Employers Shop for Health Insurance Plans Under the Affordable Care Act Guidelines for Their Employees

Under Obamacare 2015 will see employers pay penalties on not covering workers with health insurance. The law has structured plans for small business owners to provide health insurance to employees. “Larger groups are more conscious of the minimum value,” required by the ACA to avoid having to pay penalties, said Ryan Petrizzi, director of sales operations and small markets for insurer AmeriHealth New Jersey. Petrizzi participated in a panel discussion updating businesses on the law yesterday at a healthcare symposium offered by the Princeton Regional Chamber of Commerce at Mercer County Community College in West Windsor.

The Affordable Care Act has prompted owners of midsized businesses to restructure insurance plans by switching from traditional fully funded plans to self funded plans. This will allow the employer to see overall claims from workers and encourage employee wellness plans.

Starting on Jan. 1, 2015, employers with 100 or more workers will have to pay a penalty if they don’t provide insurance to at least 70 percent of fulltime workers.

In 2016, the mandate will be expanded, so that all businesses with 50 full-time employees will have to pay the penalty if they don’t provide insurance to at least 95 percent of their full-timers.

The next two years will be important in deciding how ACA affects businesses. Employers face a more immediate deadline on October 1 of this year, when they must notify workers of their right to have health insurance under the law, as well informing employees whether the employer will provide insurance next year that meets the ACA’s requirements for being both adequate and affordable for workers.

Ryan Petrizzi, director of sales operations and small markets for insurer AmeriHealth New Jersey, noted that Small Business Health Options Program, or SHOP, will have changes. While the SHOP section of the federal site is expected to be ready in 2015, a key feature of the program is being delayed another year: a provision allowing employees of businesses that bought SHOP insurance to choose their own plans through the website. This would allow workers to pay higher monthly premiums in order to have lower out-of-pocket costs, and vice-versa. With the delay, businesses that buy SHOP insurance will also be deciding on specifics of workers’ health plans.

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Rue said the ACA wanted consumers to choose their own plans through an insurance exchange or marketplace. “The exchange may have one carrier with eight or nine different plan designs, or it could have two or three carriers with three or plans each,” he noted. “They’re used to the Amazon way of doing business, so I click on something and the next day or two days later, it’s brought to my front door,” Petrizzi said, adding that insurers have traditionally worked within longer time frames. Petrizzi said many individuals who bought high-deductible plans through the marketplace didn’t know what they bought. “When they actually go into the doctor’s office and they actually have to pay the full amount, that causes some folks to be upset because they didn’t fully understand,” Petrizzi said.

Rue noted that businesses can use insurance plans with deductibles as an incentive -- reimbursing workers for out-of-pocket costs if they participate in wellness programs. Petrizzi and Rue felt free preventive care should urge consumers to continue doctor visits and assess their health.

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References:

Andrew Kitchenman, September 2014

Hannah Punitha (IRDA Licence Number: 2710062)

Source-Medindia