Bernardini & Donovan Insurance Services

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How Buying Insurance in an Exchange is Going to Work for Individuals

The first day for open enrollment into the California insurance exchange is drawing near, offering access to individual health insurance like never before. Individuals are going to be able to shop for a plan that suits their personal needs as well as being able to compare and contrast the available options. Covered California, the state exchange, offers the option to get information via a website, through the mail or by phone. All of these options are going to contain information that helps you, the consumer, decide on which plan is right for you. The website will have a variety of features that allow the user to pick and choose their plan. Available information includes premiums, what benefits are offered for each plan, provider networks and availability. Other information demonstrates how much the plan spends in order to cover medical claims in relation to administrative charges. That way, the consumer can

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What is an Individual Health Insurance Exchange

Now that the end of the year is approaching, California and other states are making sure they comply with provisions of the Affordable Care Act. One of the main provisions is providing Health Insurance Exchanges for individuals. What does this mean? It means that people can purchase individual health insurance plans to cover their medical expenses. The exchanges allow individuals to compare pricing and services, making informed decisions on what will work best for them according to the four levels of coverage offered. These plans will be available for purchase in a variety of ways: mail, web, by phone or in-person. Additionally, the exchanges will have information you need in relation to premium costs and possible subsidies. It is important to understand the intricacies of selecting a provider and how the exchanges work. Starting January 2014, everyone is required under the Affordable Care Act to carry a health insurance policy.

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Large Group Reforms Delayed till 2015

In July of 2013, the Obama Administration announced that it was delaying the large group reforms of its insurance mandate until 2015. That was a significant issue for companies that knew they would have to provide coverage for a significant number of employees. The smaller groups and individuals who are required to purchase insurance will still need to have that in place by January 1st of 2014, however, as the change does not apply to them. For companies to fall under the mandate extension, they need to have 50 or more full-time employees. However, that’s not as simple as it sounds. These employees are what’s considered to be “full time equivalent” workers. If they have worked an average of 30 hours or more per week in a given month, they fall under that designation. Companies need to keep careful track of their workers’ hours in order to determine whether they

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Healthcare Reform: Employer Responsibility

As the fully implemented Healthcare Reform provisions go into effect on January 2014, employer responsibility becomes a national issue. Although there are some pieces of Healthcare Reform that have already started to change, the brunt of the law and its implications are waiting in the wings. Large groups and their employers play a major role in the effectiveness of the law. While most large group employers do offer health insurance options, they must keep in mind that non-compliance with the law is not an option. If they do not comply, stiff penalties will result. Large group employers now carry a certain amount of employer responsibility that has never been an issue. Additionally, employers of large groups will now have to report their health care coverage compliance to the IRS, ensure all employees are notified about health care exchanges available, and run the risk of getting into serious trouble if they

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Controlling the “Play or Pay Penalty” Under Healthcare Reform

When preparing to comply with the new Healthcare Reform law, large employers should recognize the implications of non-compliance as it relates to the play or pay penalty. If your organization has over fifty full-time employees and they were there in the preceding year, you must offer an adequate health care insurance option to them or pay penalties. What does this mean? It means that if you are a large corporation, your penalties will be assessed based on the recorded number of full-time employees. The pay or play penalty can be calculated in a variety of ways. If you have a number of subsidiaries, your calculations would be different than that of a company with just one major corporation and all of the full-time employees working under that entity. This penalty applies to the corporation or entity that failed to provide “affordable” coverage, which is the main stipulation of the law.

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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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