What Large Business Employees Need to Know
If you get coverage through your employer
If you work full time at a large business with more than 50 full-time employees and get health insurance from your employer, chances are health care reform won’t affect you too much right now. The good news is there’s nothing you need to do. You can continue getting health insurance from your employer.
If you don’t have coverage, there are things you need to know.
Health plan benefits
Health care reform doesn’t require health plans for large businesses to offer essential health benefits (EHBs). But if they do, those EHBs won’t cost you more than $6,350 a year (for individuals) or more than $12,700 a year (for families). The 10 EHBs are:
- Ambulance service
- Emergency care
- Laboratory services
- Maternity and newborn care
- Mental health and substance use services
- Pediatric oral and vision services
- Prescription drugs
- Rehabilitation and habilitative services
- Services for preventive care, wellness, and chronic disease management
Health care reform only requires EHBs in health plans for people who get insurance on their own through an individual plan or through a small business employer starting in 2014.
Health care reform rewards you for taking care of your health. And HMSA is here to help keep you on track. Your employer can offer you incentives of up to 30 percent of the cost of coverage for meeting certain health goals or for participating in wellness programs, and up to 50 percent for participating in stop-smoking programs.
For example, you could receive incentives for participating in HMSA Well-Being Connection’s Healthways Well-Being Assessment, health education workshops, or stop-smoking programs. Check with your employer for details.
Healthways Well-Being Assessment is a trademark of Healthways, Inc. All rights reserved.
If you don’t get coverage from your employer
If you work part time (less than 20 hours a week) and don’t have insurance, you’ll need to get it. The health care reform law says almost all Americans need health insurance by 2014. If you don’t buy coverage, you may have to pay a fine to the federal government. Because of health care reform, you won’t be denied coverage, even if you were denied before because of a serious health condition.
How to get health coverage
If you don’t have coverage, don’t worry. We’ll help you choose an HMSA health plan that’s right for you.
Your employer can offer you incentives of up to 30 percent of the cost of coverage for meeting certain health goals or for participating in wellness programs, and up to 50 percent for participating in stop-smoking programs.
- Contact us directly, or
- Buy an HMSA plan in the Hawai‘i Health Connector, an online health insurance marketplace, starting October 1. Depending on your income, you could get financial help from the government to pay for health insurance in the Connector. Only small businesses with up to 50 employees and people who get health insurance on their own through an individual health plan can use the Connector starting in October. The state will decide later if large businesses with more than 100 employees can use the Connector starting in 2017.
Do you offer your employees a B status plan under Hawaii’s Prepaid Health Care Act? If you do, state law requires you to provide coverage to your employees’ dependents and pay at least half of that coverage. If you don't offer a B status plan, you’re not required to offer dependent coverage.
They can still get coverage by contacting us. We’ll help them choose a plan. They can also buy an HMSA plan in 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 in the Connector.
If you offer your employees family coverage, their dependents up to age 26 could get coverage under the family plan.
Remind your employees that health care reform requires almost everyone to get coverage by January 1, 2014, or pay a fine to the Internal Revenue Service. And no one will be turned down for coverage even if they have a serious health condition. So it’s important that everyone has coverage.
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.