Health Care Reform Information for Employees. Your options under health care reform

Transcription

1 Health Care Reform Information for Employees Your options under health care reform Patient Protection and Affordable Care Act (PPACA) September 2013

2 Contents 1 Your options under health care reform 2 Health care reform: Are you ready? 3 Who can receive health coverage through MassMutual? 4 MassMutual s responsibility for health care reform 5 Your responsibility for health insurance 6 Understanding the health insurance marketplaces 7 Medicaid More people now qualify 8 Frequently asked questions about health care reform 12 Glossary Disclaimer This communication has been prepared for benefits-eligible active employees of Massachusetts Mutual Life Insurance Company (MassMutual); The MassMutual Trust Company fsb; MML Investors Services LLC; MassMutual International LLC; Babson Capital Management LLC; Invicta Advisors LLC; and Cornerstone Real Estate Advisers LLC. It is not for agents, field staff or retirees. This document is not a Summary Plan Description (SPD) or a Summary of Material Modifications (SMMs) for the MassMutual Employee Welfare Benefits Plan. This document does not include tax advice; any information included should not be construed to be advice. Information contained in this document is accurate as of the September 2013 publish date. Learn more about your benefit options at MassMutual on myhr.

3 Your options under health care reform The health care reform law, officially known as the Patient Protection and Affordable Care Act (PPACA), requires most Americans to be enrolled in health insurance coverage by Jan. 1, The law is in place to make sure individuals and families have access to health insurance they can afford whether they get it from an employer, an insurance company or the government. People who are not covered by health insurance beginning in 2014 may have to pay a tax penalty. The health care reform law makes it clear: it s up to you to make sure you are enrolled in health insurance coverage beginning in Please read this information to learn more about the requirements of health care reform and the actions you will need to take. This booklet is designed to show how all the pieces fit together and where your path through health care reform begins. How does the health reform law impact me? It is up to you to have health insurance for yourself and any eligible dependents by Jan. 1, This booklet answers questions about the options available to you through MassMutual and explains the steps you need to take so that you re covered. If you are benefits-eligible, you may enroll in health coverage through MassMutual, but you likely are not eligible for any subsidy from the government. If you are not receiving health insurance from another source, like your spouse s/ domestic partner s or parent s plan, a MassMutual health plan may be your best option for coverage. The annual benefits enrollment period is Oct. 29 to Nov. 18, 2013 for coverage effective Jan. 1, If you are not benefits-eligible at MassMutual, you might be able to get health insurance through your spouse s/domestic partner s or parent s employer plan (if eligible), an individual policy through the health insurance marketplace in your state, an individual policy outside the marketplace, Medicare or Medicaid, or another source. Read on to learn more. Get more information on the marketplaces in each state at 1

4 Health care reform: Are you ready? This year, it s especially important that you pay attention to your medical coverage options to make sure you and your family have health insurance in The new health care reform law (also called the Patient Protection and Affordable Care Act or PPACA) requires most Americans to have health insurance starting Jan. 1, 2014 or risk paying a tax penalty. This chart may help you determine your next steps: Questions? Contact MassMutual Benefits: BenefitQuestions@MassMutual.com Ext Are you eligible for health coverage from MassMutual? Note: All employees working 20 or more hours per week are eligible for MassMutual-subsidized health coverage. Are you enrolled in a MassMutual medical option or will you enroll in a MassMutual medical option for 2014? Yes No Do you have coverage elsewhere (e.g., through a spouse or domestic partner)? Yes No Do you have coverage elsewhere (e.g., through a spouse or domestic partner)? Yes No Great! You re all set. Be sure to enroll in 2014 coverage. Annual benefits enrollment begins Oct. 29 and continues through Nov. 18 for coverage effective Jan. 1, Remember to print and keep a copy of your confirmation statement as proof of your coverage. You must have health insurance by Jan. 1, 2014 or you may have to pay a tax penalty. You are eligible to enroll in a MassMutual medical option. If you are going to enroll in a MassMutual option, annual benefits enrollment begins Oct. 29 and continues through Nov. 18 for coverage effective Jan. 1, You may also have other options. No Great! You re all set. Be sure to check with the plan and get confirmation of your coverage before the plan s annual enrollment is over. Important: You must have health insurance by Jan. 1, 2014 or you may have to pay a tax penalty. You may have options, as follows: If your spouse s or domestic partner s employer offers health insurance, you may be able to enroll yourself and your eligible dependents in his or her plan, if eligible. If you are under age 26 and your parent s employer offers health insurance, he or she can enroll you, if eligible. Purchase your health insurance through the health insurance marketplace (public exchange) in your state. See page 6 for more information about the marketplace. Check to see if you qualify for Medicaid benefits. Under the health care reform law, eligibility for Medicaid is expanding to include more people in many states. Even if you did not qualify before, you may have new options to enroll in Medicaid now. See page 7 for more information. 2 Learn more about your benefit options at MassMutual on myhr.

