Notice of Health Insurance Marketplace Coverage Options
The following notice provides information about the Health Insurance Marketplace, an online resource for individuals to find and compare private health insurance options. The Marketplace is available due to a key provision of the Affordable Care Act which requires that everyone have health insurance that meets certain minimum coverage and affordability requirements. Individuals who choose not to have qualifying health insurance coverage under the ACA will be required to pay a penalty.
In order to comply with the ACA, SAS is required to provide the following notice to our employees to help you understand health insurance options available through the Marketplace. As you read this notice, please keep the following information in mind:
- The availability of health insurance through the Marketplace does not affect eligibility for SAS’ health care benefits. If you and your eligible dependents are enrolled in SAS’ medical plan, you have health care coverage that meets the ACA minimal coverage standards and affordability requirements. Therefore, no action is required on your part.
- Because SAS’ health care coverage meets these standards, SAS full-time and part-time employees (and dependents) who are eligible to enroll under the SAS medical plan generally will not qualify for federal subsidies (tax credits or lower costs on premiums or out-of-pocket costs) offered in the Marketplace. If you believe you may qualify for a credit/subsidy based on your household income, you may go to the Marketplace website for more information.
- The Marketplace is primarily designed for individuals who cannot get ACA-qualifying health care coverage through their employer. If you are not eligible for SAS medical coverage or coverage through another source, you may qualify for federal subsidies offered in the Marketplace.
The following required notice provides more information about the Marketplace. If you have questions about the health care exchanges, please visit www.HealthCare.gov for more information. If you have questions about SAS benefits, contact the Benefits Department at 919-531-9090 or SAS_Benefits_Department@sas.com
New Health Insurance Marketplace Coverage Options and Your Health Coverage
When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance: the Health Insurance Marketplace. To assist you as you evaluate coverage options for you and your family, this notice provides some basic information about the new Marketplace and employment based health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.
Who can buy health coverage in the Marketplace?
Any individual may purchase medical coverage for themselves or their family in the Marketplace. Individuals who currently have health coverage through an employer or Medicare don’t need to do anything. Individuals who are uninsured or believe that their coverage is inadequate or unaffordable, may apply to the Health Insurance Marketplace to find out if they qualify for tax credits to help with the cost of coverage.
Can I save money on my health insurance premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on your household income.
Does employer health coverage affect eligibility for premium savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your employer that would cover you (and not any other members of your family) is more than 9.5% of your household income for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for a tax credit.
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for federal and state income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax basis.
What benefits will be covered in the Marketplace?
Health insurance sold in the Marketplace must cover “essential health benefits.” This includes: doctor’s office visits; emergency room services and hospitalization; pregnancy and newborn care; mental health and substance use disorder services; prescription drugs; rehabilitative services and devices; laboratory services; preventive services; chronic disease management; and children’s health services (including oral and vision care).
Which states have a marketplace and which don't?
States have three options: (1) set up their own exchange, (2) run their exchange in partnership with the federal government, or (3) let the government run their exchange for them.
Fifteen states and the District of Columbia will run their own Marketplace. They are: California, Colorado, Connecticut, Hawaii, Idaho, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, Oregon, Vermont and Washington.
Seven states are planning for a partnership exchange. They are: Arkansas, Delaware, Illinois, Iowa, Michigan, New Hampshire, and West Virginia.
The remaining states will use the federal government marketplace. They are: Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Jersey, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Wisconsin and Wyoming.
Types of Plans Available in the Marketplace:
Four tiers of coverage will be available through the Marketplace:
- Bronze Level - These plans must cover 60% of expected health care costs.
- Silver Level - These plans must cover 70% of expected health care costs.
- Gold Level - These plans must cover 80% of expected health care costs.
- Platinum Level - These plans must cover 90% of expected health care costs.
How Can I Get More Information?
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage and its cost. Please visit www.HealthCare.gov for more information, including an online application for health insurance coverage and contact information for a Health Insurance Marketplace in your area.