Health Care Reform

Health Care Reform and the Affordable Care Act

We help alleviate the stress of sponsoring employee benefit plans by helping you navigate the new rules for health insurance.

 

What is Health Care Reform? This ongoing process means constantly changing regulations that your business must comply with. From the Affordable Care Act (ACA), also known as Obamacare, to the Employee Retirement Income Security Act (ERISA), and many more, businesses today must comply with more requirements than ever. You provide employee benefits so that your employees can thrive, so you need to make sure that you’re in compliance with these laws and regulations so that your business can thrive as well.

As a part of our comprehensive employee benefits services, ISU Insurance Solutions Group LLC offers compliance services to help you get the documentation you need. We work with you and your carrier to create “wrap documents,” premium conversion plan documents, and other required notices and disclosures to employees. If you are unsure whether you have the documentation you need, contact us for a compliance audit. Protect your business from the expensive fines and penalties it could face if out of compliance!

Individuals may also face penalties for failing to comply with the ACA. ISU Insurance Solutions Group LLC is happy to assist individuals that do not have health insurance through their employers to find and enroll in a plan that meets their specific needs and budget. We can help you navigate Washington’s Health Plan Finder to determine whether you qualify for a subsidy or assist you in signing up directly with a top carrier. Contact us for information about your options.

The ACA is probably the nation’s most significant change in the laws that govern healthcare. Below you are some (but certainly not all) highlights of the new laws and how they might impact employers and individuals under age 65.

Highlights of the ACA

For Individuals and Businesses

Tax Penalties

Employers who have more than 100 or more full-time equivalent employees must offer those employees and their families and dependents to age 26, benefits that pays for 60% of the minimum essential benefits, as established by the ACA, or face a potential penalty. In 2016, the mandate applies to employers who have 50 or more full-time equivalent employees.

Individuals must now obtain qualifying coverage either through an individual policy or through their employer or face a potential penalty.

New Approval Guidelines

No pre-existing clause. Insurance companies can no longer increase rates or deny coverage because of a pre-existing condition.

Dependents up to age 26 may be added to an insurance policy for both individuals and employer coverage.

Gender is no longer a factor in determining rates.

Renewal rates are the same as new business rates.

Waiting period should not exceed 90 days.

Open Enrollment Period

Individuals must purchase their health insurance during the annual open enrollment period. Failure to do so may result in penalties and having to wait until the next open enrollment to purchase coverage. Employers are able to offer benefits year round or during their normal open enrollment as usual.

Qualifying Coverage

To be in compliance with the new healthcare reform laws and avoid costly penalties, you must purchase Insurance coverage that pays at least 60% of the costs of the following “essential benefits.” CLICK HERE FOR A LIST OF THE ESSENTIAL BENEFITS

Premium Tax Credits

Business and Individuals who purchase their health insurance through the new Health Insurance Marketplace and/or SHOP may be eligible for tax credits which are applied as a discount on your monthly insurance premium. To see if you are eligible for a tax credit (premium subsidy), please click the appropriate link below.

Individuals click here
Businesses click here

Related Resources

To help you with Health Care Reform

ACA Certified

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The consultants at ISU Insurance Solutions Group LLC are ACA Certified by the National Association of Health Underwriters and are continually educating themselves to stay abreast of new laws, regulations and legislation within the healthcare and healthcare insurance industries.

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