Bernardini & Donovan Insurance Services

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How the Play or Pay Penalty Works

One of the upcoming changes included in the healthcare reform bill is what is known as the Play or Pay penalty. It’s aimed at larger businesses with a certain amount of employees, and it is not exactly straightforward. An employer can offer health insurance , but, it must be “affordable”.  The idea behind the penalty is to offset the cost of insurance for each employee that uses the public health care plans. The specifics for the Play or Pay penalty are as follows: An employer that has 50 full-time or full-time equivalent employees (IE 100 part-time employees) must offer what is known as “affordable” coverage to all qualifying employees. When an employer does not offer health insurance to all employees, an annual tax of $2,000 for each full-time employee if one employee gets federally-subsidized coverage. In the case an employer does not offer “affordable”  coverage to full-time employees, and one employee

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How a Small Group is Defined for Health Insurance Policies

The Affordable Care Act has divided employers into two categories: small group and large group. The act itself has a test that small business owners use to determine which category they fall under. There is a general dividing line at 50 full-time employees or equivalents, although there are some benefits specifically aimed at businesses with 25 or less full-time employees. A business that employs 50 or less full-time employees falls under the small group definition. However, the full-time employee doesn’t necessarily have to be one individual. A business can have as many part-time employees as it wants as long as the equivalent number does not go over 50. In other words, an employer can have four part time employees working ten hours a week for a total of 40 hours worked. These four people working a total of 40 hours is calculated as one employee. There can be any variation

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Healthcare Reform: How does it affect large groups?

The new Healthcare Reform policies will affect everyone in different ways. Large and small business owners will definitely be affected, as well as health care organizations. As a large group employer, which is an organization that have over 50 full-time employees, you may already offer an insurance option to your employees. If you don’t, you will definitely be required to as the full policy goes into effect January 2014. What does this mean? If you do not comply with federal regulations and provide an adequate health insurance option, you will pay stiff penalties. You have to offer it to at least ninety-five percent of your employees and prove it, even if they choose to opt out of the program.  Make sure to keep proper documentation. If you don’t currently offer an adequate health insurance plan for your employees, now is the time to start looking for one. It may save

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How to Determine if you are Considered Large Group

As a business employer, there are several parts of the Affordable Care Act (ACA) that may affect your business and your group plan. Beginning in 2014, business owners with 50 full-time workers or full-time equivalents (FTEs), are considered a large group employer. As a business owner, the act requires you to offer affordable health insurance coverage to all of your full-time workers, as well as their dependent children, or be subject to penalties. Am I a ‘large group’ or ‘small group’ employer? If you are a business that employs at least 50 full-time employees or 50 full-time equivalents during the prior calendar year, you are subject to the play or pay penalties and the employer-shared responsibility provisions. There is a one-time special six-month transition rule, which applies only for 2014, which allows you to use any consecutive six -month period in 2013 rather than using the full previous twelve months

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Covered California Health Insurance Exchange: Applying for Coverage

Starting October 1, 2013, Covered California will become the primary marketplace for individual health insurance coverage. The market will feature tools which will allow insurance consumers to compare policies that offer affordability to low-income individuals and families. Services include free health insurance or significantly reduced health insurance for qualifying individuals and families. For those who wish to apply for coverage, Covered California can be initiated by phone, online, or through a licensed agent. Applicants should expect to talk with a Covered California call center representative who will screen the applicant for qualification. If qualified, the call is transferred to a county representative for completion. Income verification if through the IRS and the exchange will use the applicants last filed IRS return to verify income as an estimation of income. Applicants can prove income by showing documentation of major changes in income levels for the current year. Covered California is part

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Covered California Health Insurance Exchange: What Kind of Coverage Will you be Getting?

If you want or need to get insured, Covered California has options for health insurance. The exchange has been created to comply with the health insurance changes that are taking effect in 2014. Under the exchange, people will get individual health insurance coverage, there will be 13 commercial health plans, and more than 80% of practicing physicians and acute care hospitals will be participating. The plans provided cover doctor visits, hospital stays, prescriptions, and more. They also avoid many of the gimmicks of same plans that were seen in the past. The out-of-pocket cost is capped at a maximum of $6,350, which will reduce the risk of people going bankrupt because of large medical bills. Without the proper insurance, this possibility is still very real. The list of current insurers is only for individual health insurance coverage, but options will also be available for small businesses to work with the

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