There are two main pieces of communication that employers must share with their employees under the Affordable Care Act (ACA). The qualifications, requirements and timelines are listed below for each. But don’t worry; ISIhr will take care of these requirements for all applicable clients and employees. ISIhr is your ACA compliance expert.
Health Insurance Marketplace (Exchange) Notifications
The ACA requires Insurance Marketplaces, (formerly referred to as Exchanges) to operate in each state by January 1, 2014. These Marketplaces provide an additional option for consumers and employers to purchase insurance; the Marketplace is an alternative to purchasing private insurance, not a replacement. Applicable employers are required to provide a written notice to all employees about their respective state’s Marketplace.
What Must the Marketplace Notice Contain?
The notice will inform employees about:
- The availability of the Marketplace
- The possibility that an employee may be eligible for a premium tax credit through the Marketplace
- The impact of enrolling in the Marketplace on employer contributions and related tax benefits
The Department of Labor has issued model notices for both employers who do and those who do not offer a health plan to their employees.
- Notice for employers who offer health insurance
- Notice for employers who do not offer health insurance
Who Distributes the Notice, Who Receives it, and When?
Only employers subject to the Fair Labor Standards Act (FLSA), or otherwise identified must issue this notice. And again, ISIhr will issue this notice to all our applicable clients’ employees, both part-time and full-time, by October 1st, 2013.
Summary of Benefits and Coverage (SBC)
The SBC Regulations require group health plans and health insurers to provide each participant or enrollee with a written summary that accurately describes the plan’s benefits and coverage and that complies with the detailed requirements stated in the regulations.
There is guidance available that includes:
What Must the SBC Contain?
The SBC must describe the following:
- Principle plan design features, including cost sharing requirements such as deductibles, coinsurance, and copayments
- Exceptions, reductions and limitations on the coverage
- Examples that illustrate the benefits that would be provided in common scenarios
- Contact information for obtaining a list of network providers or information on prescription drug coverage
- Uniform definitions of standard insurance and medical terms, along with a web address pointing to a complete “uniform glossary” of key terms
Who Distributes the SBC, Who Receives it, and When?
ISIhr and the health insurance carriers we work with distribute the SBCs to all employees and their beneficiaries who participate in the medical plans. The SBC must be distributed with initial enrollment materials for a covered plan, and must be re-issued annually. If any participant or beneficiary requests a copy of the SBC outside of the enrollment period, it must be provided within 7 business days. If benefit options change significantly at any time other than in connection with coverage renewal (a ‘mid-year’ change), ISIhr will notify all plan participants at least 60 days prior to when the change takes affect.
This provision went into affect September 23, 2012, and applies to all open enrollment periods after that date.