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Health Coverage Guide by Small Business Majority

Details: So you’re thinking about buying health coverage for your business, but you’re not sure if it’s the right decision. Here you can find clear, independent information on whether group coverage is a realistic option.

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Part One: Getting Started | Health Coverage Guide by Small

Details: No question, health insurance—especially for businesses with 50 or fewer employees—can be confusing. Here in Part One: Getting Started, we offer a broad overview of the issues, rules, terminology and other information you should understand early on. Use this information to help you decide whether you’re ready to purchase health coverage

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Laws Related to Health Insurance | Health Coverage Guide

Details: Health insurance marketplaces: States must set up online marketplaces—also called health insurance exchanges—that will allow small businesses and individuals to pool their buying power and purchase health insurance. Tax credits: Small business healthcare tax credits are offered under the law to help offset the cost of insurance. These tax

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Tax Implications | Health Coverage Guide by Small Business

Details: Also, the taxability of health insurance can be affected by how you set up the health plan. For example, with just a little paperwork on the employer’s part, a worker can contribute to the cost of health insurance on a pre-tax basis, lowering the amount of the worker’s taxable income and increasing the worker’s take-home pay.

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Group Coverage Basics | Health Coverage Guide by Small

Details: The general rule is that if an employer offers group health coverage to any full-time employees, the employer must offer coverage to all full-time employees. The employer has the option to offer coverage to part-time employees (defined as those working fewer than 30 hours per week).

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Employee Rules and Rights | Health Coverage Guide by Small

Details: Summary of State Tax Provisions Relating to Health Insurance; You are here: Home » Affordable Care Act » Additional Issues » Employee Rules and Rights. Employee Rules and Rights. Does an employee have to take an employer’s insurance if offered? What is the minimum coverage that everyone is required to carry? Is there a “bare-bones” option?

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Contribution Requirements | Health Coverage Guide by Small

Details: Most insurers and health plans require employers to cover at least half of the premium cost for covered employees. This requirement is meant to encourage more employees to join the plan, and prevent what’s known as “adverse selection” where only those prone to sickness are motivated to sign up, creating a much higher-risk group for the insurer.

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Eligible Employees and Dependents | Health Coverage Guide

Details: The general rule is that if an employer offers group health coverage to any full-time employees, the employer must offer coverage to all full-time employees (defined as those working 30 or more hours per week). The employer also has the option of offering coverage to part-time employees (defined as those working 20 to 29 hours per week).

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Select Trade/Professional Associations | Health Coverage

Details: Artists’ Health Insurance Resource Center. Sponsored by the Manhattan-based Actors’ Fund of America, this site describes health insurance coverage choices and regulations in every state and provides links to artists’ groups offering health insurance plans as well as other public and private health care resources.

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Employee Census Form - Health Coverage Guide by Small

Details: This form courtesy of HealthCoverageGuide.org Employee Census Data – SAMPLE Name of Firm: Date: Address: Coverage Codes: E = Employee Only

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Purchasing Without a Broker | Health Coverage Guide by

Details: Three types of websites provide information for consumers shopping for health insurance: broker sites, health plan sites and purchasing alliance sites. At broker sites, you have a variety of plans and insurers from which to choose. Not all transactions can be completed online.

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Calculating number of employees, average annual wages

Details: How is the number of employees determined for eligibility? Only employers with fewer than 25 FTEs are eligible for the tax credit; the full credit goes to employers with 10 or fewer full-time equivalent employees (FTEs).

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Regulatory Agencies | Health Coverage Guide by Small

Details: Likewise, the Health Maintenance Organization (HMO) Act provides that HMO’s or health service plans are regulated by the states. As a result of these two federal statutes, much of the task of health insurance regulation is left to the states. However, in 2010,

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Participation Requirements | Health Coverage Guide by

Details: Also, the Affordable Care Act requires health insurance exchanges—a new way of shopping for health insurance—be made available by 2014. The exchanges will allow small employers to select among a number of health plans for their employees. In the tool box, see “Health Insurance Exchanges” for more information.

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Cost-Sharing | Health Coverage Guide by Small Business

Details: A health insurance premium is the total amount that must be paid in advance in order obtain coverage for a particular level of services. Usually health insurance premiums are billed and paid on a monthly basis. Employers typically require employees to share the cost of the plan premium, usually through employee contributions right from their

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Enrollment Options and Procedures | Health Coverage Guide

Details: Employees may decline health insurance offered by employers. This is called a waiver of coverage. If an employee waives coverage for himself or herself, he or she may not cover dependents under the employer’s plan. Note that in 2014, employees who decline coverage considered affordable and adequate under the Patient Protection and Affordable

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Multi-State Plans, Compacts and Co-ops | Health Coverage

Details: The agency that will oversee multi-state plans is the Office of Personnel Management (OPM), which is the federal agency that runs the Federal Employee Health Benefits Program. This agency covers federal employees and their families nationwide. It also includes members of Congress and their families.

