-r\jotic E Insurance Marketplace Cverage Optins and Yur Health Cverage..t - 2014 GALLAGHER BENEFIT SERVICES, INC. ARll-IUR J. GAllAGHER & CO. I AJG.COM G-Frms\GBS\Template - Wrd -.5 margis.dcx -
Frequently Asked Questins fr Emplyees abut the New Health Insurance Marketplace 1. Q: What i~ _ the "Exchange" r "Marketplace" that I've been hearing abut? A: The ExchangefMarketplace is a new health insurance marketplace in each state. The Marketplace is an n-line site where individuals and smaller emplyers may g t purchase health insurance cverage starting fr 2014. 2. Q: Why is the Marketplace being established? A: Under federal law, beginning January 1,2014 individuals will be required t have minimum essential health cverage, r else be subject t a penalty. This is referred t as the "individual mandate." The Marketplace is intended t help individuals meet the individual mandate requirement by prviding anther place t purchase cverage, and pssibly qualify fr federal assistance t d s. 3. Q: 'D I have t purchase health cverage thrugh the Marketplace? A: N. Yu may still btain health cverage frm ther surces ifyu are eligible. T avid the individual mandate penalty, yu will want t cnfinn that the cverage yu btain prvides "minimum essential cverage" under the rules. 4. Q: What are sme pssible ther surces f cverage? A: Yur emplyer, yur spuse's emplyer, Medicare (ifeligible in yur state), the individual market, etc. 5. Q: What if I am cvered under my emplyer's plan? Can I keep it? A: Yes. Mst emplyer plans will qualify as the cverage required under,the individual mandate requirements. Yu d nt need t purchase cverage thrugh the Marketplace in rder t avid the individual mandate penalty. Yu may, if yu wuld like, hwever. 6. Q: Can I drp myself r my dependents frm my grup plan t purchase a plan thrugh the Marketplace r utside f the Marketplace? A: Maybe yes. Maybe n. Emplyers and Marketplaces have very specific rules arund enrllment and disenrllment. In general, bth have an annual pen enrllment perid.(which will usually be different) and permit special enrllments during the year based n events such as marriage r birth f a child. Althugh these rules are similar, they are nt identical. In additin, determining when yu can change an electin utside the annual pen enrllment perid will be detennined by IRS rules and the terms f the grup health plan. Generally, emplyees may nt change an electin unless the emplyee experiences a change in status permitted by the IRS and allwed by the grup health plan. Page 1
7. fr assistance t my cverage the A: Individuals wh are nt ffered """"A''''n-nnp'"lt subsidies t nl1t {'h~c'p rl in n incme level and hw many aej)erlaems incme must be belw 400% f the federal level f in additin t sme ther prrlnl',,\'uf.~r ffers. cverage is cnsidered affrdable and meets minimum value reciuljrenl1erlts, yu wn't be able t lwer csts n expenses in the M(JlfK(~tPlace. incme level desn't that. Yu can see further details abut a OO:SSliDle ~~~~~...!. and the state where yu live. 8. subsidize my health cverage if I it yu pay fr cverage that yu ~'.U'VU'c.L.JV the pays a Ull'''UC.l1 u...'6 decisins abut where t btain yur health cverage. 9. Will I be able t see my same dctr ifi n... I"1<:>" '" cverage the instead A: yes. n. Insurance DUl"chase:d tflfollqn the M~rrKetp'la<)e may have different. 1M..."'''.. ''''... netwrks. Yu shuld review t see dctrs 10. When will the in my state be pen fr business? A: enrllment in the Octber 1, with cverage t becme effective 1, 2014. Please refer t the in yur state fr further infrmatin. 11. Can I enrll A: N. In this first year cverage, yu may enrll Octber 1,2013 until March 31, 2014. yu will need t wait until the next pen enrllment time in the fall unless yu have a VJ.J.<.U~J:;''-' in status that allws yu a pen enrllment 12. PlTlnl/\Vp r'~ health benefits prgram be available fr the ""...,...--,,'""'''''.. is cnsidered t be a small "'...,'nl'..."":: r and has chsen t the ""... Ir"'''''..'' with ver 100 may nt size still may ffer cverage U~'v"'''CH These FAQs were cmpiled by Gallagher BenefitServices/Inc. The intent fthis is t inl,rlrn'1n",nn "D.r:.nr,rl;n,n the prvisins and re.q'ula'd.n. address allyur issues. Itshuld nt be cnstrued as, nr is it intended advice. Yu shuld cntactyur tax advisr r an specializes in this practice area shuld address questins rdrrnrrlinpn.;)1~t:;l(/(l Page 2
