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Affordable Care Act: An Update from a Local Perspective

Ed Gussio 2Now that the Supreme Court has upheld the latest challenge to the Affordable Care Act (ACA), what does this mean for you and your business? Arizona is one of 37 states that chose not to operate its own insurance marketplace. The recent ruling would have had dramatic consequences, had the court ruled that subsidies are only available through state-based marketplaces. As it turned out, it is business as usual for the 6.4 million Americans who receive subsidies to help pay for their health insurance.  

Fewer Carriers, Plans From Which to Choose

Last month, Assurant Health announced that it would be exiting the individual health business. Customers who have Assurant Health will have the opportunity to sign up for a new plan/carrier during this year’s open enrollment, with coverage beginning Jan. 1, 2016. In addition, Connecticut General Life Insurance Company, an affiliate of Cigna, has decided not to renew pre-ACA individual medical plans in Arizona. These customers will be able to purchase ACA plans through Cigna or another carrier during this year’s open enrollment.

When is Open Enrollment?

Open Enrollment for coverage in 2016 begins Nov. 1 and ends Jan. 31. For coverage to begin on Jan. 1, applications must be completed by Dec. 15, 2015.

Important Deadlines

If your business has a self-funded or partially self-funded group medical plan, you should be aware that the Patient Centered Outcomes Research Institute (PCORI) fees are due July 31, 2015 for your enrolled employees during 2014. If your group medical plan is fully insured, most likely the insurance carrier has already built this fee ($2 per covered life for plan years ending after Sept. 30, 2013 and before Oct. 31, 2014) and will be paying it on your behalf.

More Businesses Required to Offer Coverage in 2016

Beginning Jan. 1, 2016, businesses that employed 50 or more full-time employees and full-time equivalents in 2014 will be required to offer coverage that meets minimum value and affordability requirements. There are many small employers with fewer than 50 full-time employees who will be affected by this law. Why? Because Full-Time Equivalents are a calculation of your part-time employees (those working less than 130 hours per month). To determine the number of full-time equivalents your company has, take the total number of hours worked by non-full-time employees in a month (up to 120 hours per person) and divide that number by 120. Add this number to your ongoing full-time employees and you have your total. If this number is greater than 50, then your group will be subject to the “play or pay penalty” in 2016. FBN

For more information, call the team at Benefit Logic, Inc. We are here to help you.

By Ed Gussio

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