Health Care Reform
& Your Business

What you need to know.

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Since you have fewer than
50 full-time equivalent employees,

Under the Affordable Care Act (ACA) your company is not subject to any penalties or fees for not providing employee coverage.

That's good news, but there's more...

4

Even without penalties, there are still
a few important details to be aware of.

4
Key Action Items

How to calculate full-time
equivalent employees

It's important to keep an accurate count because if you happen to have 50 or more full-time equivalent employees you may face more requirements.

Try the FTE Calculator Need to choose a different company size?

Don't miss
notification deadlines

You're required to provide notice about health insurance marketplaces to all new employees within 14 days of hire.

Remember

The deadline to distribute this notice to current employees was Oct. 1, 2013. If you haven't done so yet, now is NOT too late.

Comply with
waiting periods

If your company decides to offer benefits, make sure they meet certain standards and keep enrollment waiting periods to 90 days or less. These are new requirements for all employers who offer a group health plan.

Consider maintaining
grandfathered status

If you've offered your current health plan since March 23, 2010 your plan may be eligible for grandfathered status.

With grandfathered status, your company can keep your current plan and potentially save on benefits costs.

Remember: If you maintain grandfathered status, your company must communicate this decision to employees.

The new health care landscape offers
new options which could be better for your business and your employees.
Let's take a look...

4

Let's explore

4
Key Benefits
Delivery Options

Insurer Based

A traditional way of offering insurance, where employee benefits are provided through a single insurance carrier.

Ideal if your company wants greater control over benefits choices offered to employees, or you prefer a certain carrier.

  • Your company chooses the carrier and plans offered to employees.
  • Premium costs are agreed upon for a year, so rates won’t change.
  • Plans are often "one-size-fits-all" leaving less flexibility to tailor benefits.
  • Administration through multiple carriers may be necessary for each benefit offering – medical, dental, vision, disability, etc.

Private Exchange

Private exchanges are online marketplaces where people and businesses can shop for, compare and buy health insurance.

Ideal if your company wants multiple carrier options and a fixed-contribution model to control costs.

  • Your company can set a fixed amount to pay each year.
  • Provides a one-stop shop for multiple benefits (major medical, dental, vision, disability, life, etc.) from multiple carriers.
  • Gives employees choices to better tailor their benefits to fit their needs.
  • Plans can be fixed-benefit or fixed-contribution.
  • Employees can shop for insurance online.
  • Can reduce the burden of benefits administration and management.

SHOP Marketplace

The Small Business Health Options Program is a government facilitated insurance marketplace where small businesses and their employees have access to health insurance coverage.

Ideal if your company wants to provide major medical insurance and qualifies for the small business health care tax credit.

  • Your company can offer group major medical and dental benefits to employees.
  • Your company may receive significant tax credits if your company qualifies.
  • All plans are qualified, so your plan will be in compliance.
  • Can reduce the burden of benefits administration and management.
  • Plans do not include voluntary benefits such as hospital, disability and life insurance.
  • Your company can register online at heathcare.gov.

Self Fund

The employer funds their employee benefits. Employees pay premiums, and the company is responsible for covering all claims in the health care plan and controls any premium reserves.

Ideal if your company is looking to offer health care coverage, but wants to control costs and keep any surplus from employee premiums.

  • Your company only pays for actual insurance claims, helping to control costs.
  • Saves costs related to premium taxes and state insurance regulations.
  • Offers flexible benefits design since plans are not required to include essential health benefits or comply with actuarial value standards.
  • Your company must set stop-loss coverage to limit your company's exposure to unanticipated costs.
  • Plans are administered and managed by your company and minimum-essential coverage reporting to the IRS is required.

Make smarter benefits decisions for your business and employees.

No matter which option you choose Aflac can help your company make benefits decisions to control costs and focus on productivity.

This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit healthcare.gov (which may also be contacted at 1-800-318-2596) for additional information.

Since you have fewer than
50 full-time equivalent employees,

Under the Affordable Care Act (ACA) your company is not subject to any penalties or fees for not providing employee coverage.

That's good news, but there's more...

3

Even without penalties, there are still
a few important details for you to be aware of.

3
Key Action Items

How to calculate full-time
equivalent employees

It's important to keep an accurate count because if you happen to have 50 or more full-time equivalent employees you may face more requirements.

