014
www.okda.org 39
Don’t see your question/concern here? Please call or email us with your questions - (405)521-1600,
lindsey@3000ig.com
405.521.1600 3000 INSURANCE GROUP
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