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Federal Health Care Reform

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Information for North Carolina Employers

This website provides very general information about the Affordable Care Act. For the most complete and up-to-date information about the health care reform law, visit the federal website www.hhs.gov/healthcare.

What are the key pieces of the Affordable Care Act that will impact employers?

The impact of the Affordable Care Act on employers will vary depending on the size of the employer and other factors. For information about the impact on employers by size, go to www.sba.gov/healthcare or http://business.usa.gov/healthcare.

What responsibilities do small employers have regarding offering health care coverage to employees?

The Affordable Care Act does not penalize small employers (in North Carolina, employers with fewer than 51 employees) that do not offer health insurance to their employees.

More information for small employers is available at www.sba.gov/healthcare.

How will health insurance policies change for small employers in 2014?

Unless the small employer has a grandfathered plan, any health insurance purchased in 2014 will include coverage of Essential Health Benefits. Employers may also see changes in the cost sharing designs (deductibles, coinsurance, copays, etc.) of their plans. Rates for small employers will also be set differently in 2014 and will be based only on the age and tobacco use of covered employees and dependents, and the geographic location of the employer. For plan years starting in or after 2014, rates can no longer be based on the health status of the group.

Information about the Essential Health Benefits for North Carolina can be found at www.ncdoi.com/HealthCareReform/HCR_EHBAV.aspx.

What is the SHOP?

The SHOP, the Small Business Health Options Program, will be a marketplace where small employers may purchase coverage for their employees. In North Carolina, the SHOP will be operated by the federal government. SHOP enrollment is scheduled to begin in October, and employers may use their existing insurance broker to access the SHOP or purchase coverage without a broker.

Employers that are eligible for SHOP can call the federal Small Employer Call Center at 1-800-706-7893 to get general SHOP and small business questions answered by a customer service representative in English or Spanish. TTY users should call 1-800-706-7915. Current call center hours are Monday through Friday, 9 a.m. to 5 p.m. EST.

More information for small businesses can be found on the federal health care reform website at www.healthcare.gov/small-businesses.

How can employers find out if they are eligible for the small employer tax credit?

Tax credits are available to certain small employers (fewer than 25 employees) with low to moderate wage employees who purchase health insurance through the SHOP. For more information, go to www.irs.gov/uac/Small-Business-Health-Care-Tax-Credit:-Questions-and-Answers.

How does the federal health care reform law apply to large employers?

Non-grandfathered health plans offered by large employers are subject to requirements including limits on out-of-pocket expenditures, waiting period limitations, the prohibition of annual or lifetime dollar limits of coverage, the requirement that coverage be offered for adult children up to age 26 and for preventive services without cost sharing, and the requirement of access to internal and external appeals.

Starting in 2015, large employers will generally face a tax penalty if they fail to offer affordable and adequate coverage to their employees (and their employees’ children). For details on the tax penalty go to www.irs.gov/uac/Newsroom/Questions-and-Answers-on-Employer-Shared-Responsibility-Provisions-Under-the-Affordable-Care-Act.

More information for large employers can be found at www.sba.gov/content/employers-with-50-or-more-employees and http://business.usa.gov/healthcare.