While some provisions of the Affordable Care Act (ACA) have been delayed another year, the Health Insurance Marketplace is still scheduled to go into effect in January 2014. Starting in October 2013, the Marketplace will allow individuals to look for and compare private health plans, get answers to questions about health coverage options, and enroll in a health plan.
The federal Affordable Care Act (also known as health care reform) requires that, starting in 2014, all individuals legally residing in the United States (with very few exceptions) must have health insurance coverage, and that coverage must meet certain minimum standards. Those individuals who choose to not have health insurance coverage will be required to pay a penalty, which will be assessed via their tax returns.
You may be eligible for health insurance coverage through LSU. Whether or not you are eligible for such coverage, all employers are required to provide the Notice of Health Insurance Marketplace to employees. The Health Insurance Marketplace (also known as the Exchange) is one way for individuals, especially those who are not eligible for employer-sponsored coverage, to purchase health insurance. Some individuals may be eligible for a premium subsidy or tax credit by purchasing through the Marketplace.
Receipt of this notice does not indicate that you are eligible for or covered by any health plan. Eligibility to participate in our group health plans and applicable enrollment continues to be based on an employee meeting the eligibility and participation requirements as set out by the Office of Group Benefits.
Therefore, if you currently are not able to participate in the plan because of not meeting the eligibility and participation requirements, receipt of this Notice does not change or affect those participation requirements.
Although the notice relates to coverage options available through a Health Insurance Marketplace (more commonly referred to as the “Exchange”), LSU has no information or expertise on those options. Therefore, you will need to consult with other resources mentioned below regarding any questions you may have about Exchange coverage options, programs like Medicare, Medicaid and CHIP, or any coverage other than our group health plans.
Where can I find a Summary of Benefits and Coverage (SBC) for health plans offered through LSU?
• A SBC for plans administered by Blue Cross Blue Shield (HMO, PPO and CDHP-HSA) can be accessed at http://www.bcbsla.com/State/Pages/ogbhome.aspx
• A SBC for the Medical Home HMO plan administered by Vantage can be accessed at http://www.vantagehealthplan.com/Reform/PlanDocuments
• A SBC for the LSU First Health Plan can be accessed at http://www.lsufirst.lsu.edu
Why Am I Receiving This Notice?
This notice provides you with instructions on how to access information about the Health Insurance Marketplace, which are health plans offered to you by either your state or the U.S. Department of Health and Human Services. LSU is required to send the enclosed notice to every employee to comply with rules under the federal Patient Protection and Affordable Care Act (ACA).
Can I get Health Insurance from the Marketplace?
While you may be able to get health insurance through the Marketplace, the health plans offered through LSU meet the standards required by the ACA. Because of that, you probably won’t be able to save money on your monthly premiums or out-of-pocket costs through a Marketplace plan. You can find out for sure at www.healthcare.gov. This website provides you with a calculator that allows you to enter in your specific information and lets you know what options/programs you and your family may qualify for. The calculator can be accessed at https://www.healthcare.gov/quick-answers/#step-1.
Can I save money with a Marketplace Plan?
The costs for the Marketplace plans have not been made public to date. Whether or not you will save money will depend on your household size and income. Because LSU’s health plan offerings meet the standards required by the ACA, you’re not eligible for subsidized coverage through the Marketplace. However, if the cost of the LSU plan that covers you (and not any other members of your family) is more than 9.5% of your household income for the year, you may be eligible for a tax credit. If you buy a policy from the exchange without meeting the 9.5% rule, you may have to repay any subsidies or credits received. As you are considering your options, be aware that because the LSU plans meet ACA requirements, you may not qualify for lower costs on your monthly premiums and out-of-pocket costs, even if your income would qualify you otherwise. Also keep in mind that the State currently pays a portion of your premiums. If you choose a Marketplace plan instead, the State will no longer make a contribution to your premiums.
Where can I get information regarding premium assistance under Medicaid and the Children’s Health Insurance Program (CHIP)?
This information can be accessed at http://www.dol.gov/ebsa/pdf/chipmodelnotice.pdf
What Do I Need to Do?
You don’t need to do anything, unless you’re interested in Marketplace coverage.
What If I’m Interested in Marketplace Coverage?
• Go to www.HealthCare.gov to review the plans available in your state.
• Keep the notice attached above because it has information you’ll need to enroll in Marketplace coverage.
What if I have further questions?
You can call 1-800-318-2596 (TTY: 1-855-889-4325) or visit www.HealthCare.gov
This website is run by the federal government. It offers a comparison tool, answers to frequently asked questions, and the opportunity to enroll in insurance though the exchanges.
The Kaiser Family Foundation site provides a calculator that estimates how a Marketplace plan could impact your family.