Frequently Asked Questions

INDIVIDUAL FAQs

1- What will be the advantages to health insurance plans in 2014?

Insurance plans must offer free preventive health services such as, mammograms, diabetes screenings, flu shots, blood pressure and cholesterol checks.

2- What type of individual plans will be available to me January 2014?

There are going to be five different Individual Plans available in January 2014.

1. The Platinum Plan
2. The Gold Plan
3. The Silver Plan
4. The Bronze Plan
5. The Catastrophic  Plan

3- When can I enroll for health insurance under the exchange?

Starting October 1, 2013 for a six month period there will be an open enrollment for effective dates January 1, 2014 through March, 2014. After that time, the enrollment will be closed for health insurance until the next open enrollment which will begin October 1, 2014 for a 45 day period.

4- I heard if I choose not to have health insurance the government will charge me a penalty; is this true?

Yes, the penalty for not having insurance will be as follows:

• 2014: The penalty is $95 per adult and $47.50 per child (up to $285.00 for a family) or 1.0% of the family income, whichever is greater.
• 2015:The penalty is $325 per adult and $162.50 per child (up to $975.00 for a family) or 2.0% of the family income, whichever is greater.
• 2016 and Beyond:The Penalty is $695 per adult and $347.50 per child (up to $2,085 for a family) or 2.5% of the family income, whichever is greater.

No penalty will apply for the following reasons:

• Your religion opposes the acceptance of benefits from a health insurance policy.
• You are an undocumented immigrant.
• You are incarcerated.
• You are a member of an Indian Tribe.
• Your family income is $20,000 in 2013 or $10,000 for an individual.
• You will have to pay more than 8% of your income for health insurance, after employer contributions or tax credits.

Were you insured for the whole year through a combination of any of the following?

• Medicare
• Medicaid or the Children’s Health Insurance (CHIP)
• TRICARE
• Plan offered by an employer
• Veteran’s health program
• Grandfathered health plan in force prior to the health care reform law was in place
• Insurance purchased at least at the Bronze level

5- I just graduated from college this year can I stay on my parent’s health insurance?

Now our young adults can stay on a parent’s policy until age 26 even if they are married or living elsewhere.

6- I retired early at age 57 and lost my healthcare insurance sponsored by my employer, how do I get insurance now?

Currently when you transfer off of a group plan you need to medically qualify for an individual policy. Beginning January 1, 2014 everything will be guaranteed issue.

7- Will HSA plans still be available?

Yes, HSA’s are still going to be available under the current guidelines under the Healthcare Act.

8- Will there be a lifetime cap on the amount of health care service insurance companies will cover?

No, insurance companies will no longer be able to place a lifetime cap on the amount of health care services received by an individual. In addition, no one can be denied insurance due to a pre-existing condition.

9- Will I still be able to purchase insurance using my agent?

Absolutely, whether you go through the exchange or whether you go directly through the insurance company or through an agent the price is the same. The difference is through an agent you have an advocate.

LARGE GROUPS FAQs

1- I have 75 employees what happens if one of my employees obtains health insurance through the exchange?

If one of your employees goes into the exchange and receives health insurance with the subsidy you’ll receive a $3,000 penalty.

2- Are there any insurance plans that are going to be exempt from the Affordable Healthcare Act?

All fully insured plans must qualify under the Affordable Healthcare Act requirements.

3- Are there any penalties if I do not provide insurance to my employees?

As a large group employer with 50 or more employees there is a penalty of $2,000 per employee minus the first 30 which you get a break on.

4- What happens if an employee pays more than 9.5% of their income through the exchange?

As a large group employer if your employee goes into the exchange and receives a subsidy and is paying more than 9.5%  you are subject to a $3,000 penalty.

5- Are employers required to cover my spouse and children?

According to the Affordable Healthcare Act, an employer is required to offer health insurance for employees children. The cost of insurance for the employees children will be at the employees expense. While an employer must offer insurance for the employees children the employer does not have to offer insurance for the employees spouse.

SMALL GROUPS FAQs

1- What is the difference between small group and large group under the Affordable Healthcare Act?

Under the Affordable Healthcare Act 50 or more full time or part time equivalent employees is large group. Under 50 employees is considered small group.

2- Will employers be required by law to offer health insurance to their employees?

No, there’s nothing in the Healthcare Act that starts in January 1, 2014 saying that you have to offer your employees health insurance. However, if you are an employer and you have 50 or more full-time and part-time equivalent employees you have penalties of $2000.00 per employee or $3000.00 for each employee that goes into the exchange and receives a subsidy. There will be a leeway of amnesty of the first 30 employees but each employee after the 30 the penalty does apply.

3- I have ten employees am I required to offer health insurance?

No since you have less than 50 or 50 fulltime or part-time equivalent employees you are not required to offer them health insurance.

4- I am an employer, how do I get group insurance through the exchange?

You can get insurance directly through the SHOP or you can do it through the use of an agent and have the agent guide you through the process of how to get the insurance through the SHOP without any additional cost to you as the employer.

5- Will employers be able to keep the current health insurance they offer their employees?

Most likely not, starting in January 1, 2014, all the plans that the insurance companies offer must comply with either the bronze, gold, silver or platinum plans unless you are considered grandfathered, which means you were in a plan prior to March 1, 2010. Most Insurance companies are relaying that there will be no grandfathered plans in January 2014, so all plans will need to be changed to comply with the Healthcare Act.

6- What plans are offered for groups?

Under the Affordable Healthcare Act all plans must qualify either under the Bronze, Silver, Gold or Platinum plans.

7- As a small business will I be required to purchase insurance through the exchange?

Absolutely not, you will have the option to purchase insurance through the exchange or directly through the insurance company.

8- I am self-employed covering my family, how will the Healthcare Act impact my insurance?

If you received your plan prior to March 23, 2010 you are considered grandfathered and keep your original plan. Anything after March 23, 2010 must comply with the new healthcare guidelines that go into effect January 1, 2014.

9- How is preventive being covered under the Healthcare Act?

This was an excellent addition to health insurance starting March 1, 2010. All new policies that are written on individual and group include preventive services. For example a woman’s annual pap, mammogram, a gentleman’s prostate exam, colonoscopies for both men and women over 50 are covered now under the new law. There is a list of about 20-25 items that you will not pay anything for and are covered 100% without a deductible.

10- Will I still be able to offer flexible spending accounts to my employees?

Yes the difference is when the Healthcare Act started last January 1, 2013 you now have a maximum of $2500.00 per year.

11- Can you tell me about the new law surrounding early-retiree insurance?

It is up to your former employer to decide whether to apply to the new program or not. Only employers who already provide health insurance to early-retirees can do so.

MARKETPLACES FAQs

1- I keep hearing the term “Marketplace,” What is this exactly?

The Marketplace was developed for consumers to choose the best and most competitive health insurance plans to fit each person’s budget.

2- Does California have a Marketplace?

Yes, California does have a Marketplace.

3- When does the marketplace begin?

January 1, 2014.

4- Are there any requirements to get insurance through the Marketplace?

Yes there are:

1. You must be a US citizen or national
2. You must live in the USA
3. You cannot be currently incarcerated

5- What healthcare companies have been approved with Covered California?

Thirteen have just been approved:

• Alameda Alliance for Health
• Anthem Blue Cross of California
• Blue Shield of California
• Chinese Community Health Plan
• Contra Costa Health Services
• Health Net
• Kaiser Permanente
• L.A. Care Health Plan
• Molina Healthcare
• Sharp Health Plan
• Valley Health Plan
• Ventura County Health Care Plan
• Western Health Advantage