If You Don’t Provide Group Insurance to All Workers, Read This!

By November 13, 2018 November 28th, 2018 Affordable Care Act, Benefits & Insurance

Affordable Care ActHave you reminded your self-insured employees to sign up for a 2019 Marketplace plan, yet? This year, the enrollment period is shorter than in previous years—it runs through Saturday, December 15, 2018. (Workers in hurricane-affected areas may have until December 31, 2018.) After that, workers cannot get 2019 coverage unless they qualify for a Special Enrollment Period.

On the plus side for the uninsured, the individual mandate, which requires those not enrolled in an approved plan to pay a penalty, will no longer be in effect as of January 1, 2019. Additionally, plan costs have risen enough that in some markets, even fairly well-paid employees may be eligible for a 2018 exemption. To help your uninsured workers determine their liability, if any, share this link with them. For a “quick guide” to the Health Insurance Marketplace, click here.

There are other changes to the ACA this year, as well, including:

1. States have more leeway on how they cover the ACA’s 10 essential health benefits, or EHBs: outpatient care, emergency services, hospitalization, maternity care, mental health, prescription drugs, rehabilitation, laboratory services, preventive care and pediatric services.

2. Transitional, pre-ACA policies, which have been allowed since 2013, can continue.

3. Income verification for premium subsidies. Overstating of income (to qualify for premium subsidies) has been an issue in some states that did not expand Medicaid.
4. CMS said it has seen evidence of people in states that didn’t expand Medicaid overstating their income when their true income was below 100 percent of the federal poverty level—which would make them eligible for Medicaid, not premium subsidies.

5. States can more easily modify the 80 percent medical-loss ratio (MLR) standard required by the ACA. If a state can argue a lower standard would help “stabilize the individual market,” then the change would be allowed.

For more detail, we recommend an article by Healthcare Exec, an industry publication for healthcare executives. You can read it, here.

MarathonHR doesn’t sell insurance, but we work with partners who do. To explore any of your firm’s human resources needs, please feel free to give us a call at 678-208-2802.