What Large Businesses Need to Know
Health care reform changes
- Dependents up to age 26 can stay on their parents’ family health plan if that plan offers dependent coverage.
Certain preventive benefits are available at no additional cost to members, including:
- Blood pressure screenings
- Breast-feeding support and counseling
- Cholesterol screenings
- Flu shots
- HIV screening and counseling
- Well-woman exams
Starting October 1, 2013, the state will launch the Hawai‘i Health Connector, an online health insurance marketplace. Employers can continue to get employee health plans directly from HMSA. The state will decide later if businesses with more than 100 employees can use the marketplace starting in 2017.
Only small businesses and people who have individual health plans can use the marketplace. The state's definition of a small business in Hawaii is:
- 1 to 50 full-time employees for 2014 and 2015.
- 1 to 100 full-time employees starting in 2016.
Part-time employees who don’t have coverage
Starting in 2014, people who don’t have health insurance could pay a fine to the federal government. Part-time employees who don’t have coverage through their job can buy a health plan directly from HMSA or in the marketplace. Depending on their income, they could be eligible for financial help in the marketplace to pay for health insurance.
Essential Health Benefits
If large businesses offer any essential health benefits (EHBs), those benefits’ out-of-pocket limits are $6,350 for individuals and $12,700 for a family in 2014. EHBs are:
- Prescription drugs
- Ambulance service
- Emergency care
- Laboratory services
- Maternity and newborn care
- Mental health and substance use services
- Pediatric oral and vision services
- Rehabilitation and habilitative services
- Services for preventive care, wellness, and chronic disease management
Only health plans for small businesses with up to 50 full-time employees and people who buy individual health plan coverage on their own are required to include EHBs.
Hawaii’s Prepaid Health Care Act
Hawaii businesses must still comply with the state’s Prepaid Health Care Act. This 1974 law requires employers to provide health insurance for employees who work 20 hours or more a week for four weeks in a row (with some exceptions). Employers must contribute at least half of the employee’s premiums for single coverage. The employee contributes the rest, but no more than 1.5 percent of their wages.
New fees and taxes
To pay for health care reform changes, the federal government will impose new fees and taxes on health plans nationwide, including HMSA. This will increase premiums. We know cost increases are a hardship on businesses. We’re doing all we can to ease that burden by helping improve the care your employees receive, which will help contain costs.
Do you have to provide health care coverage to your employees’ dependents? It depends on the type of plan you offer.
A status plan: Hawaii’s Prepaid Health Care Act doesn’t require you to offer dependent coverage. However, federal health care reform requires you to offer dependent coverage starting in 2015. Until then, your employees’ dependents can contact us directly for coverage. They can also buy an HMSA plan on the Hawai‘i Health Connector, the state’s online health insurance marketplace. Depending on their income, they could be eligible for financial help to pay for health insurance if they buy it on the Hawai‘i Health Connector.
If you offer employee family coverage, dependents up to age 26 could get coverage under the family plan.
B status plan: Hawaii’s Prepaid Health Care Act requires you to provide coverage to your employees’ dependents and pay at least half of that coverage.
To-do Checklist for Employers
Health care reform requires you to:
- Report the value of your employees’ benefits on their annual W-2 form beginning with the 2012 forms. Some employers are exempt from this requirement for now, including employers who file less than 250 W-2s, multiemployer plans, health retirement account plans, and self-insured plans not subject to COBRA rules.
- Starting in 2014, report your employees’ minimum essential coverage annually to the Internal Revenue Service. Large employers with at least 50 full-time equivalent employees must file additional information about fulfilling their responsibilities.
This information is based on HMSA’s review of the Affordable Care Act (ACA). This overview is intended for educational purposes only and should not be used as tax, legal, or compliance advice.