Try the FTE Calculator Need to choose a different company size?

Don't miss
notification deadlines

You're required to provide notice about health insurance marketplaces to all new employees within 14 days of hire.

Remember

The deadline to distribute this notice to current employees was Oct. 1, 2013. If you haven't done so yet, now is NOT too late.

Comply with
waiting periods

If your company decides to offer benefits, make sure they meet certain standards and keep enrollment waiting periods to 90 days or less. These are new requirements for all employers who offer a group health plan.

The new health care landscape offers
new options which could be better for your business and your employees.
Let's take a look...

4

Let's explore

4
Key Benefits
Delivery Options

Insurer Based

A traditional way of offering insurance, where employee benefits are provided through a single insurance carrier.

Ideal if your company wants greater control over benefits choices offered to employees, or you prefer a certain carrier.

  • Your company chooses the carrier and plans offered to employees.
  • Premium costs are agreed upon for a year, so rates won’t change.
  • Plans are often "one-size-fits-all" leaving less flexibility to tailor benefits.
  • Administration through multiple carriers may be necessary for each benefit offering – medical, dental, vision, disability, etc.

Private Exchange

Private exchanges are online marketplaces where people and businesses can shop for, compare and buy health insurance.

Ideal if your company wants multiple carrier options and a fixed-contribution model to control costs.

  • Your company can set a fixed amount to pay each year.
  • Provides a one-stop shop for multiple benefits (major medical, dental, vision, disability, life, etc.) from multiple carriers.
  • Gives employees choices to better tailor their benefits to fit their needs.
  • Plans can be fixed-benefit or fixed-contribution.
  • Employees can shop for insurance online.
  • Can reduce the burden of benefits administration and management.

SHOP Marketplace

The Small Business Health Options Program is a government facilitated insurance marketplace where small businesses and their employees have access to health insurance coverage.

Ideal if your company wants to provide major medical insurance and qualifies for the small business health care tax credit.

  • Your company can offer group major medical and dental benefits to employees.
  • Your company may receive significant tax credits if your company qualifies.
  • All plans are qualified, so your plan will be in compliance.
  • Can reduce the burden of benefits administration and management.
  • Plans do not include voluntary benefits such as hospital, disability and life insurance.
  • Your company can register online at heathcare.gov.

Self Fund

The employer funds their employee benefits. Employees pay premiums, and the company is responsible for covering all claims in the health care plan and controls any premium reserves.

Ideal if your company is looking to offer health care coverage, but wants to control costs and keep any surplus from employee premiums.

  • Your company only pays for actual insurance claims, helping to control costs.
  • Saves costs related to premium taxes and state insurance regulations.
  • Offers flexible benefits design since plans are not required to include essential health benefits or comply with actuarial value standards.
  • Your company must set stop-loss coverage to limit your company's exposure to unanticipated costs.
  • Plans are administered and managed by your company and minimum-essential coverage reporting to the IRS is required.

Make smarter benefits decisions for your business and employees.

No matter which option you choose Aflac can help your company make benefits decisions to control costs and focus on productivity.

This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit healthcare.gov (which may also be contacted at 1-800-318-2596) for additional information.

Understand employer mandate requirements

Because you currently offer insurance to employees, you should not be subject to the employer mandate penalties.

The plans you offer must meet affordability and minimum value requirements. Make sure the plans you offer meet these standards to avoid triggering penalties in 2016.

Don't miss
notification deadlines

You're required to provide notice about health insurance marketplaces to all new employees within 14 days of hire.

Remember

The deadline to distribute this notice to current employees was Oct. 1, 2013. If you haven't done so yet, now is NOT too late.

Plan for reporting requirements

Beginning in 2016, you will be required to provide annual reporting to the IRS regarding the insurance you provide to employees.

Take steps now to prepare detailed records of your insurance offerings.

Consider maintaining
grandfathered status

If you've offered your current health plan since March 23, 2010 your plan may be eligible for grandfathered status.

With grandfathered status, your company can keep your current plan and potentially save on benefits costs.

Remember: If you maintain grandfathered status, your company must communicate this decision to employees.

Comply with
waiting periods

If your company decides to offer benefits, make sure they meet certain standards and keep enrollment waiting periods to 90 days or less. These are new requirements for all employers who offer a group health plan.

