The Patient Protection and Affordable Care Act (PPACA) made sweeping changes to the insurance industry landscape.

“Business owners and HR professionals will need to be in compliance with the rules and regulations set forth by PPACA. And, individuals will have increased questions about the health insurance marketplaces, individual mandate and underwriting,” says Michael Galardini, sales executive at JRG Advisors, the management arm of ChamberChoice. “As a result, employee benefits professionals will be asked to help guide both businesses and individuals through the changing marketplace.”

Smart Business spoke with Galardini about employee benefits trends small and large employers can expect to see in 2014.

What changes will small employers face?

Small employers, categorized as any employer with fewer than 50 full-time employees, will see a drastic change in 2014 in the way health insurance rates are developed for each group. Before PPACA, insurance companies could develop rates based on gender, industry, group size, health status and medical history. Post PPACA, small group rates are no longer rated, and small group insurers will only be able to vary premiums by family size, geography, tobacco use and age.

With the changes in underwriting, there also will be changes to the plan designs being offered to small employers. The establishment of Health Insurance Marketplaces and their product offerings has created a change in product design. The plan designs being offered are 90 percent, 80 percent, 70 percent and 60 percent coinsurance plans, which share the financial responsibility with the employees. These plans create larger out-of-pocket costs that most individuals are not accustomed to paying. Particularly in Western Pennsylvania, the population as a whole is most familiar with rich plan designs with no coinsurance, low deductibles and copays.

Explaining these product differences with a one-on-one approach is important to help each individual understand how his or her plan works. The business owner and/or HR professional as well as an outside advisor need to engage each employee to ensure everyone properly understands the available solutions.

What can large employers expect to see?

Large employers or those with 50 or more full-time employees also will notice significant changes in the future.

Beginning in 2015, large employers will be required to offer coverage to employees working 30 hours or more a week. There also are requirements to the type of plan that must be offered to these individuals as well as a contribution limit. The plan design must be at least a 60 percent coinsurance plan, and the employee’s contribution cannot be more than 9.5 percent of his or her household income. There are two fines an employer could receive:

  • Penalty A: Employers that do not offer coverage to full-time employees (working 30 hours or more a week) will be subject to a penalty equal to $2,000 per full-time employee minus the first 30.
  • Penalty B: Employers that offer coverage that is not of minimum value or not affordable (or both) will be subject to a penalty equal to $3,000 for every employee who receives subsidized coverage through the marketplace.

Large employers should be talking to their advisor in 2014 to determine if they will meet these guidelines.

Are there any other upcoming changes?

Lastly, and probably most significantly, is the individual mandate. Individuals are required by March 31, 2014, to have a qualified health insurance plan or pay a fine. The fine for 2014 is the greater of $95 or 1 percent of income. Individuals can purchase insurance through the marketplace or directly from an insurance company. The marketplace could offer a subsidy based on an individual’s income to help pay for premiums.

A qualified advisor will be well versed on the products available to individuals and business owners. The changes due to PPACA provide more options to purchase health insurance products, but the marketplace for health insurance is ever changing. Business owners and HR professionals need to be aware of when these changes occur and how they can impact their business.

Michael Galardini is a sales executive at JRG Advisors, the management arm of ChamberChoice. Reach him at (412) 456-7235 or michael.galardini@jrgadvisors.net.

Insights Employee Benefits is brought to you by ChamberChoice

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