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Plan Characteristics and Types | Health Coverage Guide by

Details: Plans Offered Under the Health Insurance Exchanges. The Affordable Care Act requires that by 2014, every state establish a health insurance exchange—an online marketplace where small business owners can purchase health insurance. The exchange will allow small business owners to pool their buying power and drive down the cost of health insurance.

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Benefits of Providing Coverage | Health Coverage Guide by

Details: A June 2003 supplement of Medical Care Research and Review presents a compelling case that health insurance does lead to improved health and better access to care. The supplement includes four commentaries on the topic and features a review of 25 years of research literature.

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Affordable Care Act | Health Coverage Guide by Small

Details: The law addressed some of small business owners’ top problems when it comes to health insurance, including soaring healthcare costs and limited choice among health plans. Since 2010 the increase in small business healthcare costs has been at the lowest level in years, following regular double-digit increases prior to the law’s enactment.

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How Are Deductibles Applied? | Health Coverage Guide by

Details: How Are Deductibles Applied? This example shows how deductibles add up throughout the year. In the example, the deductible is $250 per individual, the plan’s co-insurance is 90%, and the employee’s co-insurance is 10%.

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California State Laws | Health Coverage Guide by Small

Details: California law does limit a health plan’s ability to charge low rates to groups whose members are all in good health and high rates to groups that include sicker or riskier individuals. The rating protections operate by basing premium calculations on a “standard” rate that every health plan develops according to certain allowable factors.

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Helpful Tools | Health Coverage Guide by Small Business

Details: Our Health Coverage Guide is also available in Spanish at www. guiadecoberturadesalud.org. Downloads. Employee Census Data Most insurers require new customers to complete a form like this before they quote premiums. Action Plan Checklist Use this to keep track of the essential tasks associated with shopping for and purchasing coverage.

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Eligibility and Enrollment | Health Coverage Guide by

Details: Learn about the rules that govern who can and must be enrolled in an employer-sponsored health insurance plan and get practical support in managing the enrollment process. Coverage Rules vs. Options Eligible Employees and Dependents

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Point-of-Service Plan (POS) | Health Coverage Guide by

Details: A point-of-service plan (POS) is a type of managed care plan that is a hybrid of HMO and PPO plans. Like an HMO, participants designate an in-network physician to be their primary care provider. But like a PPO, patients may go outside of the provider network for health care services.

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Real Questions, Real Answers | Health Coverage Guide by

Details: A health reimbursement arrangement (HRA) is an employer-funded spending account that can be used to pay qualified medical expenses. A HRA is 100% funded by the employer. Employers can no longer offer “stand-alone” HRAs for active employees. HRAs may only be integrated with group health coverage, not with individual policies.

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Shared Responsibility Requirements | Health Coverage Guide

Details: The health plan that I offer runs on a fiscal plan year that starts in 2014 and will run into 2015. Do I need to make sure my plan complies with these new requirements in 2014 when the next fiscal plan year starts? For an employer that as of December 27, 2013, already offered health coverage through a plan that operates on a fiscal year (a

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Group Coverage Costs | Health Coverage Guide by Small

Details: The cost of health coverage is the main drawback for many small employers who want to provide healthcare for employees. Still, there are ways to keep the costs down. Below we look at typical costs of health insurance plans, as well as the paperwork and administration that come with the territory. Typical Plan Costs

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Health Maintenance Organizations (HMOs) | Health Coverage

Details: Health Maintenance Organizations (HMOs) Related Topics. Related Topics. Plan Characteristics and Types; Cost-Sharing; In a very general sense, HMOs offer predictable cost-sharing and administrative simplicity for patients. These features come with fairly restrictive rules about which providers patients may see. Participants are entitled to

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Step 3: Find a Broker | Health Coverage Guide by Small

Details: Professional health insurance brokers provide the expertise that can be very helpful in finding the best plans for your business and guiding you toward the right choices. These individuals are licensed experts who: Know the market. They can discern the best products from the merely adequate. Know the law.

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Health Savings Accounts (HSAs) | Health Coverage Guide by

Details: The savings account is controlled by the covered employee and is intended to pay small and routine health care expenses. Once the deductible amount is reached, additional health expenses are covered in accordance with the provisions of the health insurance policy. For example, an employee might then be responsible for 10% of the costs for care

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Group Coverage Options | Health Coverage Guide by Small

Details: Health Savings Accounts (HSAs) Federal legislation enacted in late 2003 authorized the creation of Health Savings Accounts (HSAs). These savings accounts are combined with a high-deductible health plan. Because high-deductible plans generally cost less than low-deductible plans, HSAs are a good option for employers who cannot afford a

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Reasons to Purchase Group Coverage | Health Coverage Guide

Details: Having health coverage encourages people to actively maintain their health and improves their access to services that may otherwise be unaffordable. See “Benefits of Providing Coverage” for research findings on how providing health insurance can benefit employers, workers and society in general. Manageable Costs and Financial Security

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Insured vs. Uninsured Costs Comparison | Health Coverage

Details: With Insurance: Without Insurance: Hospital charges: $6,500 (discounted rate for health plan) $10,500: Health plan pays: 100% (in-network hospital) 0%: Patient cost:

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Plan Contract and Implementation | Health Coverage Guide

Details: If so, they will need to know how to refuse coverage through your company’s health plan. Employee Paperwork. Employees typically need to complete an enrollment form, and may need to choose a primary care physician (PCP) from the provider directory (typically with HMO and POS plans). Some insurers are moving to online enrollment to minimize

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Employee Census | Health Coverage Guide by Small Business

Details: Insurers use an “employee census” to obtain specific information to estimate the health care costs your group is likely to incur. California law limits the types of information that the insurer can request and the ways that information can be used in determining your premium.