The new health care landscape offers
new options which could be better for your business and your employees.
Let's take a look...

3

Let's explore

3
Key Benefits
Delivery Options

Insurer Based

A traditional way of offering insurance, where employee benefits are provided through a single insurance carrier.

Ideal if your company wants greater control over benefits choices offered to employees, or you prefer a certain carrier.

  • Your company chooses the carrier and plans offered to employees.
  • Premium costs are agreed upon for a year, so rates won’t change.
  • Plans are often "one-size-fits-all" leaving less flexibility to tailor benefits.
  • Administration through multiple carriers may be necessary for each benefit offering – medical, dental, vision, disability, etc.

Private Exchange

Private exchanges are online marketplaces where people and businesses can shop for, compare and buy health insurance.

Ideal if your company wants multiple carrier options and a fixed-contribution model to control costs.

  • Your company can set a fixed amount to pay each year.
  • Provides a one-stop shop for multiple benefits (major medical, dental, vision, disability, life, etc.) from multiple carriers.
  • Gives employees choices to better tailor their benefits to fit their needs.
  • Plans can be fixed-benefit or fixed-contribution.
  • Employees can shop for insurance online.
  • Can reduce the burden of benefits administration and management.

Self Fund

The employer funds their employee benefits. Employees pay premiums, and the company is responsible for covering all claims in the health care plan and controls any premium reserves.

Ideal if your company is looking to offer health care coverage, but wants to control costs and keep any surplus from employee premiums.

  • Your company only pays for actual insurance claims, helping to control costs.
  • Saves costs related to premium taxes and state insurance regulations.
  • Offers flexible benefits design since plans are not required to include essential health benefits or comply with actuarial value standards.
  • Your company must set stop-loss coverage to limit your company's exposure to unanticipated costs.
  • Plans are administered and managed by your company and minimum-essential coverage reporting to the IRS is required.

Make smarter benefits decisions for your business and employees.

No matter which option you choose Aflac can help your company make benefits decisions to control costs and focus on productivity.

This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit healthcare.gov (which may also be contacted at 1-800-318-2596) for additional information.
4

Since you have more than 50 full-time equivalent employees, there are...

4
Key Action Items

Make employer mandate decisions

Beginning in 2016, your company is required to provide health care coverage for full-time employees and their dependents.

Not providing coverage can result in penalties.

Also, the plans you offer must meet affordability and minimum value standards to avoid triggering penalties in 2016.

Don't miss
notification deadlines

You're required to provide notice about health insurance marketplaces to all new employees within 14 days of hire.

Remember

The deadline to distribute this notice to current employees was Oct. 1, 2013. If you haven't done so yet, now is NOT too late.

Plan for reporting requirements

Beginning in 2016, you will be required to provide annual reporting to the IRS even if your company doesn't offer insurance.

Take steps now to prepare detailed records.

Comply with
waiting periods

Make sure your company keeps enrollment waiting period limits to 90 days or less. These is a new requirement for all employers who offer a group health plan.

The new health care landscape offers
new options which could be better for your business and your employees.
Let's take a look...

3

Let's explore

3
Key Benefits
Delivery Options

Insurer Based

A traditional way of offering insurance, where employee benefits are provided through a single insurance carrier.

Ideal if your company wants greater control over benefits choices offered to employees, or you prefer a certain carrier.

  • Your company chooses the carrier and plans offered to employees.
  • Premium costs are agreed upon for a year, so rates won’t change.
  • Plans are often "one-size-fits-all" leaving less flexibility to tailor benefits.
  • Administration through multiple carriers may be necessary for each benefit offering – medical, dental, vision, disability, etc.

Private Exchange

Private exchanges are online marketplaces where people and businesses can shop for, compare and buy health insurance.

Ideal if your company wants multiple carrier options and a fixed-contribution model to control costs.

  • Your company can set a fixed amount to pay each year.
  • Provides a one-stop shop for multiple benefits (major medical, dental, vision, disability, life, etc.) from multiple carriers.
  • Gives employees choices to better tailor their benefits to fit their needs.
  • Plans can be fixed-benefit or fixed-contribution.
  • Employees can shop for insurance online.
  • Can reduce the burden of benefits administration and management.

Self Fund

The employer funds their employee benefits. Employees pay premiums, and the company is responsible for covering all claims in the health care plan and controls any premium reserves.

