Your Health Insurance Options under Health Care Reform

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Maud Watkins
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1 Your Health Insurance Options under Health Care Reform The health care reform law requires that most Americans have health insurance by January 1, It is in place to make sure Americans have access to health insurance whether they get it from an employer, an insurance company or from 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 (also called the Affordable Care Act) makes it clear: it is up to you to make sure you have health insurance beginning in Cooper Standard is here to help by explaining the options available to you and the steps you need to take so that you are covered. Read this information to learn more about the requirements of health care reform and the actions you will need to take. These summaries are designed to show how all the pieces fit together and where your path through health care reform begins. So, please take a moment to read the summaries each one is about you. Your Responsibility Cooper Standard Responsibility Health Insurance Marketplaces: Understanding the Public Exchanges Medicaid More People Now Qualify Who Can Receive Health Insurance through Cooper Standard? Page 1 of 8

2 Your Responsibility for Health Insurance The health care reform law requires most Americans to have health insurance by January 1, This requirement is sometimes called the Individual Mandate. You can meet this requirement by getting health insurance through: Cooper Standard (if you are benefits eligible) Your spouse s employer Your parent s employer (if you are under age 26) A public Exchange available in your state (which may also be referred to as a Health Insurance Marketplace ) Other coverage options that may be available to you, including an insurance plan outside the public Exchange or through government programs such as Medicare and Medicaid. If you do not have health insurance by January 1, 2014, you may be required to pay a tax penalty based on your income and family status. This is important for every month you are without health insurance you may be required to pay this tax penalty. The total penalty amount will be collected as a single payment once a year. 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. Family Size Household Income (Example) How the Penalty is Calculated 2014 Tax Penalty Individual $25,000 Married Couple $40,000 $95 Flat Dollar OR 1% of ($25,000 $10,250) ($95 x 2) OR 1% of ($40,000 $20,500) $148 $195 Family of 3 (1 child < age 18) $40,000 ($95 x 2.5) OR 1% of ($40,000 $20,500) $238 Family of 4 $40,000 Family of 5 $150,000 ($95 x 3) OR 1% of ($40,000 $20,500) ($95 x 3) OR 1% of ($150,000 $20,500) $285 $1,295 * These are only examples. Actual penalties will vary based on each person s circumstances. Cooper Standard cannot provide tax advice to employees. If you have questions, talk with your tax advisor. Page 2 of 8

3 What Does This Mean For Me? It is up to you to have health insurance for yourself and any eligible dependents by January 1, Cooper Standard is here to help by showing you all of the options available to you and explaining the steps you need to take so that you are covered. As a Cooper Standard employee, you are eligible to enroll in a Cooper Standard medical plan if you are benefits-eligible. You can enroll in a Cooper Standard medical plan during annual Open Enrollment from October 18 through November 1, If you are not benefits-eligible, you will need to get health insurance through another source. That might be your spouse s employer, your parent s employer (if you are under age 26), or the Exchange available in your state. Depending on your situation, you might be eligible for coverage through Medicare or Medicaid. You can also buy a policy on your own, separate from the Exchange in your state. Learn if you are benefits eligible. If you are benefits eligible, you can continue to get health insurance through Cooper Standard. You can enroll for the first time or make changes to your current coverage during annual Open Enrollment from October 18 through November 1, If you decide to get health insurance somewhere else beginning on January 1, 2014, make a no coverage election during annual Open Enrollment. If you are not benefits eligible, look into other options. Find out if: You qualify for Medicaid benefits by contacting Medicaid in your state. State Medicaid contact information can be found at medicaid.gov. Your parents or spouse can include you on their health insurance plan. Review their plan to see if you qualify. An Exchange is the best option for you. You can find out more information about the Exchanges (or Health Insurance Marketplaces) at healthcare.gov the website sponsored by the Department of Health and Human Services. Questions: Call the Cooper Standard Benefits Service Center toll-free at Monday through Friday between 8:00 am and 6:00 pm (Eastern). Page 3 of 8

4 Cooper Standard Responsibility for Health Care Reform The health care reform law requires companies with 50 or more full-time employees like Cooper Standard to offer health insurance to full-time employees and children up to age 26. If a company does not offer health insurance, it may be required to pay a penalty to the government. Companies must offer health insurance plans that cover at least a minimum amount of health care services and those plans must be affordable as defined by the law. To be affordable, the amount that comes out of an employee s paycheck for employee-only health insurance under the lowest-cost plan that is available from the company cannot be more than 9.5% of that employee s total household income. Cooper Standard health plans meet these requirements. The health care reform law says that companies must provide health insurance to full-time employees. Under the law, full-time means working an average of 30 hours or more per week. Cooper Standard s health insurance 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 you are not eligible to receive financial assistance (known as subsidies ) from the government to purchase health coverage through a public Exchange. We are closely watching the health care changes and will provide updates about all health insurance options available to our employees. What Does This Mean For Me? Cooper Standard has carefully reviewed the medical plans to make sure we are offering coverage that makes sense for both you and the company. We plan to offer adequate and affordable health care plans to all employees working an average of 30 hours or more per week in As long as you are not receiving health insurance from another source, like from your spouse s or parent s employer plan, we believe a Cooper Standard medical plan may continue to be your best option for health insurance. If you are not benefits-eligible, find out if you can get health insurance through your spouse s or parent s plan, the Public Exchange available in your state, Medicaid or Medicare, or from another source. You can find out more information about the Exchanges and Medicaid at healthcare.gov. Page 4 of 8

