Florida Marketplace: Understanding the Health Care Law

It’s important to keep on top of the changes in the marketplace for employee benefits and administration.  More than ever, we have spent a sizable amount of time researching, reviewing, and learning the available options to small and medium sized employer groups.

Florida Marketplace for Insurance

The term marketplace is intended to represent the availability of multiple health insurance plans.  There are individual and group marketplaces.  There are private marketplaces and there are public (some states or federally maintained) marketplaces.  In our home state of Florida, the public marketplace is being facilitated via the website operated by the U.S. Centers for Medicare and Medicaid Services.  Plans can be purchased on the site or from an agent through a variety of carriers.  Premium assistance may be available to some individuals.

On the group side, small businesses have been promised the development of a public Small Business Health Options Program (SHOP) marketplace.  Right now, the public SHOP marketplace does not facilitate enrollment.  Rather, it functions as a self-service quote engine and refers the user to an agent or to the carrier directly.  Clearly it is most logical to use an independent agent who can provide insight to the plans offered, carriers, network coverage, employer premium contribution strategy, communication compliance, and on going service as needed.

We believe there has been an increasing trend in the defined contribution style of plan.  This is where the employer sets a specific dollar value to a host of employee benefit packages made available to eligible employees.

Do all employers have to offer benefits?  The answer is NO employer HAS to offer benefits, although there are compelling reasons why many do.  Healthcare reform, which we prefer to call it, requires employers with an average staff size of more than 50 full-time employees offer coverage OR they can be subject to a penalty.  The U.S. Treasury Department, which includes the Internal Revenue Service, has provided updated guidance to the provisions impacting what has become known as “pay or play”.  Very simply stated, the employer responsibility provisions require employers offer coverage or pay an assessable payment, which we call a tax.

In very general terms, employers with 100 or more full-time employees will have to offer affordable coverage to 70% of their employees during 2015.  In 2016, employers of more than 50 full-time employees, but less than 100 will have to offer employees affordable coverage.  If they do not, they will be assessed the tax.

Private marketplace options for groups exist today, and can be customized to the employer’s needs.  A budget and blueprint can be established, with on-line enrollment, termination and reconciliation of payments made in one interface.  Multiple plans, including optional coverage such as dental, vision, disability, life, and accident coverage can all be managed with minimal paper processing.

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