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Managed Care | Health Coverage Guide by Small Business

Details: The health plan goal is to take away financial incentives to prescribe too much care. Health plans may also impose rules aimed at managing the care that their members receive, such as requiring members to obtain prior authorization before elective hospitalizations or requiring referrals from primary care physicians before seeing certain

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Alternatives to Group Coverage | Health Coverage Guide by

Details: Some health care providers and insurance carriers offer discount programs instead of, or as a complement to, insurance coverage. For individuals who are uninsured, a discount program may help offset the costs of basic and specialty care that is obtained through a limited set of providers or facilities.

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Cost-Saving Strategies | Health Coverage Guide by Small

Details: Offer a health savings account (HSA) with a high-deductible plan. High-deductible plans are often significantly cheaper than standard plans. Employers can establish HSAs for employees, funded with pre-tax dollars from their paychecks, which then can be used to pay for medical expenses until the plan deductible is reached (often $2,500 or so).

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Plan Type Comparison | Health Coverage Guide by Small

Details: As you read about each type, just remember that today’s health coverage market often offers “blends” of these traditional types. * Monthly premiums represent the total cost for a single employee. If you share premium costs with the employee, your business costs will be less. Price ranges reflect California averages on July 1, 2011

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Evaluating the Plans | Health Coverage Guide by Small

Details: Health plans are complex. They’re often loaded with so many details that it can be very difficult to focus on the issues that are most important for you as a small business owner. Very generally speaking, the main considerations to worry about boil down to the plan’s benefits, cost and choice.

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Reference Guide | Health Coverage Guide by Small Business

Details: Part One and Part Two provide a step-by-step process for learning about health insurance for your business and guiding you through the purchasing process. Here we provide topic-specific information on a wide variety of insurance-related issues and links to other resources you might need.

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Keeping a Health Plan’s Grandfathered Status | Health

Details: All health plans – whether or not they are grandfathered plans – must provide certain benefits to their customers for plan years starting on or after Sept. 23, 2010 including: No lifetime limits on coverage for all plans; No rescissions of coverage when people get sick and have previously made an unintentional mistake on their application

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Public or Subsidized Health Insurance | Health Coverage

Details: The Healthy Families Program is a state and federally funded health insurance program for children with family incomes above the level eligible for no-cost Medi-Cal and below 250 percent of the federal income guidelines (in 2011, $46,332 for a family of three, according to the Department of Health Care Services).

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Step 5: Evaluate Your Options | Health Coverage Guide by

Details: Health insurance products are complicated, and getting more so. When shopping for plans, you’ll want to look carefully at coverage for the services your employees will use most, such as office visits and prescription drugs. Even though it’s used less frequently, coverage for hospitalization is also critical.

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Calculating the tax credit | Health Coverage Guide by

Details: An employer’s eligible premium contribution is capped at the average cost of health insurance for the small group market in the employer’s area. If an employer pays 80% of the premium, then the amount that counts is limited to the same portion—80% of the average cost of health insurance in their area. This provision is designed to avoid

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In-Network vs. Out-of-Network Costs Comparison | Health

Details: (the discounted rate for health plan) $14,000Plan does not recognize the $8,000 difference: Medical plan pays: 80% of discounted rate: $14,000 x 80% = $11,200: $14,000 x 60% = $8,400: Member pays: 20% of the discounted rate: $14,000 x 20% = $2,800: 40% of charges ($14,000) plus 100% of the amount the plan does not recognize ($8,000):

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Part Two: Getting Covered | Health Coverage Guide by Small

Details: In addition, the Patient Protection and Affordable Care Act introduced health insurance exchanges in 2014. The exchange provides an online marketplace allowing employers to pool their buying power and drive down the cost of coverage.

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Brokers | Health Coverage Guide by Small Business Majority

Details: Professional health insurance brokers provide the expertise that can be very helpful in finding the best plans for your business and guiding you toward the right choices. These individuals are licensed experts who: Know the market. They can discern the best products from the merely adequate. Know the law.

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Health Insurance Exchanges | Health Coverage Guide by

Details: The Department of Health and Human Services will define specific services that must be covered within these packages. This provision is designed to make sure everyone participating in the exchange has access to sufficient coverage. For more information on the exchanges, including further details about standardized plans, see “Plans Offered

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