MEDICAL COVERAGE BENEFITS
The Affordable Care Act (ACA) includes employer and individual shared responsibility requirements for health coverage.
Beginning in 2015, applicable large employers must offer affordable, minimum value health coverage to their full-time employees (and dependents), otherwise they may pay a penalty.
All annual costs to the employer are fixed and built into the cost of the premium and all risk is assumed by the insurance carrier.
- Fit for risk-averse groups
- Predictable monthly expenses
- Limit fiduciary responsibility
Health insurance plan that combines the cost savings and customization of self-funding with the financial safety and predictability of fully funded plans.
Employer sponsored healthcare that does not use traditional insurance carriers as a conduit for medical care, premiums are paid to the employer and used to pay medical claims. The employer pays for claims as they are incurred, administrative costs are fixed while other costs are variable, and all claims risk is assumed by the employer until stop loss is triggered. Fiduciary responsibilities are included — such as ACA notices and compliance with federal mandates. A good fit for those that have cash flow and reserve funds to allow for fluctuations, have administrative support to manage, and want to customize their plans.
Employers that sponsor group health plans and have employees who are Medicare-eligible may be interested in reimbursing their employees’ Medicare premiums. In general, when an employee is elibigle for Medicare due to age, an employer may reimburse his or her Medicare premiums only when:
The employer’s group health plan is a secondary payer to Medicare because the employer has fewer than 20 employees; AND
The reimbursement arrangement complies with the Affordable Care Act (ACA) because it satisfies certain design requirements (or covers fewer than two employees).
Employers may offer an individual coverage health reimbursement arrangement (HRA) to reimburse their eligible employees for insurance policies purchased in the individual market, or for Medicare premiums, as an alternative to traditional group health plan coverage, subject to certain conditions.
For more information, click here or on the image below.
Minimal Essential Coverage (MEC)
Is a health insurance policy that provides at least one of the Essential Health Benefits as defined by the Affordable Care Act (ACA).
The following types of plans meet the requirements of MEC:
- ACA Compliant employer-sponsored coverage
- Individual Marketplace coverage
- Medicare Part A
- Medicare Advantage Plus
- Most Medicaid
- CHIP, Children’s Health Insurance Program
- Certain VA coverage
- Most TRICARE types
- Peace Corps coverage for volunteers
- Refugee Medical Assistance
GAP Health Insurance
Supplemental medical product paired with an employer’s medical plan designed to provide benefits that cover certain out-of-pocket expenses as a result of a medical treatment.
Tax-advantaged medical savings account available to taxpayers who are enrolled in a high-deductible health plan.
Savings account that allows employees and/or employers to contribute pre-taxed dollars to be used toward healthcare or childcare.
* We do not offer every plan available in your area. Any information we provide is limited to the plans we do offer in your area. Please contact Medicare.gov or call 1-800-Medicare to get information on all of your options.
Did you know?
The true precursor to modern health insurance began in Texas in 1929. Justin Kimball created Blue Cross to allow teachers in Dallas to pay a hospital 50 cents a month and not be charged when, later, they went to that hospital to have children. This was actually pre-payment and not insurance, although some of them probably never had children.
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