the new health law & small businesses...a variety of health plans, including: hmos, poss, ppos...
TRANSCRIPT
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The New Health Law & Small Businesses
July 2015
Overview
• Policy Update and Broker Resources
• 2016 Health Plans
• 2016 DC Health Link Renewal Process
– Small Business Marketplace
• Frequently Asked Questions
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Which Small Businesses are Eligible
for DC Health Link?
For 2014 and 2015, employers with:
• 1-50 full-time equivalent employees (FTEs), on average in the prior
calendar year
Beginning in 2016, expands to employers with:
• 51-100 FTEs, on average in the prior calendar year
What about self-employed individuals?
DC Health Link’s small business marketplace is for employers with at least
one non-owner employee.
If you are self-employed or a sole proprietorship, partnership, or an
S- Corporation that only employs owners, then you will be able to shop the
numerous plan options in the DC Health Link’s individual and family
marketplace.
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How do I calculate “full-time equivalent”
employees?
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Help for Small Businesses
Tax credits are available if your business has
• Fewer than 25 full-time workers
• Average wages of $50,000 or less
• Pay at least 50% of the cost of single coverage
for each employee
• Purchase coverage through DC Health Link
Tax credits can cover as much as
• 50% of a for-profit employer’s contribution
• 35% of a non-profit employer’s contribution
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Transition to One Marketplace
Individual policyholders
• New and renewing
Small businesses
(50 and fewer FTEs)
• Groups currently not
offering health
insurance coverage
• Groups currently
offering health
insurance coverage,
if they choose
Individual policyholders
• New and renewing
Small businesses
(50 and fewer FTEs)
• Groups currently offering
health insurance coverage
and changing carriers,
upon renewal
• Groups currently offering
health insurance coverage
and renewing with same
carrier, if they choose
Individual policyholders
• New and renewing
Small businesses
(50 and fewer FTEs)
• All groups, upon renewal
Mid-Size Businesses
(51-100 FTEs)
• Groups newly offering or
renewing coverage, if
they choose
July 2016
2015
2014
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Easier Comparisons
Plans will be categorized into “metal levels” for easier comparison
• Metal level provides a general idea of what portion of covered healthcare expenses
will be paid by the plan, with the remaining portion to be paid by the consumer
(not including premiums)
• Plans will have different designs, such as deductibles, copays, and coinsurance
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Plan Offering Options
Employers offering coverage through DC Health Link can offer the following employee choice options:
• All plans in 1 Metal Level
• All plans from 1 Carrier
• 1 Plan
Must offer coverage to all full-time employees (30 hours per week)
• Can choose to offer coverage to other employees, including part-time employees and retirees
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Employer Contributions
Small Business Owners decide the employer contribution:
1. Select one plan to base contributions on, the “reference plan”
2. Select a percentage you will contribute for employees and dependents to enroll in
the reference plan
3. Your contribution remains fixed based on the reference plan. Employees enrolling in
any other plan will pay the difference in premium to “buy-up” or “buy-down.”
Age
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Employees may also select to “Buy Down” to a lower cost plan.
If the monthly premium is less than the employer contribution amount, the employer will pay the monthly premium amount.
Employees cannot receive cash back.
Age
Reference Plan Enrolled Plan (Buy Up) Enrolled Plan (Buy Down)
Gold PPO
Premium
Employer
Pays (80%)
Employee
Pays
Platinum PPO
Premium
Employer Pays (same as Ref Plan)
Employee
Pays
Bronze HMO
Premium
Employer Pays
(up to the same
as Ref Plan)
Employee
Pays
Vince 27 $275 $220 $ 55 $310 $220 $ 90 $185 $185 $0
Joyce 40 $365 $292 $ 73 $417 $292 $125 $250 $250 $0
Effective Date of Coverage
Options are:
• 1st of Month Following Date of Hire
• 1st of Month Following 30 Days
• 1st of Month Following 60 Days
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Small business owners
determine the effective
date of coverage for new
employees.
Participation
Minimum Employer Contribution
• 50% of single coverage in reference plan
Minimum Level of Participation
• One non-owner employee
• 2/3rds of eligible employees (not including
waivers)
– Employees declining to enroll because of other
coverage do not count against participation
requirement if their other coverage is:
• Another employer’s health plan (spouse’s
employer plan), or
• Governmental health plan (Medicare, Medicaid,
TRICARE).
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Note: Employers who cannot satisfy minimum participation and/or minimum contribution will be able to enroll during a special annual enrollment period each year for coverage effective January 1st.
The DC Health Link Advantage
for Small Business
Employer competitive edge
Flexible plan options
Same purchasing power as larger employers
Wide range of plans available
Simplified billing
Tax credits to offset costs
Work with a Broker
Same coverage options as Members of Congress!
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Simply put …..
What Information Do I Need to Get Started?
