Essential Health Benefits in the Antelope Valley

June 19, 2019

If your clients are business owners or in leadership roles, they’re probably wondering what they need to do. But don’t worry. We’ll walk you both through the changes in this article, part of our ongoing series on health care reform. Most of the headlines link to more information. You can also check out our timeline and FAQs on our health care reform website.

Starting in 2013, your clients should:

Report health plan values on W-2s

Business owners must report the value of their health plans on W-2 s. This was optional in 2012. Businesses need to report the value if they had 250 W-2s in 2013. If they had less than 50 W-2s, they have until 2014 to show the value. Even though it’s reported, the value is not taxed.

Tell workers about exchanges

Employers need to tell workers about the health insurance marketplaces (also known as exchanges). It’s one more way for workers to compare and buy health plans. Employers also need to tell workers how to get help with costs through subsidies. This rule is expected to go into effect in the summer or fall of 2013.

To prepare for 2014, your clients should:

Know if the business is a “small group” or “large group”

Today “small group” includes businesses with two to 50 workers. But with health care reform, a business will be considered “small group” if it has one to 100 workers. States may put off this change until 2016.

Update the company rules on waiting periods

Many new workers have a “waiting period” before benefits kick in. With health care reform, this waiting period can’t be longer than 90 days.

Offer coverage if they have more than 50 workers

In 2014, employers with more than 50 workers may be penalized if they don’t offer workers health carecoverage. They also may be penalized if any workers get government aid to lower the cost of their coverage through health insurance marketplaces (also called exchanges). The U.S. Chamber of Commerce has developed this penalty calculator to help determine whether companies must offer coverage and what the penalty might be based on the number of full-time employees.

Review and update benefits

Small group plans must cover an “essential health benefits” package starting in 2014.This rule applies to nongrandfathered plans sold inside and outside the health insurance exchanges. Large groups don’t need to offer essential health benefits but if they do, they can’t have an annual or lifetime dollar limit on those benefits.

Offer workers health coverage, even with a health issue

Health plans and businesses can’t refuse to cover workers because they have (or had) cancer, asthma, high blood pressure, arthritis or some other health problem.

This article applies to:•California

•Small Group, Large Group, and Individual (under 65)

**Ever need Insurance in Lancaster or Palmdale please call 661.726.1337