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The New Health Law & Small Businesses

July 2015

Overview

• Policy Update and Broker Resources

• 2016 Health Plans

• 2016 DC Health Link Renewal Process

– Small Business Marketplace

• Frequently Asked Questions

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Which Small Businesses are Eligible

for DC Health Link?

For 2014 and 2015, employers with:

• 1-50 full-time equivalent employees (FTEs), on average in the prior

calendar year

Beginning in 2016, expands to employers with:

• 51-100 FTEs, on average in the prior calendar year

What about self-employed individuals?

DC Health Link’s small business marketplace is for employers with at least

one non-owner employee.

If you are self-employed or a sole proprietorship, partnership, or an

S- Corporation that only employs owners, then you will be able to shop the

numerous plan options in the DC Health Link’s individual and family

marketplace.

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How do I calculate “full-time equivalent”

employees?

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Help for Small Businesses

Tax credits are available if your business has

• Fewer than 25 full-time workers

• Average wages of $50,000 or less

• Pay at least 50% of the cost of single coverage

for each employee

• Purchase coverage through DC Health Link

Tax credits can cover as much as

• 50% of a for-profit employer’s contribution

• 35% of a non-profit employer’s contribution

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Transition to One Marketplace

Individual policyholders

• New and renewing

Small businesses

(50 and fewer FTEs)

• Groups currently not

offering health

insurance coverage

• Groups currently

offering health

insurance coverage,

if they choose

Individual policyholders

• New and renewing

Small businesses

(50 and fewer FTEs)

• Groups currently offering

health insurance coverage

and changing carriers,

upon renewal

• Groups currently offering

health insurance coverage

and renewing with same

carrier, if they choose

Individual policyholders

• New and renewing

Small businesses

(50 and fewer FTEs)

• All groups, upon renewal

Mid-Size Businesses

(51-100 FTEs)

• Groups newly offering or

renewing coverage, if

they choose

July 2016

2015

2014

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Easier Comparisons

Plans will be categorized into “metal levels” for easier comparison

• Metal level provides a general idea of what portion of covered healthcare expenses

will be paid by the plan, with the remaining portion to be paid by the consumer

(not including premiums)

• Plans will have different designs, such as deductibles, copays, and coinsurance

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Plan Offering Options

Employers offering coverage through DC Health Link can offer the following employee choice options:

• All plans in 1 Metal Level

• All plans from 1 Carrier

• 1 Plan

Must offer coverage to all full-time employees (30 hours per week)

• Can choose to offer coverage to other employees, including part-time employees and retirees

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Employer Contributions

Small Business Owners decide the employer contribution:

1. Select one plan to base contributions on, the “reference plan”

2. Select a percentage you will contribute for employees and dependents to enroll in

the reference plan

3. Your contribution remains fixed based on the reference plan. Employees enrolling in

any other plan will pay the difference in premium to “buy-up” or “buy-down.”

Age

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Employees may also select to “Buy Down” to a lower cost plan.

If the monthly premium is less than the employer contribution amount, the employer will pay the monthly premium amount.

Employees cannot receive cash back.

Age

Reference Plan Enrolled Plan (Buy Up) Enrolled Plan (Buy Down)

Gold PPO

Premium

Employer

Pays (80%)

Employee

Pays

Platinum PPO

Premium

Employer Pays (same as Ref Plan)

Employee

Pays

Bronze HMO

Premium

Employer Pays

(up to the same

as Ref Plan)

Employee

Pays

Vince 27 $275 $220 $ 55 $310 $220 $ 90 $185 $185 $0

Joyce 40 $365 $292 $ 73 $417 $292 $125 $250 $250 $0

Effective Date of Coverage

Options are:

• 1st of Month Following Date of Hire

• 1st of Month Following 30 Days

• 1st of Month Following 60 Days

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Small business owners

determine the effective

date of coverage for new

employees.