Insurance Frm Apprved OMB N. 1210 0149 (expires 1 31 2017) When parts f the health law take effect in 2014, there will be a new way t buy health insurance: Health Insurance Marketplace. T assist yu as yu evaluate ptins fr yu and yur family, this ntice prvides sme basic infrmatin abut the new Marketplace and emplyment-based health cverage ffered by yur emplyer. What is the Health Insurance The Marketplace is designed t help yu find health insurance that meets yur needs and fits yur budget. The Marketplace ffers "ne-stp shpping" t find and cmpare private health insurance ptins. Yu may als fr new kind f tax credit that lwers yur mnthly premium right away. Open enrllment fr health insurance cverage thrugh the Marketplace begins in Octber 2013 fr cverage starting as early as January 1, 2014. eligible Can I Save Mc::>nev n my Health Insurance Premiums in the M'arl(61tplace Yu may Qualify t save mney and lwer yur mnthly premium. but nly if yur emplyer des nt ffer cverage, r ffers cverage that desn't meet certain standards. The savings n yur premium that yu're eligible fr depends n yur husehld incme. Des t::nlpl~:jye~r Health hnrih.:ijf-" fr Premium S:::1BViinn;<:: Yes. If yu have an ffer 'f health cverage frm yur emplyer that meets certain standards, yu will nt be eligible fr a tax credit thrugh the Marketplace and may t enrll in yur emplyer's health plan. Hwever, yu may be eligible fr a tax credit that lwers yur mnthly premium r a reductin in certain cst-sharing if yur emplyer des nt ffer cverage t yu at 'all r des nt GlHer cverage that-meets certain standards. If the cst- f a plan frm yur emplyer that wuld cver yu (and nt any ther members f yur family) is mre than 9.5% f yur husehld incme fr the year, r if the cverage yur emplyer prvides des nt meet the "minimum value" standard set by the Affbrdable Care Act, yu may be eligible fr a tax credit. 1 Nte: If yu purchase a health plan thrugh the Marketplace instead f accepting health cverage ffered by yur emplyer, then yu may lse the emplyer cntributin (if any) t the emplyer-ffered cverage. Als, this emplyer cntributin -as well as yur emplyee cntributin t emplyer-ffered cverage- is ften excluded frm incme fr Federal and State incme tax purpses. Yur payments fr cverage thr9ugh the Marketplace are made n an aftertax basis. HwCan I Get Mre Infrmatin? Fr mre infrmatin abut yur cverage ffered by yur emplyer, please check ybur summary plan descriptin r cntact: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~-=~-=~~ The Marketplace can help yu evaluate yur cverage ptins. including yur eligibility fr cverage thrugh the Marketplace and its cst. Please visit HealthCare.gv fr mre infrmatin, including an nline applicatin fr health insurance cverage and cntact infrmatin fr a Health Insurance Marketplace in yur area. 1 An emplyer-spnsred health plan meets the "minimum value standard" if the plan's share f the ttal allwed benefit csts cvered by the plan is n less than 60 percent f such csts.
PART B: Infrmatin Abut Health Cverage Offered by Yur Emplyer This sectin cntains infrmatin abut any health cverage ffered by yur emplyer. If yu decide t cmplete an applicatin fr cverage in the Marketplace, yu will be asked t prvide this infrmatin. This infrmatin is numbered t crrespnd t the Marketplace applicatin" Here is sme basic infrmatin abut health cverage ffered by this emplyer: -As yur em plyer, we ffer a health plan t: ](I All emplyees. Eligible emplyees are: All full-time emplyees wrking 30 hurs r mre per week Sme emplyees. Eligible emplyees are: -With respect t dependents: XI We d ffer cverage. Eligible dependents are: Spuse and legal children We d nt ffer cverage. ~ If checked, this cverage meets the minimum value standard, and the cst f this cverage t yu is intended t be affrdable, based n emplyee wages. Even if yur emplyer "intends yur cverage t be affrdable, yu may still be eligible fr a premium discunt thrugh the Marketplace. The Marketplace will use yur husehld incme, alng with ther factrs, t determine whether yu may be eligible fr a premium discunt. If, fr example, yur wages vary frm week t week (perhaps yu are an hurly emplyee r yu wrk n a cmmissin basis), if yu are newly emplyed mid-year, r if yu have ther incme lsses, yu may still qualify fr a premium discunt. If yu decide t shp fr cverage in the Marketplace, HealthCare.gv will guide yu thrugh the prcess. Here's the emplyer infrmatin yu'll enter when yu visit HealthCare.gv t find ut if yu can get a tax credit t lwer yur mnthly premiums. I "
The infrmatin belw crrespnds t the Marketplace Emplyer Cverage Tl.,Q6Jii/6..lEi.On5Wii$ ~cflq.. J< QR. 91l.s /Ifr emplyers, but will help ensure emplyees unders ta nd their cverage chice s. 13. Is the emplyee currently eligible fr cverage ffered by this emplyer, r will the emplyee be eligible in the next 3 mnths? Yes (Cntinue) 13a. If the emplyee is nt eli'gible tday, including as a result f a waiting r prbatinary perid, when is the emplyee eligible fr cverage? (mm/dd/yyyy) (Cntinue) N (STOP and return this frm t emplyee) If the plan year will end sn and yu knw that the health plans ffered will change, g t questin 16. If yu dn't knw, STOP and return frm t emplyee. 16. What change will the emplyer make fr the new plan year? Emplyer wn't ffer health cverage Emplyer will start ffering health cverage t emplyees r change the premium fr the lwest-cst plan available nly t the emplpyee that meets the minimum value standard.* (Premium shuld reflect the discunt fr wei/ness prgrams. See questin 15.) a. Hw much wuld the emplyee have t pay in premiums fr this plan? $ b. Hw ften? 0 Weekly 0 Every 2 weeks 0 Twice a mnth 0 Mnthly 0 Quarterly 0 Yearly An emplyer-spnsred health plan meets the "minimum value standard" If the plan's share f the ttal allwed benefit csts cvered by the plan is n less than 60 percent f such csts (Sectin 36B(c)(2)(C)(ii) f the Internal Revenue Cde f 1986)