ACA Marketplace Notice Guidance and Employee Q & A
Back in May of this year (2013) the Department of Labor set a new deadline of OCTOBER 1, 2013 (originally March 1, 2013) for most employers to provide notices to their employees pertaining to the soon to be formed “health insurance marketplaces”. Since this deadline is rapidly approaching, this week’s blog post is dedicated to assisting readers and stakeholders with compliance with this requirement.
Click here to access the DOL’s Technical Release of this requirement –
Technically, the DOL only required employers subject to the Fair Labor Standards Act (FLSA) to provide the “marketplace notices”. But since the vast majority of employers are subject to FLSA, it is generally become accepted that any business or organization of any size should consider providing the notices. Notices are required to be made to ALL employees, regardless of plan participation, full-time/part-time status, etc. Note: To access the DOL’s guidance on FLSA applicability to your company/organization, click – http://www.dol.gov/elaws/esa/flsa/scope/screen24.asp
The DOL has provided two (2) different notice templates, depending on whether the affected company/organization offers health insurance coverage to its employees:
1. Employers offering health insurance – http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf
2. Employers NOT offering health insurance – http://www.dol.gov/ebsa/pdf/FLSAwithoutplans.pdf
Additionally, the DOL has modified its model COBRA notice template to include language referencing the marketplaces – http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwMTMwNTA4LjE4NTg3MzExJm1lc3NhZ2VpZD1NREItUFJELUJVTC0yMDEzMDUwOC4xODU4NzMxMSZkYXRhYmFzZWlkPTEwMDEmc2VyaWFsPTE3NTU3NTIzJmVtYWlsaWQ9ZXJpY2Euc3Rvcm1Aenl3YXZlLmNvbSZ1c2VyaWQ9ZXJpY2Euc3Rvcm1Aenl3YXZlLmNvbSZmbD0mZXh0cmE9TXVsdGl2YXJpYXRlSWQ9JiYm&&&103&&&http://www.dol.gov/ebsa/modelelectionnotice.doc
In anticipation of resultant questions (if not confusion!) resulting from receipt of the new notice, I have developed a “Marketplace Notice Q & A” which includes eight (8) questions I anticipate recipients of the notice might have. The intent of this Q&A is to explain the reason for the notice and what it says. Feel free to copy/paste the eight (8) Q&A’s into a document to be included with your notice template, and make any necessary edits. Hopefully the document will reduce the number of questions that might otherwise be generated by the distribution and receipt of the notice.
MARKETPLACE NOTICE Q & A
Q1. What is this notice?
A1. The Affordable Care Act (also referred to as The Patient Protection and Affordable Care Act, Health care Reform Law, and “Obamacare”) requires companies like ours to provide its employees with a notice which explains the availability of new “health insurance marketplace coverage options”.
Q2. Why am I receiving this notice?
A2. As an employee of XYZ Co. regardless of whether you have elected health insurance through our plan, or whether you are a full time or part time employee, we are required by federal law to provide this notice to current employees no later than October 1, 2013. Employees hired after October 1, 2013 will be provided the notice within 14 days of hire date.
Q3. Am I eligible for health insurance through the new, PUBLIC marketplace referred to in the notice?
A3. Yes, you are eligible to purchase health insurance through the PUBLIC marketplace.
Q4. Am I eligible for a subsidy from the federal government to help pay for health insurance coverage purchased through the PUBLIC marketplace?
A4. You may be eligible for a subsidy for coverage purchased on the PUBLIC marketplace based on two factors – 1. the required minimum value (60%) level of coverage offered at XYZ Co.; and 2. the cost for EMPLOYEE ONLY coverage at XYZ Co. (i.e., if your portion of the premium is less than 9.5% of your previous year’s W-2 income you are not eligible. If it is greater than 9.5% of your previous year’s W-2, you may be eligible for a subsidy). You can verify eligibility for subsidy eligibility by visiting the federal government’s website at www.healthcare.gov
Q5. If I currently have health insurance coverage through XYZ Co., what happens to this coverage if I decide to purchase coverage through the PUBLIC marketplace?
A5. If you choose to purchase coverage through the PUBLIC marketplace, you will forfeit the employer contribution toward the cost of your health insurance coverage here. Also, it is important to note that coverage purchased through the PUBLIC marketplace is paid for with after-tax dollars. At XYZ Co., your portion of the cost of health insurance is paid with before-tax dollars .
Q6. Can my spouse and dependents over the age of 25 purchase coverage through the PUBLIC marketplace?
Q7. Is my spouse eligible for a subsidy from the federal government to help pay for health insurance coverage purchased through the PUBLIC marketplace?
A7. It is possible, and would depend on the following factors: 1. your spouse’s W-2 income; 2. the level of coverage your spouse’s employer provides; and 3. the amount of the premium your spouse pays for coverage through their employer. Your spouse can verify subsidy eligibility by visiting www.healthcare.gov.
Q8. Am I required to do anything specifically with this notice, and/or take any particular action as a result of receiving this notice?
A8. No. As an employer, we are required to provide the notice to all of our employees (see Q.2). As an employee, you are not required to do anything with the notice, or take any particular action. The notice is intended to make you aware of another source from which to purchase health insurance coverage.