Utah Health Insurance Marketplace Exchange

In Utah, the health insurance marketplace exchange is bifurcated in two.  The Federal government runs the individual exchange and the State government runs the small business exchange.  The Individual and Family Exchange is accessed at www.HealthCare.gov.  Select “Get Insurance” and then “Individuals & Families.”  Next choose Utah from the drop-down box.  The website won’t become active until October 1, 2013, but you can gather some general information at this point.  The individual mandate to have health insurance coverage or else pay a penalty begins January 1, 2014.

Because of the complexity in figuring out how to purchase health insurance on the exchange, and in determining whether financial subsidies apply for purchasing insurance, the Affordable Care Act created the concept of “navigators” to help with the application process.  Such assistance is particularly needed by those who haven’t had health insurance in the past.  The term “navigators” appears to have recently been changed to “marketplace assisters.”  Find help from navigators at https://localhelp.healthcare.gov/.  

The Utah small business exchange is called Avenue H and is accessed at www.avenueh.com.  The website is currently active.  A small business is one with 2 to 50 employees.  Avenue H provides a unique way for an employer to provide health insurance to its employees.  Rather than the employer purchasing a group plan for the employees, Avenue H is a “defined contribution” type of plan.  The employer provides a set amount of money that the employee controls and uses to purchase their choice of health insurance.  Employees can compare plans and premiums from different providers and apply for coverage online.  See the website for more details. 

The next several weeks and months will bring many changes into the health insurance marketplace.  In addition to the websites listed above, the IRS has a web page devoted to the Affordable Care Act at www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-Home.

Employer Notice Required by October 1, 2013, Regarding Health Insurance Marketplaces (Exchanges)

One of the key provisions of the Affordable Care Act (Obamacare) is the establishment of health insurance marketplace exchanges.  As originally contemplated, the States would each establish their own exchange.  But, the U.S. Supreme Court ruled that the Federal government couldn’t punish States that chose not to establish exchanges by withholding Federal Medicaid cost sharing payments.  Following the ruling, many States chose not to set up state-run exchanges.  The Federal government will establish and run exchanges in those States.  The government has recently been using the term “health insurance marketplaces” in place of the original term, “exchanges.”  The marketplaces are supposed to be up and running October 1, 2013 with policies beginning coverage as early as January 1, 2014. 

The ACA requires employers to give notice to all of their employees about the existence of marketplaces in their states.  All employees must be given the written notice regardless of health insurance plan enrollment status (if applicable) or of part‐time or full-time employment status.  The notice must be given to new employees within 14 days of starting work.  The notice is required even though an employer might not be a “large” employer subject to the employer health insurance mandate now postponed to 2015.  The notice requirement applies to employers subject to the Fair Labor Standards Act. 

If employees are not offered affordable, “bronze-level” health insurance benefits, they may go to the marketplaces to purchase health insurance.  Employees with household income of up to 400% of the Federal poverty level may receive tax subsidies to offset the cost of premiums.  The government is requiring employers to educate their employees about the marketplaces. 

The government has provided two model notices at www.dol.gov/ebsa/healthreform/.  You must select the proper notice.  The proper notice depends upon whether or not you, as the employer, currently offer health insurance to your employees.  The model notice is provided in “Word document” format so that you can complete it for your business. 

There is no financial penalty if you fail to provide the required notice in a timely manner.  Quoting from the DOL website at http://www.dol.gov/ebsa/faqs/faq-noticeofcoverageoptions.html,   “Q: Can an employer be fined for failing to provide employees with notice about the Affordable Care Act's new Health Insurance Marketplace?  A: No. If your company is covered by the Fair Labor Standards Act, it should provide a written notice to its employees about the Health Insurance Marketplace by October 1, 2013, but there is no fine or penalty under the law for failing to provide the notice.”