We can help you understand your obligations under the complex laws of Healthcare Reform.

The Affordable Care Act (the ACA) was passed and first implemented in 2010.  This extensive Healthcare legislation was originally intended to better our healthcare system, however with nearly 2,700 original pages of healthcare bill and over 41 amendments, the law is complex and many need help interpreting the ACA correctly.

Our compliance experts continually work to stay well-informed of industry laws and trends.  As employee benefit specialists, we understand how the law directly affects employers and we work with businesses to help them comply with the ACA, while staying productive and profitable.

Highlights of the Affordable Care Act

For your information, we have listed some (but certainly not all) of the highlights of the new law and how it may impact employers and individuals under 65.  We strongly suggest you call our office at (805) 379-9374 or fill out the contact form directly to the right for more assistance.

Employers who have 50 or more full-time equivalent employees must offer those employees and their families and dependents up to age 26, benefits that pay for 60% of the minimum essential benefits, as established by the ACA, or face a potential penalty.

The mandate:  Beginning in 2015, if you have 50 or more full-time equivalent employees who are not offered health coverage, and at least one employee receives a premium tax credit/cost sharing subsidy in the exchange, your tax penalty is $2,000 annually multiplied by the number of full-time employees (excluding the first 30 employees).   The penalty is increased each year by the growth in insurance premiums.

Individuals must now obtain qualifying coverage either through an individual policy or through their employer or face a potential penalty.

The mandate:  In 2016 the penalty for non-compliance will be $695 for each adult family member, and $347.50 for each child, or 2.5% of household income, whichever is greater.

  • No pre-existing clause. Insurance companies can no longer increase rates or deny coverage because of a pre-existing condition.
  • Dependents up to age 26 may be added to an insurance policy for both individuals and employer coverage.
  • Gender is no longer a factor in determining rates.
  • Renewal rates are the same as new business rates.
  • Waiting period should not exceed 90 days.

To be in compliance with the new healthcare reform laws and avoid costly penalties, you must purchase Insurance coverage that pays at least 60% of the costs of the following “essential benefits:”
-Ambulatory patient services
-Emergency services
-Hospitalization
-Maternity and newborn care
-Prescription Drugs
-Mental health and Substance Abuse disorder services
-Rehabilitative and habilitative services and devices
-Pediatric services, including oral and vision care
-Preventive and wellness services, and chronic disease management

Individuals and Businesses who purchase their health insurance through the new Health Insurance Marketplace (Covered California) and/or SHOP may be eligible for tax credits which are applied as a discount on your monthly insurance premium. To see if you are eligible for a tax credit (premium subsidy), please use the appropriate calculator below.