5 Health Insurance Marketplaces: Understanding the Public Exchanges The health care reform law says that each state must offer a public health insurance marketplace or a public Exchange. These Exchanges will allow individuals and families to buy health insurance themselves instead of getting it through their employers. Public Exchanges will be available in each state and operated by the state, by the federal government, or through a partnership between the state and federal government. How Does the Public Exchange 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 Public Exchange 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 public Exchange will have some benefits in common: Preventive care services, like routine check-ups and wellbaby care visits will be covered at 100% you pay nothing. 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. Limits on how much an individual pays out of pocket (such as a copay, coinsurance or deductible) in any given year. In addition, the Public Exchanges can help you find out if you are eligible for financial assistance to pay for health insurance through the Exchange. 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. Please note that if you qualify for Cooper Standard health insurance (i.e., work an average of 30 hours or more a week), you will not be eligible for subsidies through the Public Exchanges. That is because Cooper Standard offers health plans that meet the health care reform law requirements for providing comprehensive and affordable coverage. There is more to come The Public Exchanges are there to help you find the best plan for you and your family. They can also help you determine if you are eligible for any subsidies or qualify for Medicaid. Again, please note that the Cooper Standard medical plans meet the minimum value requirements, which means that any employee who works an average of 30 or more hours a week is not eligible for a subsidy. Open enrollment through the public Exchanges will begin October 1, Health insurance coverage purchased through the Public Exchanges will start on January 1, Contact information for the Public Exchanges will be available later this summer. Page 5 of 8

6 What Does This Mean For Me? It is up to you to have health insurance for yourself and any eligible dependents by January 1, Cooper Standard is here to help by explaining the options available to you and the steps you need to take so that you are covered. If you are benefits-eligible, you are eligible for health insurance through Cooper Standard, but you are not eligible for subsidies from the government. As long as you are not receiving health insurance from another source, like your spouse s or parent s plan, we believe a Cooper Standard health plan may be your best option for coverage. If you are not benefits-eligible, you are not eligible for health insurance through Cooper Standard. You might be able to get health insurance through your spouse s or parent s employer plan, an individual policy through the Public Exchange in your state, an individual policy outside the Public Exchange, Medicare or Medicaid, or another source. Check to see if you qualify for financial assistance through the Public Exchanges. Are you benefits eligible? If you are benefits eligible, you do not qualify for financial assistance from the federal government through the Public Exchanges because you are eligible for the Cooper Standard health insurance plan, which provides comprehensive, affordable coverage. If you are not benefits eligible, the Public Exchange in your state will help you see if you meet the requirements to qualify for financial assistance. You can find out more information about the Exchanges (or Health Insurance Marketplaces) at healthcare.gov, the website sponsored by the Department of Health and Human Services. You should also check to see if you qualify for Medicaid as described in the next section. Page 6 of 8

7 Medicaid More People Now Qualify Medicaid is the nation s primary program for providing individuals and families at lower income levels with health insurance. Depending on where you live, eligibility for Medicaid may be expanding so that more people qualify for benefits. Even if you have not 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 January 1, 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 What Does This Mean For Me? If you are eligible for Medicaid in your state, you can receive health insurance through Medicaid. It is up to you to have health insurance for you and any eligible dependents by January 1, If you do not have health insurance by that date, you may pay a tax penalty based on your income and family status. You may pay an annual penalty for every month you are without coverage. To find out more, check out page 2 of this document. Check to see if you qualify for Medicaid. Check the Medicaid website in your state. State Medicaid contact information can be found at medicaid.gov. If your household income is below the cut-off, you may qualify for Medicaid. If your household income is more than the cut-off, you do not qualify for Medicaid. If you are eligible for both Medicaid and health insurance through Cooper Standard, you should: Compare health insurance plan options and costs to determine the best choice for you. Get more information about your specific coverage options and eligibility under Medicaid by contacting Medicaid in your state. State Medicaid contact information can be found at medicaid.gov. Call the Cooper Standard Benefits Service Center toll-free at Monday through Friday between 8:00 am and 6:00 pm (Eastern). Page 7 of 8

8 Who Can Receive Health Insurance through Cooper Standard? The health care reform law says that employers with at least 50 employees must offer health care coverage to employees who work an average of 30 hours per week. The coverage must include certain benefits at an affordable price as defined by the law. If not, tax penalties may apply. The law does not require employers to offer health insurance to parttime employees (that is, those working, on average, less than 30 hours per week). Cooper Standard meets that requirement by offering health insurance to all employees who work an average of 30 or more hours a week. What Does This Mean For Me? Cooper Standard currently offers health insurance to all employees in the U.S. who work an average of 30 or more hours per week. If that applies to you, you can have Cooper Standard health insurance. If you work 30 hours or more per week and want to receive health insurance through Cooper Standard, please enroll, make changes or confirm and continue current elections at hrsolutions.cooperstandard.com (click on Benefit Service Center) from October 18 to November 1, If you work less than 30 hours per week, learn about your other options for health insurance. Visit healthcare.gov, the website sponsored by the Department of Health and Human Services, or the new Health Care Reform page on hrsolutions.cooperstandard.com (click on Benefit Service Center). This document provides a summary of the Cooper Standard Health & Well-Being Benefit Plan. In the event of a conflict between this document and the respective plans, the plan shall govern. Nothing in this or any other benefits document or oral representation should be construed as an employment contract or a guarantee of benefits. Cooper Standard reserves the right to terminate or change the program or any of the plans at any time and has sole discretion to make the final decision in all areas of interpretation and provisions of the plan or any of the benefits, including the terms of eligibility for any of the benefits provided. Page 8 of 8

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

Health Care Reform Information for Employees Your options under health care reform Patient Protection and Affordable Care Act (PPACA) September 2013 Contents 1 Your options under health care reform 2 Health