Ideal if your company is looking to offer health care coverage, but wants to control costs and keep any surplus from employee premiums.

  • Your company only pays for actual insurance claims, helping to control costs.
  • Saves costs related to premium taxes and state insurance regulations.
  • Offers flexible benefits design since plans are not required to include essential health benefits or comply with actuarial value standards.
  • Your company must set stop-loss coverage to limit your company's exposure to unanticipated costs.
  • Plans are administered and managed by your company and minimum-essential coverage reporting to the IRS is required.

Make smarter benefits decisions for your business and employees.

No matter which option you choose Aflac can help your company make benefits decisions to control costs and focus on productivity.

This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit healthcare.gov (which may also be contacted at 1-800-318-2596) for additional information.

Understand employer mandate requirements

Because you currently offer insurance to employees, you should not be subject to the employer mandate penalties.

The plans you offer must meet affordability and minimum value requirements. Make sure the plans you offer meet these standards to avoid triggering penalties.

Don't miss
notification deadlines

You're required to provide notice about health insurance marketplaces to all new employees within 14 days of hire.

Remember

The deadline to distribute this notice to current employees was Oct. 1, 2013. If you haven't done so yet, now is NOT too late.

Plan for reporting requirements

There are new W-2 reporting requirements you should be aware of.

Also, beginning in 2016, you will be required to provide annual reporting to the IRS regarding the insurance you provide to employees.

Comply with
waiting periods

Make sure your company keeps enrollment waiting periods to 90 days or less. This is a new requirement for all employers who offer a group health plan.

Consider maintaining
grandfathered status

If you've offered your current health insurance plan since March 23, 2010 your plan may be eligible for grandfathered status.

With grandfathered status, your company can keep your current plan and potentially save on benefits costs.

Remember: If you maintain grandfathered status, your company must communicate this decision to employees.

The new health care landscape offers
new options which could be better for your business and your employees.
Let's take a look...

3

Let's explore

3
Key Benefits
Delivery Options

Insurer Based

A traditional way of offering insurance, where employee benefits are provided through a single insurance carrier.

Ideal if your company wants greater control over benefits choices offered to employees, or you prefer a certain carrier.

  • Your company chooses the carrier and plans offered to employees.
  • Premium costs are agreed upon for a year, so rates won’t change.
  • Plans are often "one-size-fits-all" leaving less flexibility to tailor benefits.
  • Administration through multiple carriers may be necessary for each benefit offering – medical, dental, vision, disability, etc.

Private Exchange

Private exchanges are online marketplaces where people and businesses can shop for, compare and buy health insurance.

Ideal if your company wants multiple carrier options and a fixed-contribution model to control costs.

  • Your company can set a fixed amount to pay each year.
  • Provides a one-stop shop for multiple benefits (major medical, dental, vision, disability, life, etc.) from multiple carriers.
  • Gives employees choices to better tailor their benefits to fit their needs.
  • Plans can be fixed-benefit or fixed-contribution.
  • Employees can shop for insurance online.
  • Can reduce the burden of benefits administration and management.

Self Fund

The employer funds their employee benefits. Employees pay premiums, and the company is responsible for covering all claims in the health care plan and controls any premium reserves.

Ideal if your company is looking to offer health care coverage, but wants to control costs and keep any surplus from employee premiums.

  • Your company only pays for actual insurance claims, helping to control costs.
  • Saves costs related to premium taxes and state insurance regulations.
  • Offers flexible benefits design since plans are not required to include essential health benefits or comply with actuarial value standards.
  • Your company must set stop-loss coverage to limit your company's exposure to unanticipated costs.
  • Plans are administered and managed by your company and minimum-essential coverage reporting to the IRS is required.

Make smarter benefits decisions for your business and employees.

No matter which option you choose Aflac can help your company make benefits decisions to control costs and focus on productivity.

This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit healthcare.gov (which may also be contacted at 1-800-318-2596) for additional information.
4

Since you have more than 100 full-time equivalent employees, there are...

4
Key Action Items

Understand employer mandate decisions

Beginning in 2015, your company is required to provide health care coverage for full-time employees and their dependents.

Not providing coverage can result in penalties.

Also, the plans you offer must meet affordability and minimum value standards.

