Nebraska's Department of Insurance recently released preliminary premium rates for all health plans that were submitted for use for plans under the federal Affordable Care Act in Nebraska for 2014. Individual premium rates will be different based on geography, tobacco use, and age. Some of the plans will be offered on the individual Marketplace exchange and other will be offered outside of the exchange. Nebraska Health Rate Comparision 8-21-2013
In addition, the NDOI has posted nine plan scenarios to help prepare consumers on upcoming rate changes. The scenarios are based on silver and gold metallic plans purchased through the Marketplace exchange. Examples include:
|Nine Plan Scenarios|
|Plan||Blue Cross/Blue Shield|
% of change
% of change
|1. 26 yr old single male in Lincoln on a silver plan||83% increase||144.65% increase|
|2. 26 yr old single female in Lincoln on a silver plan||22% decrease||64.83% increase|
|3. 30 yr old single male in Lincoln on a silver plan||82% increase||143.04% increase|
|4. 30 yr old single female in Lincoln on a silver plan||12% decrease||59.41% increase|
|5. Family coverage in Omaha, 2 adults aged 35, 2 children on a silver plan||25% increase||14.47% increase|
|6. Family coverage in Lincoln, 2 adults aged 45, 2 children on a gold plan||18% increase||9.32% increase|
|7. Coverage in Omaha, 2 adults aged 60 on a gold plan||19% increase||12.64% increase|
|8. Family coverage in Hastings, 1 adult aged 50, 3 children on a silver plan||12% increase||0.64% decrease|
|9. Family coverage in Hastings, 1 adult aged 50 - tobacco user, 3 children on a silver plan||21% increase||5.06% decrease|
Confused about the Affordable Care Act health reform law? You are not alone.
An April 2013 health reform survey conducted by the Kaiser Family Foundation found that nearly half of the general population say that they did not have enough information to understand the health reform law and its impact on their family.
The Affordable Care Act ushers in new terms, procedures, rules and regulations that each and every consumer needs to better understand when considering their health insurance needs. As a business owner, you must be aware of the ACA and how it affects you and your employees.
- Read the 7 Key Terms in the Affordable Care Act that Small Businesses Should Know, written by Meredith K. Olafson, Senior Poicy Advisor for the U.S. Small Business Administration.
- For a more comprehensive glossary, see the National Association of Insurance Commissioner’s Glossary of Health Terms.
Section 1512 of the Affordable Care Act creates a new Fair Labor Standards Act regulation (FLSA section 18B) that requires employers to issue a notification to employees of coverage options available through the marketplace. If applicable, the act also requires notification of COBRA* (continuation of coverage) for health coverage alternatives offered through the marketplace.
What does this mean to your small business?
If you fall under the FLSA guidelines, you are required to provide notification of coverage options to each employee, regardless of plan enrollment status or of part-time or full-time status. Starting October 1st, as an employer you must provide notification of coverage within 14 days of an employee’s start date.
For current employees, you will need to provide notification no later than October 1st. To satisfy the content requirements for FLSA, Section 18B, model language is available from the U.S. Department of Labor, Employee Benefits Security Administration.
You may also download fill-in forms provided below that will fulfill this requirement:
- FLSA model for employers who do not offer a health plan, en español | MS Word format
- FLSA model for employers who do offer a health plan, en español | MS Word format
- Technical briefing to help guide you through the process
- See also the EBSA website for Spanish versions of the models
If you have more than 20 employees, use the Model COBRA Election Notice to offer employees and their families the opportunity to temporarily extend their health coverage (called continuation coverage) where coverage under the plan would end. This model advises qualified beneficiaries to investigate health care coverage through an exchange, as an alternative to COBRA* continuation coverage.
Penalties for non-compliance
The ACA does require employers to provide the Employee Notification to all part-time and full-time employees by October 1, 2013. However, at this time, the ACA regulations do not identify specific penalties for failure of notification. See EBSA FAQ
Unsure whether FLSA applies to your business?