5 Who can receive health coverage through MassMutual? The health care reform law, officially known as the Patient Protection and Affordable Care Act (PPACA), requires most Americans to be enrolled in health insurance by Jan. 1, In 2014, MassMutual will continue to offer health coverage to all employees who are regularly scheduled to work 20 or more hours per week. About MassMutual coverage MassMutual offers two options of high deductible health plan coverage to employees located in the contiguous U.S. (employees located in Hawaii or Puerto Rico have access to coverage that meets local requirements). Coverage available from MassMutual meets the Minimum Essential Coverage standard required under the Individual Mandate. See Your Responsibility for Health Insurance on page 5. Learn more about health coverage options on myhr. than $50,000 who is enrolled in Option 2. So MassMutual generally pays between 63% and 99% of the cost of your coverage. What does this mean? Because you re offered company-subsidized coverage from MassMutual, you will likely not be eligible for a subsidy from the federal government if you choose to purchase coverage through a public health insurance marketplace (previously called the public exchange ). When can I enroll? If you are benefits-eligible, you can enroll in a MassMutual medical option during the annual benefits enrollment period, which is Oct. 29 to Nov. 18, 2013 for coverage effective Jan. 1, Who can I cover? You can cover yourself, a spouse or domestic partner, and eligible children generally up to age 26. Does the company subsidize my coverage? The coverage you get through MassMutual is subsidized by the company that means that MassMutual pays a portion of the cost of your coverage. The company subsidy varies depending on your base salary, the number of dependents you cover, and which medical option you choose. It usually ranges from the equivalent of about 63% for an employee with a base salary in excess of $250,000 who is enrolled in Option 1 to 99% for an employee with a base salary less Get more information on the marketplaces in each state at 3

6 MassMutual s responsibility for health care reform Beginning in 2015, companies with 50 or more full-time employees like MassMutual may be penalized if they fail to offer health insurance that is affordable and provides a certain minimum value to full-time employees and their dependents, including children up to age 26. Companies must offer health insurance plans that cover at least a minimum amount of health care services and those plans must be affordable. To be affordable, the amount that comes out of an employee s paycheck for employee-only health insurance under the lowest-cost plan that s available from the company can t be more than 9.5% of that employee s total household income. MassMutual health coverage meets these requirements. As noted above, beginning in 2015, companies that do not provide health insurance coverage that meets the affordability and minimum value requirements to full-time employees may have to pay a penalty to the government. Under the law, full-time means those working an average of 30 or more hours per week. MassMutual meets that requirement today by providing access to health coverage to any employee scheduled to work 20 or more hours per week. MassMutual s health coverage provides more than the minimum amount of health care services the law requires, and it also is considered affordable under the health care reform law. That means that if you are benefits-eligible at MassMutual, you are not likely eligible to receive financial assistance (known as subsidies ) from the government to purchase health coverage through a health insurance marketplace. Learn more about government subsidies in Understanding the Health Insurance Marketplaces on page 6. What does this mean for me? MassMutual plans to continue offering companysubsidized comprehensive and affordable health care options to all employees regularly scheduled to work 20 or more hours per week in As long as you are not getting health insurance from another source, like from your spouse s/domestic partner s or parent s employer plan, MassMutual health coverage may continue to be your best option. What do I need to do? If you are not benefits-eligible, find out if you can get health insurance through your spouse s/ domestic partner s or parent s plan, the health insurance marketplace available in your state, Medicaid or Medicare, or from another source. You can find out more information about the health insurance marketplace and Medicaid at We are closely watching the health care changes, and will provide updates about this information when necessary. 4 Learn more about your benefit options at MassMutual on myhr.