Don't miss
notification deadlines

You're required to provide notice about health insurance marketplaces to all new employees within 14 days of hire.

Remember

The deadline to distribute this notice to current employees was Oct. 1, 2013. If you haven't done so yet, now is NOT too late.

Plan for reporting requirements

There are new W-2 reporting requirements you should be aware of.

Also, beginning in 2016, you will be required to provide annual reporting to the IRS even if your company doesn't offer insurance.

Comply with
waiting periods

Make sure your company keeps enrollment waiting periods to 90 days or less. This is a new requirement for all employers who offer a group health plan.

The new health care landscape offers
new options which could be better for your business and your employees.
Let's take a look...

3

Let's explore

3
Key Benefits
Delivery Options

Insurer Based

A traditional way of offering insurance, where employee benefits are provided through a single insurance carrier.

Ideal if your company wants greater control over benefits choices offered to employees, or you prefer a certain carrier.

  • Your company chooses the carrier and plans offered to employees.
  • Premium costs are agreed upon for a year, so rates won’t change.
  • Plans are often "one-size-fits-all" leaving less flexibility to tailor benefits.
  • Administration through multiple carriers may be necessary for each benefit offering – medical, dental, vision, disability, etc.

Private Exchange

Private exchanges are online marketplaces where people and businesses can shop for, compare and buy health insurance.

Ideal if your company wants multiple carrier options and a fixed-contribution model to control costs.

  • Your company can set a fixed amount to pay each year.
  • Provides a one-stop shop for multiple benefits (major medical, dental, vision, disability, life, etc.) from multiple carriers.
  • Gives employees choices to better tailor their benefits to fit their needs.
  • Plans can be fixed-benefit or fixed-contribution.
  • Employees can shop for insurance online.
  • Can reduce the burden of benefits administration and management.

Self Fund

The employer funds their employee benefits. Employees pay premiums, and the company is responsible for covering all claims in the health care plan and controls any premium reserves.

Ideal if your company is looking to offer health care coverage, but wants to control costs and keep any surplus from employee premiums.

  • Your company only pays for actual insurance claims, helping to control costs.
  • Saves costs related to premium taxes and state insurance regulations.
  • Offers flexible benefits design since plans are not required to include essential health benefits or comply with actuarial value standards.
  • Your company must set stop-loss coverage to limit your company's exposure to unanticipated costs.
  • Plans are administered and managed by your company and minimum-essential coverage reporting to the IRS is required.

Make smarter benefits decisions for your business and employees.

No matter which option you choose Aflac can help your company make benefits decisions to control costs and focus on productivity.

This material is intended to provide general information about an evolving topic and does not constitute legal, tax or accounting advice regarding any specific situation. Aflac cannot anticipate all the facts that a particular employer or individual will have to consider in their benefits decision-making process. We strongly encourage readers to discuss their HCR situations with their advisors to determine the actions they need to take or to visit healthcare.gov (which may also be contacted at 1-800-318-2596) for additional information.
Full Time Equivalent Employees

Number of hours worked by your part-time employees per-month, divided by 120, plus the number of full-time (at least 30 hour per week) employees you have. To get a yearly number, the FTEs for 12 calendar months are averaged.

Employer Mandate

Simply offering insurance may not be enough to satisfy the employer mandate. Remember, employers with 50 or more full-time equivalent employees must provide health insurance to all full-time employees and their dependents. This is commonly referred to as the employer mandate.

Employer Mandate (Over 100 Employees - Provides Insurance)

Simply offering insurance may not be enough to satisfy the employer mandate. Remember, employers with 50 or more full-time equivalent employees must provide health insurance to all full-time employees and their dependents. This is commonly referred to as the employer mandate.

To help phase in the requirement, your company must offer insurance to at least 70 percent of full-time employees and their dependents in 2015, and to at least 95 percent in 2016 and in subsequent years.

Further, if your company did not offer insurance to dependents in 2013 or 2014, you will not be penalized for not providing coverage to dependents in 2015, as long as you are taking steps to provide the coverage in 2016.

Employer Mandate Required

The Employer Shared-Responsibility Provision of the Affordable Care Act requires employers with 50 or more full-time equivalent employees to provide health insurance to all full-time employees and their dependents. This is commonly referred to as the employer mandate.

