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Access Health Special Enrollment Period – April 1 – 30, 2015

Access Health CT has announced a special enrollment period from April 1 through April 30, 2015.  This special enrollment period is intended to allow both individuals and families the opportunity to enroll in coverage in 2015.   This is a chance for people who did not have health coverage in 2104 and are now subject to a federal tax penalty to get the coverage they need.

Although, individuals who do not qualify for an exemption from Access Health and went without health care coverage in 2014 will have to pay a penalty.  The penalty is $95 per adult or 1 percent of their income, whichever is greater.  This amount is added in when they file their taxes this year. Additinally, the tax penalty will increase to $325 per adult or 2% of income for the 2015 calendar year.

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Affordable Care Act Enrollment And Plan Changes

We want to make sure everyone is aware of both the Affordable Care Act Enrollment And Plan Changes. Affordable Care Act plans (Also called Obama Care) are those purchased through the Connecticut Exchange via the Access Health Website.   A premium subsidy is only available to those who enroll through the Access health site.  Anthem , Connecticare and Healthy Partners are the three insurance companies available through the exchange.   People that enrolled outside of the exchange are not eligible for any type of premium help.  For those that did enroll via the exchange there rules regarding new enrollments and plan changes for existing members.

New Enrollments–

The general period for someone to register and enroll in a plan through the Access Health site ended on March 31, 2014. The site does not accept new enrollments for the remainder of the year.  A new enrollment window will open in October of 2014.  This will allow new members to apply for a January 1, 2015 start date.

Special Election Period–

Additionally, some people are allowed to enroll in a plan outside of the enrollment period.  This is true if they have a special election reason to do so.  Special elections reasons include, losing group health insurance or an individual health plan during the year, moving to a different state, a change in Medicaid or Husky status and losing COBRA benefits.

Plan Change for existing members–

In fact, Existing members are not allowed to make a plan change outside of the normal enrollment period. This is true, unless they qualify for one of the special election periods above.  A doctor who decides to no longer accept or participate with a Affordable Care Act plan during the year is not a valid reason to make a plan change.

Crowe and Associates is here to help you.  Call us if you have any questions about health insurance.  Please contact us either by phone at (203)796-5403 or by email at Edward@croweandassociates.com.

The Affordable Care Act brings major changes for large group employers in Connecticut. Employers that meet the definition of “Large Group” will need to meet thresholds for affordable care and adequate coverage.  Failure to meet the guidelines will result in penalties for the employer.  Employer groups will

In Connecticut, a large group is one with more than 50 eligible employees however, the definition of a small group will change some time between 2014 and 2016 as the number will be moved groups with 100 or more eligible employees. Full time, part time and seasonal employees count toward the total amount of employees eligible.   A portion of part time employees count toward the full time total.  This number can be determined by multiplying the average number of hours worked per month by the number of part time employees and then dividing by 120.  Example:  40 seasonal employees working an average of 90 hours a month divided by 120  40 x 90 divided by 120 = 30 extra full time employees.  Multiple companies with the same EIN number must also be combined.  If a there are multiple companies with under 50 employees under the same EIN, the employee count will be combined to determine groups size.

Seasonal employees’ hours are included when determining applicable large employer status.  An employer will not be a large group if it employed 50 or more full-time employees for no more than 120 days in he preceding calendar year and the employees causing it to reach or exceed the 50 full-time employee threshold were seasonal for more than 120 days.

Large groups will face a penalty if they have an inadequate or unaffordable offering.  The penalty will be $2,000 per employee per year, excluding the first 30 employees.    The penalty will only be triggered if an employee goes to the individual exchange and qualifies for a subsidy.   If an employee does not qualify for a subsidy on the exchange, the employer will not be subject to a penalty.  Spousal coverage is not a requirement for employers and the will not be penalized if a spouse is able to receive a premium tax credit on the exchange.

The changes listed above will not be applicable to groups with renewals in 2013.  For example, if a groups renews the group insurance plan in October of 2013, they will not be subject to the new guidelines until October 1, 2014 when the plan renews.  It is likely that many groups will look at a late year renewal as a means to buy more time and avoid the new guidelines for another 12 months.