Help for those affected by the hurricanes | Learn More

A message from Aflac

To our policyholders in areas affected by the recent hurricanes, please know that the thoughts and prayers of everyone at Aflac are with you. We are working with government agencies that represent all declared disaster areas to ensure we do everything possible to help you. Based on that guidance, we have extended the due dates for policy premiums by 60 days for those living in places that have been declared disaster areas. If you have a question about your policy or need help, contact us at 800-992-3522. To help with the recovery, Aflac made a $500,000 donation to the American Red Cross, and our employees are making their own private contributions. Please be safe, as the care of you and your families is paramount.

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Important details about health care reform for individuals and families with job-based coverage

The rulebook on health care may have changed, but with insurance through your employer, you’re already ahead of the game. The law requires most individuals to have qualifying health coverage (QHC), so being enrolled in a job-based plan helps you meet this requirement. Still, there are a few details you’ll want to understand to make sure your plan fits your coverage needs and your budget.

What you need to know:

  • You have more options.
    Health care reform established public government-facilitated marketplaces. This means that along with the option to buy insurance through your employer, you can now choose to buy coverage directly through a private insurer or through a government facilitated marketplace, which you can access at healthcare.gov.
  • If you choose non-employer coverage through the health insurance marketplace, you may lose your employer’s contribution.
    Though you have more options, it’s important to remember the value of your job-based benefits. If your employer contributes financially to your job-based coverage, this can help tremendously with purchasing health care coverage. However, if you purchase insurance through the government-facilitated marketplace, you may lose your employer’s contribution – if any – to health insurance benefits offered at work.

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  • Value matters — actuarial value, that is.
    When you start comparing the cost of plans, be sure you’re comparing apples to apples. Health care reform established actuarial value (AV) standards to help you better shop for health insurance. To quickly see the value of a plan, look for the following metal levels: Bronze (60 percent), Silver (70 percent), Gold (80 percent) and Platinum (90 percent). Most job-based plans offer approximately 80 percent AV. Plans with a higher AV will likely have higher up-front monthly premium costs but offer greater coverage for medical expenses, protecting you from high out-of-pocket costs.
  • Even with job-based coverage, you’re likely to have out-of-pocket health care costs.
    If you’re seeing higher out-of-pocket medical costs, you aren’t alone. Health care costs are on the rise, and a recent study by The Commonwealth Fund found 29 percent of adults who had been insured all year reported problems paying their medical bills or were paying off medical debt.1 Even with the best medical coverage, it’s important to understand how your plan works and the potential out-of-pocket costs you may encounter.
  • Spouse coverage may not be offered despite health care reform.
    Although applicable large employers, those with 50 more full-time equivalent employees, are required to offer health care coverage to full-time employees and their dependents, spouse coverage isn’t required. Should spouse coverage be discontinued for your plan, your spouse will be able to purchase coverage either through their employer, a private insurer or healthcare.gov.
  • You may be eligible for premium subsidies if your employer’s benefits don’t meet two criteria.
    If your employer’s coverage doesn’t meet the following criteria, you may be able to purchase coverage through the government-facilitated marketplace in your state and receive subsidies to help offset the cost of health care coverage.
    • Coverage must be considered affordable: The cost of the individual plan can’t exceed 9.5 percent of your household income. However, family coverage may exceed this standard and still meet requirements.
    • Coverage must offer minimum value: The plan must have at least a 60 percent actuarial value (AV). This means it pays on average 60 percent of the cost of covered benefits and is equivalent to a bronze plan in the individual market.

Additionally, you may qualify for Medicaid or Medicare. To learn more, visit medicare.gov.

What you need to do:

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1. Request a notice of coverage options from your employer.
Most employers are now required to communicate to employees about health care coverage options, including those offered by the company and those available through your state. Most employers either provided this notice before Oct. 1, 2013 or within 14 days of hire, but if you haven’t received one yet, it isn’t too late. The notice will include information about whether your job-based benefits meet health care reform standards and if you may be eligible for premium subsidies in the individual market.

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2. Maintain compliant coverage.
Whether you keep your current job-based plan or purchase a plan through a private insurer or government-facilitated marketplace, be sure to get your questions fully answered during benefits enrollment, and choose the plan that fits your coverage needs and your budget.

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3. Plan for out-of-pocket costs.
Don’t let the unexpected take you out of the game. Take advantage of voluntary insurance options, flexible spending accounts and any other benefits your employer offers to help cover out-of-pocket costs not covered by major medical insurance. To learn more about voluntary insurance, visit aflac.com/individuals.

To learn more about the health care reform, visit: aflac.com/healthcare_reform/individuals, healthcare.gov or irs.gov/uac/Affordable-Care-Act-Tax-Provisions-for-Individuals-and-Families.