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Plans are available for employers wanting to help employees lower and offset the cost of purchasing their own individual qualifying insurance coverage.

• Employer sets a fixed dollar amount to support the employee’s cost of individual insurance coverage.
• Employer establishes what is qualifying insurance coverage and covered through a selected third party administrator.
• Employee is free to choose what eligible coverage fits their 
• needs and must provide proof of payment.
• The third party administrator adjudicates the expense and provides reporting to employer with the reimbursement amount.
• Employers choose when the allowance is paid, and the payment is made after-tax directly to the employee.
• Plan is exempt from nondiscrimination testing.

I'm uniquely qualified to counsel you and your employees on the benefits available.  Contact me at wwwHeartlandHub.com

You can obtain health insurance coverage outside of Open Enrollment if you qualify for a Special Enrollment Period (SEP).  The Federal Government defines an SEP as "A time outside of the Open Enrollment period during which you and your family have a right to sign up for health coverage following certain life events that involve a change."

So the answer is a big fat no unless  you qualify for an SEP.  It's that simple. Or is it? The events listed below qualify as an SEP.  However, enrollment must take place for yourself and any eligible dependents within 60 days  if any of the following events below occur.   

Sounds confusing doesn't it?  You bet it is! An SEP is not your only option of obtaining coverage.  Another option is a short-term policy until Open Enrollment resumes November 15, 2014.  With all this confusion, it's a wonder most individuals haven't a clue where to turn. That takes the "care" right out of healthcare, doesn't it? However, an agent  trained to counsel both on and off the marketplace will be able to assist you.  It is extremely important to ask your agent if he/she is a Federally Facilitated Marketplace agent.  It's also helpful if he/she represents all major carries in your region! 

So, here is that list of SEP qualifications:

• Loss of group coverage because of termination of employment (except for 
gross misconduct) or reduction in hours.
• Loss of group coverage because of the death of the enrollee.
• Loss of group coverage because of a divorce or legal separation.
• Your dependent loses group coverage because 
of loss of eligibility as a dependent child.
• Loss of group coverage because the group enrollee’s initial enrollment for Medicare.
• Loss of minimum essential coverage (failure to pay premium or a rescission of coverage allowed under federal law does not qualify as a loss of minimum essential coverage).
• Newly acquired dependents through marriage, birth, adoption, or placement for adoption.
• If you become a citizen, national or lawfully present individual in the U.S.
• If you are qualified, but experience an error in enrollment.
• If you are enrolled in another Qualified Health Plan and you successfully demonstrate to the Exchange that your Qualified Health Plan has substantially violated a material provision of its contract.
• If you are newly eligible or lose eligibility for advance payment of the premium tax credit, or you experience a change in eligibility for cost sharing reductions.
• If you become eligible for new Qualified Health Plans offered through the Exchange because of a permanent move.

This law is constantly shifting. Stay up to date with a broker who understands the law!

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The Affordable Care Act (ACA) is complex.  With its complexities also come some surprising ways to play differently.  The numbers do not lie and I'll show you why.

In the process of offering group health insurance, an employer is generally required to participate 50% toward an eligible employee’s group health premium.  Because the employer is in essence ‘subsidizing’ the policy already, this generally means that NO subsidy is available from the federal government if an employee chooses to purchase an individual policy through the Health Insurance Marketplace.  The logic is this prevents a family from ‘double dipping’ their subsidies.

Try as the government might in shutting down Defined Contribution strategies such as the Section 105 HRA’s and Section 125 FSA’s, there are still clever and legal means for the employer to attract, retain and keep healthy their quality employees.

Here’s a case in point:

Let's consider an employee family of four with an income of $50,000 a year.

For the employee to insure his entire family, he can either:

• Insure the family through the employer for $9,384 after 50% eligible employee contribution.
• Get insurance from the company for himself at a cost of $1,560 after the employer contribution and then insure the rest of the family on their own Silver Plan for $7,800.  Total cost of $9,360 to insure the entire family.  No government subsidies are here because the family is not eligible because the employer had "affordable" insurance for the employee.

But the employee and his family could have saved thousands of dollars per year if the employer did not offer group insurance.

The reason is that with the absence of group health insurance, the entire family would qualify for a Federal Subsidy.

The total cost to the family after subsidies would be only  $3,360 a year, a saving of  $6,000 a year for the family.

A difference of $6,000 a year is huge for a household with $50,000/year income, this is not a minor factor! 

Numbers have been calculated through CoOportunity Health website.  Click HERE to find out how much you can save or visit my Individual & Family Insurance page for more links.

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