7 Your responsibility for health insurance The health care reform law requires most Americans to have health insurance by Jan. 1, This requirement is sometimes called the Individual Mandate. You can meet this requirement by getting health coverage through: MassMutual (if you are benefits-eligible) Your spouse s or domestic partner s employer, if eligible Your parent s employer (if you are under age 26), if eligible A health insurance marketplace available in your state (which may also be referred to as a public exchange) Other coverage options that may be available to you, including through government programs such as Medicare and Medicaid. Note: If you decide to get health insurance somewhere else on Jan. 1, be sure to choose No medical during annual benefits enrollment to terminate your MassMutual health coverage. If you terminate your MassMutual coverage, you forfeit MassMutual s subsidy for the cost of your coverage and you will not be eligible to reinstate MassMutual coverage until the next annual benefits enrollment period (unless you have a mid-year qualifying event). Additionally, if you terminate coverage during annual benefits enrollment, you will not be eligible for COBRA. Starting Jan. 1, 2014, for every month you are not enrolled in health insurance, you may have to pay a tax penalty. The total penalty amount will be collected as a single payment once a year when you file your federal taxes. Below are examples of the tax penalties for 2014, using a tax filing threshold in 2014 of $10,250 for individual tax returns and $20,500 for jointly filed tax returns for those under age 65. For any dependent under age 18, the penalty is one half of the individual penalty amount tax penalties Family Size Household Income (Example) How the Penalty is Calculated 2014 Tax Penalty Greater of: Individual $25,000 $95 flat dollar (limited to $285 for a family for 2014) or 1% of ($25,000 $10,250) $148 (household income minus the tax filing threshold) Greater of: Married Couple $40,000 ($95 x 2) or 1% of ($40,000 $20,500) $195 (household income minus the tax filing threshold) Family of 3 Greater of: $40,000 ($95 x 2.5) or 1% of ($40,000 $20,500) (1 child < age 18) (household income minus the tax filing threshold) $238 Greater of: Family of 4 $40,000 ($95 x 3) or 1% of ($40,000 $20,500) $285 (household income minus the tax filing threshold) Greater of: Family of 5 $150,000 ($95 x 3) or 1% of ($150,000 $20,500) $1,295 (household income minus the tax filing threshold) These are only examples. Actual penalties will vary based on each person s circumstances. This information is not tax advice. If you have questions, talk with your tax advisor. Get more information on the marketplaces in each state at 5

8 Understanding the health insurance marketplaces The health care reform law says that each state must offer a health insurance marketplace, also called a public exchange. If a state does not offer a health insurance marketplace, then the federal government will establish one for that state. The health insurance marketplace allows individuals and families to buy health insurance themselves instead of getting it through their employers. Health insurance marketplaces (public exchanges) will be available in each state and will be operated by the state, by the federal government, or through a partnership between the state and federal government. How does the marketplace work? You will be able to enroll online or speak with a representative to help you find a health insurance plan that meets your needs. Each marketplace will offer a range of plan choices, and each will provide its own set of benefits and have its own cost. But all the plans available through the marketplace will have some benefits in common: 1 Preventive care services, like routine check-ups and well-baby care visits will be covered at 100% you will pay nothing. 2 No lifetime dollar maximums, or dollar caps, on essential health benefits. Those include hospitalization, outpatient services, maternity care, prescription drugs, emergency care, and preventive services. 3 Limits on how much an individual pays out of pocket (such as a copay, coinsurance or deductible) in any given year. Government subsidies (or financial assistance) In addition, the health insurance marketplace can help you find out if you are eligible for financial assistance to pay for health insurance purchased through the marketplace. Assistance may be available to help pay your premiums and also to help limit your cost when you use your benefits. Assistance like this is called a subsidy. Eligibility for subsidies is, in part, based on your family s household income. Do I qualify for financial assistance through the health insurance marketplace? If you are benefits-eligible, you likely do not qualify for financial assistance from the federal government through the health insurance marketplace. That s because MassMutual offers coverage that meets the health care reform law s affordability and minimum value requirements. If you aren t benefits-eligible, the health insurance marketplace in your state will help you determine if you meet the requirements to qualify for financial assistance. You can find more information about the marketplaces at the website sponsored by the Department of Health and Human Services. Health insurance marketplace open enrollment begins Oct. 1, 2013 for coverage that starts on Jan. 1, Learn more about your benefit options at MassMutual on myhr.

