Islanders Insurance

Employer Sponsored Group Medical Plans:

Beginning October 1, 2010 employer sponsored group medical plans were available for groups of 1.  This allows that sole proprietors without employees, small corporations with just the owner active in the business, etc. will be eligible for this coverage.  This has become available in response to the “health care reform” initiatives.  To qualify, 75% of your earned income must be derived from that business pursuit as well as the employee must work a minimum of 30 hours per week.

Stop by our office to discuss.  The primary benefit of employer sponsored plans is broader coverage than the individual market place plus there is no health underwriting/screening.

Reform Timeline:

2011 – Dependent coverage to 26, No lifetime dollar limits, Restricted annual dollar limits to 2014, No pre-existing condition limitations for enrollees up to 19 (during open enrollment periods only), No HSA reimbursement for non-prescribed drugs, Increased penalties for non-qualified HSA distributions, Income-based Medicare Part D premiums, Insurers subject to medical loss ratio rules.

2012 – Employers to distribute uniform summary of benefits and coverage to participants, Employers to provide 60-day advance notice of material modifications for mid-year changes, Form W-2 reporting for health coverage (track in 2012 for W-2 form provided early in 2013, Coverage for additional women’s preventative care services bgins (plan years on or after August 1, 2012).

2013 – Employers notify employees about exchanges, Medical device manufacturer’s fees start, Higher medicare payroll tax on wages exceeding $200,000 individual/$250,000 couples, Change in medicare retiree drug subsidy tax treatment takes effect, Exchanges initial open enrollment period to begin, Auto enrollment likely to begin in 2014.

2014 – Health insurance exchanges, Individual coverage mandate, Financial assistance for exchange coverage of lower income individuals, Medicaid expansion, HIPAA wellness limit, Employer shared responsibility, Additional reporting and disclosure, Dependent coverage to age 26 for any covered employee’s child, No annual dollar limits, No pre-existing condition limits, No waiting period over 90 days, Health insurance industry fees begin.