1. Federal Employer Identification Number (EIN)
2. DC Business Address
3. Number of Full-Time Equivalent Employees (FTEs) in Prior Calendar Year
4. Employee Census - for each eligible employee
– Date of Birth
– Social Security Number (SSN) or Tax Identification Number (TIN)
– Employee Email Address (for open enrollment notice only)
– Date of Birth for all Dependents (optional – for cost estimations only)
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Five Steps to Offering Coverage through DC Health Link
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Select Broker
Enter Employee
Info
Review Plan
Options
Calculate
Employer
Contributions
Verify
Eligibility for
the Small
Business
Marketplace
Choose New
Employee
Coverage Start
Date Rules
Employees review
their options
Select the plan
that is best for
their needs
Pay 1st
Month’s
Premium
(due by 12th of
the month)
Payment Open Enrollment
Enrollment Eligibility
Quoting
Broker
Employer
Employees
How Long Does It Take?
Employers (and brokers) should note that DC Health Link’s initial group set up
and employee enrollment timeline will run a minimum of 1 month (“fast-track”)
and no more than 3 months (longest), with the typical employer taking 45 days.
Fast Track Longest Track
Select Plans
& Contributions 1-7 Days 45 Days
Employee
Open Enrollment 10 Days 30 Days
First Premium
Payment By the 12th of the month
Carrier Administration 2 weeks
TOTAL 1 month (minimum) 3 months (maximum)
Example:
August 1, 2015 Coverage
Begin by
July 1, 2015
Begin as early as
May 1, 2015 15
Deadlines
Employer Application Employee Open Enrollment Period 1st Premium Payment
Coverage Effective Date
Earliest Date to Start
Must be Completed by
Earliest Start Date
Must be Started By
End of Open Enrollment
Must be received by
Sep 1, 2015 Jun 1, 2015 Aug 1, 2015 Jul 1, 2015 Aug 1, 2015 Aug 10, 2015 Aug 12, 2015
Oct 1, 2015 Jul 1, 2015 Sep 1, 2015 Aug 1, 2015 Sep 1, 2015 Sep 10, 2015 Sep 14, 2015
Nov 1, 2015 Aug 1, 2015 Oct 1, 2015 Sep 1, 2015 Oct 1, 2015 Oct 10, 2015 Oct 14, 2015
Dec 1, 2015 Sep 1, 2015 Nov 1, 2015 Oct 1, 2015 Nov 1, 2015 Nov 10, 2015 Nov 12, 2015
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This is for initial employer groups offering through DC Health Link for the first time:
Deadlines
Employer Application Employee Open Enrollment Period
Coverage Effective Date
Earliest Date to Start
Must be Completed by
Earliest Start Date
Must be Started By
End of Open Enrollment
Sep 1, 2015 Jun 1, 2015 Aug 5, 2015 Jul 1, 2015 Aug 5, 2015 Aug 13, 2015
Oct 1, 2015 Jul 1, 2015 Sep 5, 2015 Aug 1, 2015 Sep 5, 2015 Sep 13, 2015
Nov 1, 2015 Aug 1, 2015 Oct 5, 2015 Sep 1, 2015 Oct 5, 2015 Oct 13, 2015
Dec 1, 2015 Sep 1, 2015 Nov 5, 2015 Oct 1, 2015 Nov 5, 2015 Nov 13, 2015
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This is for renewal employer groups offering through DC Health Link:
Broker Resources
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2016 Employer Renewals
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2016 Carriers & Plans
A variety of health plans, including: HMOs, POSs, PPOs and HSA-Compatible Products
There are also 2 multi-state small business plans offered through CareFirst BlueCross BlueShield.
2016 Proposed
Plans
Individual & Family
Marketplace
Small Business
Marketplace
Aetna — 18 plans
CareFirst 15 plans 53 plans
Kaiser Permanente 11 plans 24 plans
United Healthcare — 41 plans
TOTAL 26 plans 136 plans
Below are the number of plans filed through DISB for plan year 2016. To review the plans and proposed rates please go to disb.dc.gov.
Frequently Asked Questions
• Does DC Healthlink plan on going back to composite ratings?
– No, composite ratings are no longer allowed under new federal regulations
• How are brokers assigned by employers through DC Health Link?
– Brokers are assigned through by selecting “Broker Agency” and searching then
using the “select” function.
• Will brokers automatically be assigned for conversion groups?
– Yes this will pre-populate into the employer’s account from the information
provided by the carriers.
• Do employers have to fill out a new application at renewal?
– Employers MUST go back into the system at renewal and review their plan
offerings for the upcoming plan year. Unlike employees, employers must take
action at renewal time.
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Contact Information
Producer Relations Team [email protected]
Small Business Support Team [email protected]
855-532-5465
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Thank you! To learn more:
Visit us at
www.DCHealthLink.com
Download the mobile app on iTunes or Google play:
DC Health Link - Small Biz
Follow us on Twitter:
@DCHealthLink
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