PART A: General Information
When key parts of the health care law took effect in 2014, there became a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic information about the new Marketplace and employment-based health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers “one-stop shopping” to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October for coverage starting as early as January 1 of the following year.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn’t meet certain standards. The savings on your premium that you’re eligible for depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer’s health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the “minimum-value standard” set by the Affordable Care Act, you may be eligible for a tax credit.1
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution—as well as your employee contribution to employer-offered coverage—is often excluded from income for federal and state income-tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan description or contact ASR Health Benefits at 800.968.2449.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the Marketplace and its cost. Please visit HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.
PART B: Information About Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your employer. If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to correspond to the Marketplace application.
Here is some basic information about health coverage offered by this employer:
- As your employer, we offer a health plan to: Some employees.
Eligible employees are:
Individuals working in full-time employment for at least 40 hours or more per week or part-time employment for at least 20 hours or more per week. Such individuals must complete any required waiting period for plan coverage and must submit any required application for health plan coverage on a form that is acceptable to the employer.
- With respect to dependents: We do offer coverage.
Eligible dependents are:
- The employee’s legal spouse. However, working spouses with other available employer- based coverage are generally not eligible to enroll for coverage under the plan (an exception based on the spouse’s share of the premium cost may apply).
- The employee’s domestic partner (some restrictions apply). However, working domestic partners with other available employer-based coverage are generally not eligible to enroll for coverage under the plan (an exception based on the domestic partner’s share of the premium cost may apply).
- The employee’s or enrolled domestic partner’s natural child, stepchild, legally adopted child, or a child placed with the employee or domestic partner for adoption (age limits apply).
- A child who has been placed under the legal guardianship of the employee or enrolled domestic partner and is considered a “dependent” of the employee or domestic partner for tax exemption purposes under Section 152 of the Internal Revenue Code of 1986, as amended (age limits apply).
- A child for whom the employee or enrolled domestic partner is obligated to provide medical care coverage under an order or judgment of a court of competent jurisdiction and could be considered a “dependent” of the employee for tax exemption purposes under Section 152 of the Internal Revenue Code of 1986, as amended (age limits apply).
- A child for whom the employee or enrolled domestic partner is obligated to provide medical coverage under a Qualified Medical Child Support Order (age limits apply).
X If checked, this coverage meets the minimum-value standard, and the cost of this coverage to you is intended to be affordable, based on employee wages.
Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed midyear, or if you have other income losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the Marketplace, HealthCare.gov will guide you through the process. Here’s the employer information you’ll enter when you visit HealthCare.gov to find out if you can get a tax credit to lower your monthly premiums.
The information below corresponds to the Marketplace Employer Coverage Tool. Completing this section is optional for employers, but will help ensure employees understand their coverage choices.
If the plan year will end soon and you know that the health plans offered will change, go to question 16. If you don’t know, STOP and return form to employee.
1 An employer-sponsored health plan meets the “minimum-value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.
2 An employer-sponsored health plan meets the “minimum-value standard” if the plan’s share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs (Section 36B(c)(2)(C)(ii) of the Internal Revenue Code of 1986).