9 Medicaid More people now qualify Medicaid is the nation s primary program for providing lower-income individuals and families with health insurance. Depending on where you live, eligibility for Medicaid may be expanding so that more people qualify for benefits. Even if you haven t qualified before, you may qualify now. Each state runs its own Medicaid program and decides what services to offer. If you qualify, the health insurance provided through Medicaid meets the health care reform law s individual mandate the part of the law that requires Americans to have health insurance by Jan. 1, What does this mean for me? If you are eligible for Medicaid in your state, you can receive health insurance through Medicaid. Find out if you are eligible for Medicaid by contacting Medicaid in your state. Contact information is at If you are eligible for both Medicaid and a MassMutual medical option, compare health insurance plan options and costs to determine the best choice for you. It s up to you to have health insurance for you and any eligible dependents by Jan. 1, To find out more, read Your Responsibility for Health Insurance on page 5. Medicaid provides coverage for a range of benefits, including: Doctor visits Emergency care Hospital care Vaccinations Prescription drugs Vision Hearing Long-term care Preventive care for children Get more information on the marketplaces in each state at 7

10 Frequently asked questions about health care reform Eligibility for MassMutual health coverage 1 What is the Individual Mandate? The Individual Mandate requires that most Americans be enrolled in health insurance by Jan. 1, Only people meeting very specific criteria are exempt from meeting the coverage requirement and paying the tax penalty. The exceptions are listed under question 6 of the Individual Shared Responsibility Provision Q&A page on IRS.gov. 2 What happens if I don t have health insurance on Jan. 1, 2014? If you don t have health coverage by that time, you may owe a tax penalty to the federal government. It will apply for every month you don t have health coverage on and after Jan. 1, 2014 and you will be required to pay this tax penalty when you file your 2014 annual federal income tax return in If I m covered by MassMutual health coverage, does that take care of the individual mandate for me? Yes. If you re covered under MassMutual health coverage on Jan. 1, 2014, you ll meet the requirements for the individual mandate. 4 Is MassMutual changing eligibility rules for health insurance? Employees regularly scheduled to work 20 or more hours a week will still be eligible for coverage. 5 Can I cover my children under my MassMutual plan? Yes, if they meet eligibility requirements, you can cover your children up to age 26 (coverage ends at the end of the month in which the child turns age 26). Please see the Dependent Eligibility Worksheet for eligibility details. 6 Does health care reform mean I ll need to give up my MassMutual health coverage? No. If you currently have company-subsidized coverage through a MassMutual medical option, you can keep it as long as you continue to be an eligible employee regularly scheduled to work 20 or more hours per week. If you re getting your coverage somewhere else (like from the employer health plan of a parent or a spouse/domestic partner), it s a good idea to check now to see if there are any changes to that coverage for You also have the option to get coverage through Medicaid, if you re eligible. The most important thing is to be sure you re covered on Jan. 1, 2014 and after. 8 Learn more about your benefit options at MassMutual on myhr.

