How are pregnancy and birth control covered by new health plans?

Pregnancy will be covered on new individual and family health plans 

New plans must include coverage for pregnancy as part of the Essential Health Benefits coverage. You must enroll in an Affordable Care Act compliant plan with an effective date of January 1, 2014 or after.

If you are planning on keeping your current coverage and are interested in maternity coverage, it's a good idea to check your plan before making a final decision on new plan options.  

Covered contraceptive methods

New plans must also offer cover contraceptive methods and counseling for all women, as prescribed by a health care provider.

These plans must cover the services without charging a copayment, coinsurance, or deductible when they are provided by an in-network provider.

All Food and Drug Administration-approved contraceptive methods prescribed by a woman’s doctor are covered, including:

• Barrier methods (used during intercourse), like diaphragms and sponges
• Hormonal methods, like birth control pills and vaginal rings
• Implanted devices, like intrauterine devices (IUDs)
• Emergency contraception, like Plan B® and ella®
• Sterilization procedures
• Patient education and counseling

Plans aren’t required to cover:

• Drugs to induce abortions
• Services related to a man’s reproductive capacity, like vasectomies

The Exchange App is included in all our business plans

There's no doubt about it: we all live busy lives. There's so many personal and professional obligations that sometimes it's nearly impossible to manage.

So for many of us, a smartphone is our lifeline. We use them to manage our time and responsibilities, to receive information on-the-go, and stay connected to others.

We understand the importance of having quick and easy access to information, especially when it comes to benefits. It seems like the only time we really need the information is when it's hard to access it - like, when we're driving a sick child to the Emergency Room, standing in line at the pharmacy, or sitting in the doctor's office waiting room.

That's why we developed the smartphone Exchange App, which is included in all our business plans. Employees can enjoy 24/7 access to their benefits, claims, or check provider networks. They can enroll in benefits or make changes right there on their phone.

Employees can also use the app to access any of the information included in the company's custom benefit management system: payroll information, Human Resource policies and procedures, company announcements, update profile information, make changes to dependent status, get quotes on voluntary insurance products, and more.  

The Exchange App is just one more way that we're making employee benefits simple.

What happens if a Large Business doesn't offer health insurance to it's employees?

You are subject to penalties starting in 2015.

What is the penalty?

If you are a Large Business (50 or more employees), then you are required to offer health insurance or pay a penalty in 2015. The penalty for not offering health insurance is $2,000 per employee per year. You get a waiver for the first 30 employees.

So, for example, let's say that your business employees 72 full-time equivalents and you don't offer qualified health insurance.

You get a waiver on the first 30, so that leaves 42 employees to pay penalty for.
42 x $2,000 = $84,000 annual penalty.

Is it better to pay or play?

Many Large Businesses are asking if they should pay or play? Is it better to not offer health insurance and pay the annual penalty or is it better offer affordable health insurance to their employees?

Our Pay or Play Calculator will show you, down to the penny, the cost for both options. And we'll advise you on the pros and cons of each.

What if my plan is not affordable?

A Large Business plan has to pass an Affordability Test for each and every employee. What the employee pays toward the employee-only premium cannot exceed 9.5% of his/her Modified Adjusted Gross Income.

If your plan is unaffordable, and at least one employee tries to use a tax subsidy to get lower costs on Individual or Family Insurance plans, then the penalty is $3,000 per employee per year.

For example, if there was a business with 72 employees:

72 employees x $3,000 = $216,000 annual penalty

What about the plan I have now for Large Businesses?

You can keep it. You shouldn't see any changes in benefits or pricing until you next plan renewal.

How the Affordable Care Act changes Large Business Plans 

Under ACA, a Large Business is one with 50 or more full-time equivalent employees.

The Affordable Care Act had very little effect on  how Large Business health plans are underwritten, priced or the benefits they will provide. However, there were significant changes to Individual, Family, and Small Business plans under the new law.

The law affects Large Business plans by penalizing employers who do not offer health coverage to employees. A Large Business is also penalized if the plan offered doesn't pass the Affordability Test for each employee.

Penalties have been delayed until 2015 to give Large Businesses time to make sure that their plan is compliant with the law. Our experts will conduct a review of your plan and show you all your options. When you work with a Private Exchange, you know that your plan is 100% compliant. And the exchange takes care of all the required reporting, calculations, and employee notifications for you.

You can keep your current group plan and still use the Private Exchange technology and services such as a smartphone benefit App, custom benefit management system, intra-office communication, payroll services, outsourced Human Resources, COBRA, FSA, HSA Administration, and more.

How do I know if our health plan is affordable under the Health Reform Law?

The employee portion of the monthly premium cannot exceed 9.5% of his or her Modified Adjusted Gross Income.

What is considered in the Affordability Testing?

For the Affordability Testing, you'll look at 1) what the employee pays toward employee-only coverage (not family coverage) 2) the employee's annual income (not the household income).

Originally, the intent of the law was to ask employers to gather income from the employee's entire family and calculate affordability of the family premium, but it was determined that it would be too difficult on the employer and leave too much room for error. The unintended consequence of this change was that many families who would have qualified for subsidy will not be able to use it if the employee passes the Affordability Test.

How do we handle the testing?

You don't have to because we will. Our experts will determine if your plan is affordable for each employee. And if it's not, we will show you several different strategies and advise you on which option is best for your business.

What is considered a full-time equivalent employee under the Health Reform law?

A full-time equivalent employee (FTE) is one who is a true employee of your business, generally receiving a W-2 at the end of the year, who works 30 or more hours per week.

Why is it important to know how many FTEs work for my business?

It's important because you need to know if you are considered a "Small" or "Large" Business under the Affordable Care Act. A Small Business is defined as one with less than 50 FTEs (2-49). A Large Business has 50 or more FTEs employed. If you are Self-Employed (business of one), then you are considered a business but not an employer, so you will shop for Individual and Family policies instead. 

The pricing, benefits, and how plans are issued by the insurance company will be different for Small and Large Businesses. 

Do I count part-time or seasonal employees?

You do not have to offer benefits to part-time or seasonal employees, but they can partially count toward your total number of FTEs.

For every 30 hours worked by different part-time employees, it counts as one FTE. For example, if you have two part-timers who work 15 hours per week, together they work 30 hours per week and count as one FTE. 

Seasonal employees only count toward your total number of FTEs if they work 120 or more days in the year. 

How to calculate your Modified Adjusted Gross Income (MAGI)

Generally, your Modified Adjusted Gross Income (MAGI) is the total of your household's Adjusted Gross Income and any tax-except interest income you may have (amounts on lines 37 and 8b from IRS Form 1040).

How to calculate your Gross Income (GI)

Your gross income is the total money you earn through wages, interests, dividends, rental income, royalty income, capital gains, business income, farm income, unemployment, and alimony. It includes your salary, interest, income from investments, and any income you made through business, trade, or investments.

How to calculate your Adjusted Gross Income (AGI)

This is your GI minus your IRS deductions: things like IRA contributions, moving expenses, alimony paid, self-employment taxes, and student loan interest.

GI - Deductions = AGI

How to calculate your Modified Adjusted Gross Income (MAGI) and why it's important to healthcare

The MAGI is the magic number that determines if you qualify for a tax subsidy to lower the premium or out-of-pocket expenses through an Individual or Family health policy through the exchange.

Your MAGI is your ADJ with some items added back and counted again.

AGI + IRA Contribution Deductions + Student Loan or Interest Deductions + Excluded Foreign Income + Employee Savings Bonds used to pay higher education + Employer-paid adoption expenses = MAGI

It's simpler than it seems

For most people, the AGI is the same as their MAGI. .