Ask The Health Care Experts

Ask The Health Care Experts

Officials from HealthPartners and Doherty Employer Services answer questions regarding the latest in health care reform.

Questions not answered during our live August 14 webinar are addressed below by Julie Bunde of HealthPartners and Greg Thurston of Doherty Employer Services. To sign up for the final webinar in our four-part series, which will be held October 23, click here.

Q&A with Julie Bunde, director of product management and product and market solutions at Bloomington-based HealthPartners:

Q. How does open enrollment work with no pre-existing conditions? Can’t people just call from the ambulance and enroll?

A. No, this is one of the big changes with individual market rules. With guaranteed issue and the individual mandate, there is a set period of time, called open enrollment, in which people can enroll. This year, open enrollment will run from October through March, but in future years, it will shorten. In the case of HIPAA life events such as a birth or marriage, there will be a special enrollment right outside of the open enrollment period.

Q. Does the employer pay a penalty if an employee wants to elect coverage through the exchange, but affordable coverage is available through the employer?

A. The penalty, starting in 2015, only applies if a person accesses a subsidy and if it is a large group. If an employee is offered coverage of minimum value and meets requirements for affordability, they cannot have a subsidy, so no penalty applies.

Q. Will a small group be compliant with out-of-pocket rules if they offer a plan that meets actuarial value but with a deductible higher than $2,000 (single)/$4,000 (family), or will the employer have to set up an HRA/HSA to contribute to the deductible as well?

A. Regulations allow plans to increase deductible levels above these limits in order to achieve a bronze level actuarial value.

Q. Do you expect increases to self-insured plans to help cover the costs of the exchange?

A. Self-insured employers are generally not impacted by the exchange. However, they will pay the Transitional Reinsurance fee, which will help pay for new, formerly uninsured individuals coming into the market.

Q. With the employer-shared responsibility delay, are employers still required to offer coverage to employees who work 30 or more hours a week?

A. There is no requirement to offer coverage. Coverage is only required if an employer wants to avoid the penalty, beginning in 2015.

Q. Is it true the exchange application is 15 pages long?

A. The paper form is not final, but expected to be more than 10 pages. The preferred approach is to use the online enrollment form for exchange applications.

Q. Any updates on the federally facilitated exchange (FFE)?

A. The FFE continues to prepare for launch, which requires some heavy lifting. Recent news articles voice concern that the federal data hub will not be certified in time. Be prepared for more news about bumps and glitches.

Q. Are employers required to provide employee notices for temporary employees through a temp agency?

A. In this case, the temp agency would provide the notice.

Q. It looks like the employee notices must individualized to the employee. Is that true?

A. Yes. Part B of the notice is specific to the individual employee regarding affordability, and Part C, which is optional, is specific to the individual employee.

Q. Can an employer email the required employee notices?

A. Employers need to abide by the ERISA electronic communication safe harbor.

Q. What does the 2015 delay mean for employers whose plan year runs from September through August each year? When do health care reform laws kick in?

A. While we are awaiting further guidance, it is expected that the transition safe harbor would remain in effect.

Q. Will bariatric surgery be covered on the exchange?

A. Bariatric surgery is not included in the list of essential health benefits (EHB). We don’t know what benefits will be offered above and beyond EHBs.

Q&A with Greg Thurston, director of benefits at Edina-based Doherty Employer Services:


Q: Regarding Notice of Exchange—conflicting information is out there. Does the notice have to be given to all employees or only benefit eligible employees.

A: All employers who are subject to the Fair Labor Standards Act (which is almost every employer) must provide the notice to all employees (whether benefit eligible or not) no later than October 1, 2013. All employees hired after October 1 (whether benefit-eligible or not) must be provided the notice within 14 days of their date of hire.

Q: Will there be a separate exchange notice for each state?

A: The government has not issued separate model notices for each state. The model notice refers only to healthcare.gov. If employees go to that website, they are able to enter their specific state and are directed to the appropriate exchange.

Q: How do you determine full-time status for drivers who are paid by mile and not based on hourly pay?

A: The employees should submit timesheets each pay period showing the hours that they worked. This should be done even in the absence of health care reform since you could need the information to prove that you are complying with Federal minimum wage and over-time requirements.