11 Eligibility for coverage through other sources 7 What is a health insurance marketplace, or public exchange? A health insurance marketplace is a place where people can buy individual health insurance policies when they don t have or don t want health coverage through their employer or from another source (like through a parent s or a spouse s/domestic partner s health plan). Each state will have its own marketplace, either set up by the state itself, by the federal government or by a partnership of both the state and federal government. The health insurance marketplace (also called a public exchange) will offer a choice of coverage options so that people who live in the state can choose the type of plan that works best for their health care needs and their budget. 8 I m eligible for MassMutual health coverage, but what if I d rather join my spouse s/domestic partner s plan that he/she purchases through a health insurance marketplace? You don t have to enroll in a MassMutual health plan. If you d rather be covered under your spouse s/ domestic partner s plan (through his or her employer or under a plan purchased through a health insurance marketplace), that s okay just be sure to choose No medical in the enrollment portal during the annual benefits enrollment period. Because you have health coverage available to you through MassMutual that meets affordability and minimum value requirements, you likely won t be eligible for any subsidy from the federal government for coverage purchased elsewhere. 9 If I like a plan offered through a health insurance marketplace better than what s offered by MassMutual, can I still choose that coverage instead? Yes, you can choose health coverage through your state s health insurance marketplace instead of through MassMutual. But because you have health coverage available to you through MassMutual that meets affordability and minimum value requirements, you likely won t be eligible for any government subsidy from the federal government for coverage purchased through a marketplace. Additionally, MassMutual will not subsidize any coverage purchased elsewhere. 10 Can my spouse/domestic partner and I get our health coverage from different places my coverage under a MassMutual health plan and his/her coverage through a plan from the health insurance marketplace? Yes, you and your spouse/domestic partner can enroll in different health plans and either of you can cover any dependent children up to age 26. The important thing to remember is that you all will need to have health coverage on and after Jan. 1, 2014, whether it comes from the same health plan or from two different plans. 11 Am I required to cover my spouse/domestic partner under the health care reform law? No. You don t have to provide health coverage for your spouse/domestic partner. If you choose not to, your spouse/domestic partner will still need his/her own coverage on and after Jan. 1, It can come from his/her employer, or from health coverage purchased in a health insurance marketplace. Get more information on the marketplaces in each state at 9

12 12 What are my health coverage options for my spouse/domestic partner? If you are eligible for MassMutual health coverage, you can enroll your spouse/domestic partner in your MassMutual medical option. Or, if you decide not to enroll him/her, he/she can get coverage through a health insurance marketplace where he/she lives. He or she might have other options, too, like coverage through his/her employer or a parent s health plan (if under age 26). 13 Does my health coverage through the military satisfy the individual mandate requirement? Yes, military benefits such as TRICARE satisfy the individual mandate requirement of the health care reform law. 14 If I get my coverage through a health insurance marketplace, will I be able to choose the doctors I want? Many different plans will be offered through the marketplaces. Some will offer more choice of providers than others. When you compare the plans that you can choose from, you ll be able to see which ones let you choose any doctor, and which ones only offer benefits from doctors who are part of a network. 15 If I want to get my coverage through the health insurance marketplace in the state where I live, what s the process? The federal government expects that state health insurance marketplaces will begin open enrollment on Oct. 1, 2013, and will offer health plans that start providing coverage on Jan. 1, Visit healthcare.gov for details. Help with paying for health insurance costs 16 Is it true that the government will give some people money to help pay for health insurance costs? Yes. For certain low- and middle-income people who cannot get health coverage at work at a price the health care reform law calls affordable, or who are not eligible for health coverage from their or their spouse s/domestic partner s employer that meets affordability and minimum value requirements, the federal government will offer financial help paying for health insurance purchased through a health insurance marketplace. This financial help is called a subsidy. 17 How much of a subsidy is the government providing? The amount of the subsidy will depend on each person s household income. It s important to know that, generally, if you are eligible for health coverage through MassMutual, you are not eligible for a subsidy. If you are not eligible for health coverage through MassMutual, you may be eligible for a subsidy depending on your household income. It s not just your income that counts, but the combined income of everyone in your household. Starting in Oct. 2013, you can contact the health insurance marketplace in your state to see if you qualify for a subsidy. Check the website sponsored by the Department of Health and Human Services, to get contact information for the health insurance marketplace in your state. 10 Learn more about your benefit options at MassMutual on myhr.

