FAQs for Small Employers
The following questions and answers prepared by ORLA's healthcare expert, Garth Rouse, are intended to be used for general information about the Affordable Care Act (ACA). Before implementing any benefit changes please consult a professional specializing in
this field as this law is continuously changing and evolving.
If you are an employer with fewer than 50 FTE’s (small employer):
Q: Will I be required to offer health insurance coverage in the future?
A: No, the Affordable Care Act (ACA) does not require you to offer coverage. There will be penalties for employers who have 50 or more FTE’s (defined as “large employers”) and don't offer coverage starting in 2015, but under that number, employers are not subject to the penalties.
Q: If I am an operator that is not considered a large employer, should I even care about this legislation?
A: Yes, for reasons too numerous to mention here, but following are important:
Q: When will Oregon's exchange be enrolling people for coverage?
Beginning January 1, 2014 almost all citizens of the United States will be required to have health insurance coverage or pay a penalty. This is known as the “Individual Penalty” and includes you and your employees. Depending on your income, you may be eligible for tax credits to help pay for monthly premiums. For example, an individual earning up to $45,900 a year or a family of four earning up to $94,200 a year will get a tax credit to help cover the cost of their premiums. You may also be eligible for cost-sharing assistance to help pay for copays, deductibles, and other out-of-pocket costs. You will be able to find out if you are eligible for financial assistance by answering a series of questions on the Cover Oregon website beginning in October 2013.
To qualify for the subsidy, you must purchase coverage through Cover Oregon. The act requires all employers to comply with certain requirements. One requirement is that you provide a notice about Cover Oregon to your employees by October 1st this year and at the time of hiring for employees hired on or after that date (regardless of your employee count). Starting in 2014, employers meet the requirement if they provide written notice within 14 days of the employee's start date.
A: Cover Oregon will open enrollment beginning October 1, 2013 for coverage to begin January 1, 2014. You (the employer) are required to provide notification to your employees with information about these exchanges prior to the October 1, 2013 date.
Q: How much are the subsidies?
A: They range based on age, income, and number of people covered.
Q: What is the Individual Penalty for not being covered?
A: In 2014 it is the greater of $95 per person ($47.50 per child) up to a maximum of $285 or 1% of your adjusted gross pay. In 2015 the numbers go to $325 per person (maximum of $975) or 2% of adjusted gross pay. By 2016 the amounts are $695 per person (max of $2,085) or 2.5% of adjusted gross pay.
Q: If I offer my employees group insurance coverage at work, are they eligible for the government subsidy?
A: Not if the plan you offer meets “Minimum Essential Coverage.”
Q: If I am offering coverage to my employees now, will I have to change plans?
A: No. You are not required to change plans, but you may be subject to (individual) penalties if your plan does not meet “Minimum Essential Coverage.” You will want to check with your insurance agent or insurance company to see if your plan meets this definition.
Q: What is the difference between buying an insurance plan through Cover Oregon and buying a plan directly from an insurance company?
A: Through Cover Oregon, individuals will be able to check their eligibility and apply for public health care programs, such as Medicaid. They will also be able to apply for financial assistance (tax credits and cost-sharing assistance) to help make private health coverage more affordable. Small employers that offer coverage through Cover Oregon will be able to provide their employees with more plan choices. And, only through Cover Oregon, small employers will be able to apply for the small business tax credit. Cover Oregon will make it easy to purchase quality health insurance at the most affordable price. Plans will be rated based on customer service and quality, and it will be easy to compare features and prices of plans offered by competing health insurance companies.
Q: I have other questions about the healthcare law and providing insurance to my employees, how do I get those answered?
A: You can submit a healthcare question via email or call ORLA at 800.462.0619. Visit Cover Oregon for health insurance questions or talk with your advisors.