Resources

November 2016 DeChristopher Newsletter

How does the Marketplace Open Enrollment impact employer-sponsored health plans?

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Most employers opt for annual open enrollment periods the month prior to when their health plan renews. With Marketplace open enrollment underway, we have been fielding questions on how to handle two different open enrollments.

Here are the top five most commonly asked questions related to National Open Enrollment and employer sponsored health plans:

Q1: If our company’s open enrollment has already passed, can an employee leave our plan to enroll in an individual Exchange plan?

A1: Yes, but you may want to remind the employee he/she may be better off remaining on the employer plan. If the employer sponsored health plan meets the ACA’s affordability and minimum value benchmarks, the employee will not qualify for a subsidy through the Exchange. Furthermore, the employee will lose any employer subsidy towards health premiums.

Q2: What are the deadlines for enrollment in the Exchange this year? A2: Each year, the Health and Human Services (HHS) releases Benefit and Payment Parameters (BPP) for the coming year. Here’s what to expect going forward:

  • November 1, 2016 to January 31, 2017 – for coverage effective in 2017
  • November 1, 2017 to January 31, 2018 – for coverage effective in 2018
  • November 1, 2018 to December 15, 2018 – for coverage effective in 2019

Q3: How can an employee find out more on Exchange coverage?

A3: Employees should visit www.healthcare.gov

Q4: What is the penalty for not having insurance in 2016?

A4: Refer to the separate resource being provided by TDG titled 2016 2017 Shared Responsibility Penalty. TDG clients can request a copy of this resource in Spanish.

Q5: I am an employer and I just received a notice from the Marketplace stating my employee has qualified for a subsidy. The notice states I may be subject to an employer penalty.

A5: If you don’t agree with the notice, you can file an appeal with the Marketplace. Employers have 90 days from the date stated on the notice from the Marketplace to file an appeal.

Work with your broker advisor for guidance on how to file a successful appeal. For more information on how to file an appeal, visit: https://www.healthcare.gov/marketplaceappeals/employer-appeals/

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