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Pathway Health Insurance Experts, Inc. | Copyright 2017
The Patient Protection and Affordable Care Act (PPACA) is a new law intended to ensure that everyone in America has access to affordable quality healthcare coverage. It requires that everyone purchase qualified coverage or pay a tax penalty. As a result, the insurance Marketplace Exchange is one of the options available to help you comply with this law.
As an option, smaller businesses will be able to shop for healthcare benefits for their employees in their state or federally run on-line Marketplace Exchange through the Small Business Health Options Program (SHOP). But, to be considered for a subsidy, you must have no more than 25 full-time equivalent employees, which is determined by a formula relating to number of part-time/full time employees.
Note: the only advantage to purchasing a plan thru SHOP (versus regular carrier channels) is for the subsidy since you will not have a large a selection of plans to choose from on the Marketplace Exchange.
What kind of employee benefit plans does SHOP offer?
SHOP will have four tiers of standardized health coverage (bronze, silver, gold and platinum). While the plans will be offered by various insurance companies, they are standardized. In other words, regardless of carrier, each plan contains the same essential benefits. These benefits range from nearly 90% of healthcare cost coverage down to 60.4% of coverage. For example, Platinum coverage will have the most expensive insurance premium but the least amount of out-of-pocket financial responsibility.
And, for a wider range of policy options (if 25 or less employees), or if you have more than 25 employees, you will still be able to purchase group health insurance through normal insurance carrier channels, like you do today and with... more plan options to choose from.
Also, for those employers with 50 or more employees, you will need further assistance to avoid costly penalties and to comply with all aspects of PPACA or Healthcare Reform. Please contact our office for more information.
We can help you determine your best options, both on & off the Marketplace Exchange.
A New Option for Affordable Healthcare Insurance
Grandfathered plans are exempt
from some rules of the law.
Through SHOP, Small businesses may purchase health benefits for their employees and may also qualify for a tax credit. However, going through the Exchange may not be your best option. We recommend you contact our office to explore a wide selection of group benefits options both on and off the Exchange.
How does this affect your business?
In 2015, if you have 100 or more full-time equivalent employees, and beginning in 2016 if you have more than 50 full-time equivalent employees, in which you do not offer health coverage, and at least one employee receives a premium tax credit/cost sharing subsidy in the Exchange, the penalty to the employer is $2,000 annually multiplied by the number of full-time equivalent employees (excluding the first 30 employees). The penalty is increased each year by the growth in insurance premiums.
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