ACA Expertise

The consultants at Benefits Planners, Inc. are continually educating themselves to stay abreast of new laws, regulations and legislation within the healthcare and healthcare insurance industries.

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Healthcare Reform, The Affordable Care Act

How it affects everyone.

Benefits Planners, Inc. can keep you informed of all of the latest changes in Healthcare Reform to ensure you are prepared and compliant, especially when it comes to the most recent healthcare reform, the Affordable Care Act (ACA).

The ACA, also known as OBAMA CARE, is currently being implemented and is probably the nation’s most significant change in the laws that govern healthcare.

Below you will find some (but certainly not all) highlights of the new law and how it may impact employers and individuals under 65.

Highlights of the Affordable Care Act

For Individuals and Businesses

How Healthcare Reform Affects You or Your Business

Employers who have 50 or more full-time equivalent employees must offer those employees and their families and dependents to age 26, benefits that pays for 60% of the minimum essential benefits, as established by the ACA, or face a potential penalty.

Individuals must now obtain qualifying coverage either through an individual policy or through their employer or face a potential penalty.

Grandfathered and Grandmothered health plans may have some leniency in the ACA tax penalties, but strict rules apply. If you think you may have a Grandmothered or Grandfathered plan, contact us today to get more information.

New rules for health insurance companies.

No pre-existing clause. Insurance companies can no longer increase rates or deny coverage because of a pre-existing condition.

Dependents up to age 26 may be added to an insurance policy for both individuals and employer coverage.

Gender is no longer a factor in determining rates.

Renewal rates are the same as new business rates.

Waiting period should not exceed 90 days.

Individuals must purchase their health insurance during the annual open enrollment period. Failure to do so may result in penalties and having to wait until the next open enrollment to purchase coverage. Employers are able to offer benefits year round or during their normal open enrollment as usual.

You may be subject to a tax penalty if you do not comply with the “Essential Benefits” of ACA.  Specifically, to be in full compliance with the law, your insurance policy must cover at least 60% of the costs of the Essential Benefits.

Essential Benefits
  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Prescription Drugs
  • Mental health and Substance Abuse disorder services
  • Rehabilitative and habilitative services and devices
  • Pediatric services, including oral and vision care
  • Preventive and wellness services, and chronic disease management
EMPLOYERS

Employers who have more than 50 full-time equivalent employees must offer those employees benefits that pays for 60% of the minimum essential benefits.  The penalty will apply when at least one employee receives a premium tax credit in the exchange.  As a result, your penalty will be $2,000 per year multiplied by the number of full-time employees, and excludes the first 30 employees.   The penalty is increased each year by the growth in insurance premiums.

INDIVIDUALS

The penalty may also affect individuals who fail to obtain qualifying health insurance.  Individuals can have coverage through their employer, or through an individual policy to satisfy the requirement.  If  you do not have qualifying health insurance, the tax penalty will be $695 for adults. Additionally, the penalty is $347.50 for each child. However, the maximum family penalty is the greater of 2.5% of income, or three times the adult penalty, which is $2,085.  Accordingly, when you file your annual tax return, your penalty will apply.