The U.S. Department of Labor uses the general guidelines that FLSA applies to employers that employ one or more employees who engage in, or produce goods for, interstate or foreign commerce or the company has an annual dollar volume of sales or receipts of more than $500,000. The FLSA guidelines are broad in scope and apply to most businesses. Use the interactive FLSA Advisor to help determine your FLSA status.
Check out this slideshow to help prepare you for the ACA Notification mandate:
- Getting Ready for Open Enrollment: Preparing for 2014 Focusing on New ACA Requirements (Source: Mercer)
Communication is Needed
- Start Communicating about Health Care Changes (Source: SHRM)
*Consolidated Omnibus Budget Reconciliation Act of 1985
As you consider your options for employee health insurance, one factor to evaluate is how your business stacks up to what competitors are doing in terms of talent recruitment and retention. Without careful cost analysis and discussions with your employees, you may end up paying too much or not offering the right incentives to attract and retain high quality employees.
You can compare your company’s benefit package with those of your competitors. Look at companies that are in similar industries, geographic regions and relatively of the same size. How does your total out-of-pocket costs, premium structures and employee contribution rates compare to other businesses that offer health insurance coverage? What other forms of benefits do your competitors offer besides health insurance? Benefits such as retirement, paid leave, day care, concierge services can be just as rewarding and important to your employees.
In a 2011 survey of employers, researchers found that 85 percent of employees would choose to remain at their jobs after their employer stopped offering ESI [employer-sponsored insurance], however, 60 percent would also like to be made “whole” and receive an increase in their wages. To find out what other businesses are providing, talk with insurance carriers, industry associations and brokers and ask for their comparative, benchmarking reports. Also, allow employees to be involved and make decisions about the types of benefits that are most valued and useful to them. Dr. Brooks Holcum provides a list of benefits that will add to your discussions.
On national level, how do you compare? The Kaiser Family Foundation recently released results from the 2013 Employer Health Benefits Survey that gives an overall picture of employer insurance benefits.
|►Percentage of firms offering health benefits, by size: 45 percent of firms with 3-9 workers provided health insurance; 68 percent of firms with 10-25 workers; 85 percent of firms with 25-49 workers and 91 percent of firms with 50-199 workers.|
|►Offer rates vary by firm characteristics: |
|►Of small firms (3-199 workers) offering health benefits, 88 percent offer one plan type and 11 percent offer two plan types. The largest plan type (49 percent) was a Preferred Provider Organization (PPO) followed by a 25 percent Point of Service (POS) and 20 percent High Deductible Health Plan/Savings Option (HDHP/SO).|
|►Of the small firms that do not offer health benefits, the most cited reasons were cost of health insurance is too high (50 percent); firm is too small (16 percent); employees are generally covered under another plan (15 percent) and most employees are part-time or temporary workers (8 percent).|
|►Most all (99 percent) of large firms (more than 200 workers) and 76 percent of smaller firms (less than 200 workers) offered some type of employee wellness program. Of the small firms, 8 percent link the wellness program to a financial incentive.|
This data provides just a snap shot of what your competition is providing their employees. Doing your own research will help you stay competitive in a very dynamic and changing health benefits environment.
Information provided here is from a variety of resources managed by government agencies, professionals, organizations, and non-profits. The information is not intended as tax or legal advice, and it may not be relied on for the purpose of avoiding any federal or state tax penalties.
There is no implied or intended endorsement by UNL Extension of any website, information, or videos provided within this website. Nor is there any implied endorsement by the creators of the information and videos used within this website to UNL Extension. Use of the information is for educational purposes only and is designed to serve as a starting point for you to further discuss your business options with an attorney, accountant, human resource (HR) consultant, or other advisor who is well-versed in the new health care regulations.
UNL Extension ACA Team
For questions or additional information, email: ACAbizNE@unl.edu
Phone: Marilyn Schlake (402.472.4138); Carroll Welte (402.374.2929); Jim Crandall (308.995.3889); Charlotte Narjes (402.472.1724)