13 Health care costs 18 Will my health care costs continue to go up? One of the goals of the health care reform law is to make health insurance affordable for all Americans. MassMutual also wants to make sure that our medical options stay affordable for our employees. That s why MassMutual continues to invest in a wide range of wellness programs and services to promote good health and prevent disease, when possible. Health care costs keep rising, and some of what s causing price increases isn t within our control. But MassMutual is working hard to control what we can, and we ll ask our employees to help by using their medical benefits wisely and taking action to improve their health. We ll keep providing you with the information to help you make wise choices. 19 Does the health care reform law help limit my out-of-pocket health care costs? Yes. The health care reform law puts limits on what you have to pay out of your own pocket each year. Whether you get your coverage through MassMutual, through a health insurance marketplace, or from somewhere else, these limits will be in place to help keep your costs down. 20 I saw a number on my Form W-2 that showed the value of the health care coverage MassMutual provided to me in Am I being taxed on that? No. Reporting the value of your health care coverage is another requirement of the health care reform law. MassMutual puts that value in box 12, code DD of your Form W-2. The value of your MassMutualprovided health care coverage isn t taxable to you. It s there just for your information. The out-of-pocket limits for the MassMutual medical options are lower than the proposed maximum out-of-pocket limits under the health care reform law: Individual out-of-pocket maximum Family out-ofpocket maximum MassMutual Option 1 MassMutual Option 2 Proposed Health Care Reform limits $3,000 $4,500 $6,350 $5,000 $9,000 $12,700 Get more information on the marketplaces in each state at 11

14 Health care reform glossary Affordable Care Act (ACA) See Patient Protection and Affordable Care Act (PPACA). Affordable Coverage A medical plan is deemed affordable when the amount that comes out of an employee s paycheck for employee-only coverage under the lowest-cost plan available does not exceed more than 9.5% of that employee s total household income. MassMutual health coverage meets this requirement for affordability. Annual Limit or Annual Maximum A maximum amount of money your health plan will pay for a particular service, or number of visits that the health plan will cover for a particular service in a given year. If you reach it, you must pay all health care costs for that particular service for the rest of the year. Benefits-Eligible Employees who are allowed to enroll in a MassMutual medical option are benefits-eligible. Employees who are regularly scheduled to work 20 or more hours per week are eligible to enroll in a medical option with MassMutual paying for a portion of the cost of coverage. Cost-Sharing Discounts Reduced dollar amounts for health plan features like annual deductibles and co-pays that are available to some people who get their health insurance through the health insurance marketplace. To be eligible for these reduced dollar amounts, the person buying the coverage must qualify based on the amount of his or her household income. These discounts generally are not available if you are eligible to enroll in a MassMutual medical option. Employer Responsibility Beginning in 2015, each company employing at least 50 full-time-equivalent employees must provide health coverage that provides at least a minimal value of benefits at a price employees can afford. Essential Health Benefits These are a set of services that must be covered by certain health plans. These services include: Ambulatory patient services Emergency services Hospitalization Maternity and newborn care Mental health and substance use disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services and chronic disease management Pediatric services, including oral and vision care All health insurance plans offered through the health insurance marketplace must cover these services. State Medicaid plans must cover them too. Employer health plans are not required to cover essential health benefits, but MassMutual medical options do cover most of these benefits as well. In addition, health plans cannot put a lifetime or annual dollar limit on benefits that are available for these services. MassMutual health plans do not include lifetime or annual dollar limits on these benefits. 12 Learn more about your benefit options at MassMutual on myhr.

15 Federal Poverty Level (FPL) The FPL is a measure of income level issued annually by the Department of Health and Human Services. Federal poverty levels are used to determine your eligibility for certain programs and benefits that are available as a result of the Patient Protection and Affordable Care Act. View the 2013 Poverty Guidelines. Government Subsidy This is a form of financial assistance provided by the federal government. Under the Patient Protection and Affordable Care Act, those who qualify can receive this assistance in the form of an advanced tax credit or cost-sharing discount when purchasing health insurance through a health insurance marketplace. Guaranteed Issue This part of the Patient Protection and Affordable Care Act requires health plans to enroll individuals regardless of health status, age, gender, or other factors. Except in some states, guaranteed issue doesn t limit how much you can be charged if you enroll. Benefits-eligible employees have guaranteed issue for MassMutual health plans. Guaranteed Renewal A part of the Patient Protection and Affordable Care Act that requires health plans to renew your policy as long as you continue to pay premiums. Except in some states, guaranteed renewal doesn t limit how much you can be charged if you renew your coverage. Benefits-eligible employees have guaranteed renewal of their coverage under MassMutual health plans. Health Insurance Marketplace/ Affordable Insurance Exchanges This is a service set up in each state through which individuals and small businesses can buy affordable and qualified health insurance plans. The marketplaces will offer a choice of health plans that provide different levels of benefits and have different costs. High-Cost Health Plan Excise Tax (a.k.a., Cadillac Tax ) A provision of the health care reform law that goes into effect in 2018 and imposes a tax on employer plan sponsors and insurance companies that provide high-cost health plans. This tax encourages employers and insurance companies to offer plans that make premiums more affordable. Individual Health Insurance Policy This is health coverage that can be purchased that is not elected through an employer or linked with employment. These health insurance policies are regulated under state law. Individual Mandate The rule under the Patient Protection and Affordable Care Act that says all Americans must have health insurance that meets basic minimum standards by Jan. 1, If not, a tax penalty may apply. Enrollment in a MassMutual health plan satisfies the individual mandate. Job-Based Coverage This is health insurance that is offered to an employee (and often to his or her family) by his/her employer. Get more information on the marketplaces in each state at 13

