In this newsletter
- Surviving the Reform Storm – Thank you for choosing DDI!
- Time is running out for 2014 individual/family health insurance enrollment– GET THE FACTS
- Employer Mandate delayed again, or at least parts of it! READ IMPORTANT DETAILS BELOW
- 2014 Compliance Reminder for Group Health Plans
Surviving the Reform Storm – Thank you for choosing DDI!
We’re grateful to have you as a health insurance client and/or colleague, whether you are new to DDI or have been with us for years. 2013 was a stormy year to say the least! Thank you for trusting us to guide you through the unprecedented health insurance changes. We know that you experience change in your business and lives, and we are humbled by the challenges you face to run your businesses and care for your families. Health insurance is a major decision for everyone.
With Dena’s 23 years’ of industry experience,and our team’s 60+ years, our goal is to serve you and help make sense of health care reform and your health care choices. We want you to have the necessary information to help you make the best health plan and benefits decisions for yourself, your family and your organization. We are committed to helping you weather the continued health reform storm. Thank you for letting us serve you.
Stay tuned for our next E-Newsletter when, in order to better serve our clients, we will announce the move to our new more “centrally located” office!
The DDI Team—Dena, Brandi, Kellie, and Ryan
Time is Running out for Individual Health Insurance Enrollment – March 31st,
2014!!!
Open and Special Enrollment –Background
The Affordable Care Act (ACA) allows individuals to enroll in Individual and Family coverage during an annual Open Enrollment Period, regardless of any pre-existing health condition.
The initial Open Enrollment began on October 1, 2013 and continues through March 31, 2014, for this year ONLY.The initial effective date of coverage was January 1, 2014 and depends on when enrollment is completed. Subsequent open enrollments will occur between October 15th and December 7th of each year for an effective date of January 1st of the following year.
Still need to pick a plan? Contact DDI at info@ddibenefits.com or 503-206-5654 for help. Go to www.ddibenefits.com to shop online. We are here to help you! Open enrollment ends in 5 weeks!!
In addition to Open Enrollment, certain individuals may enroll in coverage during Special Enrollment periods if they experience certain qualifying life events. Special Enrollment also is available without regard to pre-existing medical conditions. Please see below for a list of qualifying life events.
Special Enrollment –Qualifying Life Events
You may qualify for Special Enrollment if you experience any of the following qualifying events:
Special Enrollment extends for 60 calendar days following one of these events:
- Loss of minimum essential coverage for subscriber and any dependents;
- Birth or adoption of a child (including placement for adoption);
- Loss of eligibility for employer-sponsored coverage due to termination of employment;
- Loss of eligibility for employer-sponsored coverage due to reduction of work hours;
- Loss of employer-sponsored coverage due to death of employee;
- Loss of employer-sponsored coverage due to divorce or separation;
- Loss of employer-sponsored coverage due to Chapter 11 bankruptcy of employer;
- Becoming entitled to Medicare coverage;
- Loss of employer-sponsored coverage due to loss of dependent child status;
- New eligibility or new ineligibility for advance premium tax credits, or change in eligibility for cost-sharing reductions;
- Gain of access to a new qualified health plan due to a permanent move;
- Adequate demonstration to exchange (“marketplace”) of a qualified health plan’s substantial violation of a material contract provision; and
- The exchange (“marketplace”) evaluates and determines enrollment or non-enrollment in a qualified health plan was unintentional, inadvertent, or erroneous,
and was caused by an error, misrepresentation, or inaction of an officer, employee, or agent of exchange (“marketplace”) or of US Health and Human
Services or its instrumentalities
ACA employer mandate delayed an additional year for mid-size employers
Last Monday, the Internal Revenue Service (IRS) released final shared responsibility regulations, popularly known as the ‘employer mandate.’ Of note is the delay for companies employing 50-99 workers until January 1, 2016, of the key provision to provide health insurance or face a penalty. This update gives mid-size employers an additional year to comply with the requirement. Penalties for employers not providing health insurance were originally scheduled to take place at the beginning of 2014. However, in July 2013, the IRS deferred compliance with this provision until 2015. Companies with 100 or more full-time employees are still required to comply by January 1, 2015, but only to 70 percent of their FTE’s, and then to 96 percent by 2016. Additional provisions in the update applied to employers with 50 or more employees include:
- Employer penalties: employers with 100 or more employees offering health insurance coverage to 70 percent of their full-time employees (working an average of 30 hours per week) will not face a penalty, but they must expand coverage to 96 percent of their employees by 2016
- Volunteer employees: volunteers for government or tax-exempt organizations (e.g., volunteer firefighters, emergency responders) will not be considered full-time employees; any hours that they work will not be counted toward the hours of service used to determine the obligation to provide health insurance
- Educational employees: teachers and other educational employees will not be considered part-time employees based solely on the fact that their school closes or operates on a limited schedule during the summer; adjunct faculty members of colleges will be credited with 2.25 work hours per week for each hour spent teaching, which means a 15-hour (equating to approximately 33.75 hours) teaching week would be considered full-time and a 12-hour (27 hours) teaching week would not
Note: the ACA included a provision to require employers with 50 or more full-time employees during the prior year to offer health insurance that is affordable and provides minimum value and impose a penalty on those who do not meet the requirement. The employer mandate does not apply to small businesses with fewer than 50 employees. www.deloitte.com
2014 Compliance Reminder for Group Health Plans:
Employers of all sizes and all health plan types, including self-funded plans, must comply with the new 90-day wait period rule for new hires to be eligible for health insurance in 2014. The new rule takes effect on the first day of the new plan year in 2014. So if your plan renews March 1st, your plan must be in compliance on March 1st, 2014. In order to be in compliance with coverage taking effect on the 90th day from the hire date for all potential new hires, the eligibility rule will have to be the “first of the month following 60 days” of employment since most health plans are only effective the first of the month.
A new hire eligibility rule of “first of the month following 30 days, or date of hire” would also comply. Please contact DDI with any questions regarding your contract and compliance.
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