FAQ’s 1) What level of Medical care subsidy is FHDA offers to employees who meet ACA requirements?
A. The District supports single coverage for employee only at the BRONZE level less employee share of cost based on IRS guideline for 9.5 percent of an employee’s W-‐2 wages from the employer.
For example, if the monthly premium for single (bronze plan) is $600, and your W-‐2 reflects $50,000 for a household of two, $50,000 X 9.5% = $4,750/12 mo. = $395.83/Employee monthly share of cost. The District reimburses member: $600 -‐ <$395.83> = $204.17/Employer monthly share of cost. IMPORTANT: To enroll for health under the ACA provision sponsored by FHDA, you must waive all premium assistance for insurance purchased via Covered California.
2) How does the Affordable Care Act affect me?
A. If an employee who is not currently eligible for FHDA medical coverage works on average 30 or more hours per week during the measurement period (December 1, 2013 through November 30, 2014), FHDA will be required to offer medical coverage to be effective January 1, 2015 (based on current law). 3) I don’t have coverage now. What can I do?
A. If you do not have health insurance now, you may want to check into the new coverage available through the exchange for 2014, as described by Covered CA. Under current law, if you do not have health insurance in 2014, you will have to pay a penalty to the Federal government. For further assistance, please contact Covered California at 1-‐800-‐300-‐1506 or click this link: http://www.coveredca.com/contact/. 4) Health insurance companies participating under Covered CA for 2015 1) Anthem Blue Cross of CA 2) Blue Shield of CA 3) Chinese Community Health Plan 4) Health Net 5) Kaiser Permanente 6) L.A. Care Health Plan 7) Molina Healthcare 8) Sharp Health Plan 9) Valley Health Plan 10) Western Health Advantage
Coverage Tiers The Covered California health insurance marketplace offers four tiers of coverage options: platinum, gold, silver and bronze. These options are based on the percentage of full actuarial value of benefits the plan is designed to provide, and are as follows: platinum 90%, gold 80%, silver 70%, and bronze 60%. Coverage Designs Each plan offers a choice of Copay Plan or Coinsurance Plan. Covered CA Copay Plans are similar to HMO plans, while Coinsurance Plans are PPO plans. Rates Without Subsidies Individuals will be able to determine the amount they would pay based on family size, age and income for 2015. 5) What medical insurance plan options are available to me via Covered CA? A. To determine eligibility rules and access to different health insurance plan options, you must provide to CoveredCA.com the following: Home residence address including zip code Annual Household Income (projected amount for the year in which health coverage will be effective, i.e. 2015) Number of people are in your household Contact information such as phone and email address Gender Height Weight Date of Birth Declaration of the following status: • Pregnancy or Adoption • Use of Smoking or Non-‐Smoking • Health Conditions 6) Can an employee opt out of tracking if they have other medical coverage and don’t need FHDA’s medical benefits? A. No. FHDA will be required to report to the Federal government who is and is not a “full-‐time employee” as defined in the Affordable Care Act (working on average 30 or more hours per week). The fact that you do or do not want/need FHDA’s medical benefits has no bearing on this requirement.
7) How to seek monthly premium variance from the District for self-‐coverage? A. You must present to the District with the following evidence of coverage (for initial enrollment to validate your plan of selection and proof of payment (on a monthly basis) as you prepay for your monthly premium with post tax dollars. Note: District supports BRONZE Plan for SELF-‐coverage provided through Covered CA for medical enrollment only. You are responsible for all premium differential based on choice of plan selection and level of coverage. All required documentation must be submitted to the District Benefits Unit via pdf/email to
[email protected] or fax: 650-‐949-‐6299. Reimbursements are processed monthly on the last Thursday of the month, and checks go out by the first of the month. 8) Termination of Active Employment A. Monthly premium variance reimbursement of health premium will cease effective the last date of the month that your active employment is ended. Questions: For enrollment, contact Covered California at 1-‐800-‐300-‐1506 or www.coveredca.com. For ACA monthly premium reimbursement, send your monthly request with required documentation to the Benefits Unit via fax: 650-‐949-‐6299, or pdf/email:
[email protected].