16 Medicaid This is a state-run health insurance program for low-income adults, families and children, pregnant women, the elderly, people with disabilities, and, in some states, others who qualify. The federal government provides a portion of the funding for Medicaid and sets guidelines for the program. States decide how they design their programs, so Medicaid (and what the program is called in each state) varies state by state. The Patient Protection and Affordable Care Act expands Medicaid eligibility in many states. Medicare This is a federal system of health insurance for people age 65 and older and for certain younger people with disabilities or end-stage renal disease (ESRD). Out-of-Pocket Limit or Out-of-Pocket Maximum (OOP) The OOP limit is the most you might pay during the calendar year before your health plan begins to pay 100% of the allowed amount. This generally includes annual deductibles and coinsurance payments. This limit never includes your premium, charges from out-of-network health care providers above the plan s maximum reimbursable charge or health care expenses your health plan doesn t cover. Patient Protection and Affordable Care Act (PPACA) The Patient Protection and Affordable Care Act (PPACA), also known as the health care reform law, is a law passed in March 2010 to improve access to affordable health insurance for many Americans. Minimum Essential Coverage This is the type of coverage an individual must have to meet the individual mandate under the Patient Protection and Affordable Care Act. You can get it from individual market policies, job-based coverage (including a MassMutual health plan), Medicare, Medicaid, CHIP, TRICARE and certain other coverage. Not Benefits-Eligible Employees who are not allowed to enroll in MassMutual health coverage because they are not in an eligible employee class (e.g., interns, those regularly scheduled to work fewer than 20 hours per week, etc.). Out-of-Pocket Costs Expenses for medical care that aren t reimbursed by your health plan. They include deductibles and coinsurance for covered services, plus any costs for services that aren t covered. Premium This is the amount that must be paid for your health insurance. Your premium for MassMutual coverage is paid through payroll deductions every other week, for a total of 26 payments per year. Preventive Care Routine services like screenings, check-ups, and patient counselling that help prevent illnesses, disease, or other health problems. Under the Patient Protection and Affordable Care Act, you and your family may be eligible for some of these services, with zero out-of-pocket costs. Public Exchanges See Health Insurance Marketplace, above. Qualified Health Plan A plan that is certified by the health insurance marketplace and provides essential health benefits, follows established limits on cost-sharing (like deductibles, co-pays and out-ofpocket maximum amounts), and meets other requirements. 14 Learn more about your benefit options at MassMutual on myhr.

17 Tax Penalty This is the amount you may owe starting Jan. 1, 2014, for every month you do not have health insurance. If you owe a tax penalty, you will need to pay it to the IRS when filing your annual tax return. For instance, if you went without coverage from January through March in 2014, you would add up the monthly penalty for the three months you didn t have coverage and pay it in 2015 when filing your 2014 tax return. Wellness Programs These are programs intended to improve and promote health and fitness, usually offered through the workplace, and sometimes offered through individually purchased plans. These programs offer you incentives to participate. At MassMutual, our wellness program Live Healthy, Live Well generally provides wellness incentives in the form of deposits into a JPMorgan Chase health savings account. Get more information on the marketplaces in each state at 15

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19 MassMutual. We ll help you get there.

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