A.k.a. No denial based on pre-existing conditions. Insurers must issue health coverage to small groups or individuals without discriminating because of a pre-existing condition.
Insurers cannot refuse to renew health plans due to the amount of services used by an individual during the previous year or as a result of the health status of an individual.
The Affordable Care Act requires that only the following five factors influence premium costs:
For informational purposes only, employers that file 250 or more W-2s per year are required to report the value of employer-sponsored health coverage on an employee's W-2 form. The form should include the amount paid by both the employer and employee.
Box 12 on the W-2 form is where employers must indicate whether or not certain health coverages were offered. A few of the targeted health coverages are:
Effective Jan. 1, 2015:
Beginning on the first day of their 2015 plan year, "large" employers with 100+ full-time* or full-time equivalent (FTE) employees must provide affordable** minimum essential health coverage to at least 70% of full-time employees.
Employers who do not comply with these requirements may face fines of:
With Marketplace Open Enrollment here, it is important to consider the health care plan options available to small business owners and their employees. Consider the following three options:
Shopping for health insurance through the federal marketplace for the 2015 calendar year begins on November 15, 2014 and ends on February 15, 2015. Whether you are buying for yourself, your family or your employees, here are a few things you should know.
Open Enrollment for Individuals
Find more marketplace tips and troubleshooting on Healthcare.gov.
It's flu season - have you gotten your flu shot yet? This vaccine and several others are free to health plan enrollees under new Affordable Care Act regulations for preventive services.
The Affordable Care Act designated certain preventive services, including vaccinations, for adults and children available at no cost to the employee. Any deductible or copay designated on the medical plan must be waived when a covered preventive service is performed and billed as preventive care.
Some preventive services are subject to age and frequency limitations, so it is important to check with your health carrier in advance to determine eligibility.
Free preventive services available to adults include:
FICA – Federal Insurance Contributions Act
Includes: Social Security and Medicare taxes. These federal taxes are meant to provide benefits for retirees, disabled, or surviving children of workers who have died.
Half of the tax is paid by employees, and the other half is paid by the employers.
Seasonal employees who will work fewer than 120 days in a calendar year - are not included in the calculation of Full Time Equivalent (FTE) employees. The number of FTEs determines whether an employer is considered a "large" (50+ FTEs) or "small" (<50 FTEs) employer.
Cafeteria plans allow employees to receive certain benefits on a pre-tax basis, in accordance with IRS Section 125. Qualified benefits for cafeteria plans include:
The IRS issued new regulations for cafeteria plans on September 18, 2014.
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