Employer Mandate Required (Over 100 Employees - No Insurance)

The Employer Shared-Responsibility Provision of the Affordable Care Act requires employers with 50 or more full-time equivalent employees to provide health insurance to full-time employees and their dependents. This is commonly referred to as the employer mandate.

To help phase in the requirement, your company must offer insurance to at least 70 percent of full-time employees and their dependents in 2015, and to at least 95 percent in 2016 and in subsequent years.

Further, if your company did not offer insurance to dependents in 2013 or 2014, you will not be penalized for not providing coverage to dependents in 2015, as long as you are taking steps to provide the coverage in 2016.

Employer Mandate Penalties

Penalties include:

$2,000 per full-time (at least 30 hour per week) employee, excluding the first 30 employees. This fine applies to employers with 50 or more FTEs who don’t offer minimum essential health care coverage for all full-time employees and their dependents. Most employer-provided group coverage will qualify as minimum essential coverage.

$3,000 for each full-time (at least 30 hour per week) employee that is certified as having received a subsidy through a public exchange, up to a cap of the above penalty. This is generally a lesser penalty and applies if an applicable large employer offers minimum essential coverage but the coverage is not affordable or does not offer minimum value.

Affordability and Minimum Value Requirements

Affordable: The employee portion of the premium for self-only coverage is less than 9.5 percent of the employee’s W-2 income.

Minimum value: The health plan covers at least 60 percent of the total allowed cost of benefits.

Additionally, since your company has 100 or fewer employees your company will need to meet small group requirements in 2016:

  • Include essential health benefits
  • Provide certain preventive services at no cost to employees
  • Set limits on cost-sharing
Affordability and Minimum Value Requirements (Over 100 Employees)

Affordable: The employee portion of the premium for self-only coverage is less than 9.5 percent of the employee’s W-2 income.

Minimum value: The health plan covers at least 60 percent of the total allowed cost of benefits.

Triggering Penalties

Penalties are triggered if your company does not offer insurance that satisfies the employer mandate and at least one full-time (at least 30 hour per week) employee or their dependent receives a subsidy through a public exchange.

W-2 Reporting

W-2 reporting of employer sponsored coverage is required for all businesses submitting 250 or more W-2s. Learn more.

Annual Reporting

Learn more about Employer-Sponsored Coverage Reporting

Accurate Count

Number of hours worked by your part-time employees per-month, divided by 120, plus the number of full-time (at least 30 hour per week) employees you have. To get a yearly number, the FTEs for 12 calendar months are averaged.

now is NOT too late

Learn more here:

Aflac.com

Model Notices:

If your company doesn't offer insurance

If your company offers insurance

Certain Standards

Benefits offered in the small group market must:

  • Cover at least 60 percent actuarial value
  • Include essential health benefits
  • Provide certain preventive services at no cost to employees
  • Set limits on cost-sharing
May

Your plan may qualify if your company did not make changes that lower benefits or your employer contribution, or significantly increase employee paid deductible, coinsurance or copayment costs. Learn more.

Grandfathered Status

Grandfathered plans are exempt from a number of mandates and reporting requirements, but also cannot make significant changes to benefits or costs.

Fixed-Benefit or Fixed-Contribution

Fixed benefit: Your company can choose which benefits options are available to your employees.

Fixed contribution: Your company can choose the amount to pay towards benefits, and your employees choose their benefits options.

If Your Company Qualifies

Your company must have 25 or fewer full-time equivalent (FTE) employees that have average annual wages less than $50,000. Learn more.

Voluntary Benefits

Voluntary benefits, also called supplemental insurance, help people protect their financial well-being in the event of a serious accident or illness. Unlike major medical insurance, voluntary pays cash benefits directly to the policyholder, unless otherwise assigned.

Saves Costs

Insured plans may be subject to an annual insurers fee which could potentially raise premiums 2 ‐4 percent. Self‐funded plans are not required to pay the fee which could translate to lower premiums.

Stop Loss Coverage

With no annual or life-time dollar limits on essential health benefits offered by the self-funded plan, your company must consider an appropriate level of stop-loss coverage. With this coverage, your company agrees to cover claims up to a certain level based on the total number of anticipated claims over one year, allowing you to limit your company’s maximum risk to costs.

Minimum-essential Coverage Reporting

Minimum essential coverage reporting is required for self-funded plans beginning in 2016. Learn more.