Participation

Minimum Employer Contribution

• 50% of single coverage in reference plan

Minimum Level of Participation

• One non-owner employee

• 2/3rds of eligible employees (not including

waivers)

– Employees declining to enroll because of other

coverage do not count against participation

requirement if their other coverage is:

• Another employer’s health plan (spouse’s

employer plan), or

• Governmental health plan (Medicare, Medicaid,

TRICARE).

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Note: Employers who cannot satisfy minimum participation and/or minimum contribution will be able to enroll during a special annual enrollment period each year for coverage effective January 1st.

The DC Health Link Advantage

for Small Business

Employer competitive edge

Flexible plan options

Same purchasing power as larger employers

Wide range of plans available

Simplified billing

Tax credits to offset costs

Work with a Broker

Same coverage options as Members of Congress!

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Simply put …..

What Information Do I Need to Get Started?

1. Federal Employer Identification Number (EIN)

2. DC Business Address

3. Number of Full-Time Equivalent Employees (FTEs) in Prior Calendar Year

4. Employee Census - for each eligible employee

– Date of Birth

– Social Security Number (SSN) or Tax Identification Number (TIN)

– Employee Email Address (for open enrollment notice only)

– Date of Birth for all Dependents (optional – for cost estimations only)

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Five Steps to Offering Coverage through DC Health Link

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Select Broker

Enter Employee

Info

Review Plan

Options

Calculate

Employer

Contributions

Verify

Eligibility for

the Small

Business

Marketplace

Choose New

Employee

Coverage Start

Date Rules

Employees review

their options

Select the plan

that is best for

their needs

Pay 1st

Month’s

Premium

(due by 12th of

the month)

Payment Open Enrollment

Enrollment Eligibility

Quoting

Broker

Employer

Employees

How Long Does It Take?

Employers (and brokers) should note that DC Health Link’s initial group set up

and employee enrollment timeline will run a minimum of 1 month (“fast-track”)

and no more than 3 months (longest), with the typical employer taking 45 days.

Fast Track Longest Track

Select Plans

& Contributions 1-7 Days 45 Days

Employee

Open Enrollment 10 Days 30 Days

First Premium

Payment By the 12th of the month

Carrier Administration 2 weeks

TOTAL 1 month (minimum) 3 months (maximum)

Example:

August 1, 2015 Coverage

Begin by

July 1, 2015

Begin as early as

May 1, 2015 15

Deadlines

Employer Application Employee Open Enrollment Period 1st Premium Payment

Coverage Effective Date

Earliest Date to Start

Must be Completed by

Earliest Start Date

Must be Started By

End of Open Enrollment

Must be received by

Sep 1, 2015 Jun 1, 2015 Aug 1, 2015 Jul 1, 2015 Aug 1, 2015 Aug 10, 2015 Aug 12, 2015

Oct 1, 2015 Jul 1, 2015 Sep 1, 2015 Aug 1, 2015 Sep 1, 2015 Sep 10, 2015 Sep 14, 2015

Nov 1, 2015 Aug 1, 2015 Oct 1, 2015 Sep 1, 2015 Oct 1, 2015 Oct 10, 2015 Oct 14, 2015

Dec 1, 2015 Sep 1, 2015 Nov 1, 2015 Oct 1, 2015 Nov 1, 2015 Nov 10, 2015 Nov 12, 2015

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This is for initial employer groups offering through DC Health Link for the first time:

Deadlines

Employer Application Employee Open Enrollment Period

Coverage Effective Date

Earliest Date to Start

Must be Completed by

Earliest Start Date

Must be Started By

End of Open Enrollment

Sep 1, 2015 Jun 1, 2015 Aug 5, 2015 Jul 1, 2015 Aug 5, 2015 Aug 13, 2015

Oct 1, 2015 Jul 1, 2015 Sep 5, 2015 Aug 1, 2015 Sep 5, 2015 Sep 13, 2015

Nov 1, 2015 Aug 1, 2015 Oct 5, 2015 Sep 1, 2015 Oct 5, 2015 Oct 13, 2015

Dec 1, 2015 Sep 1, 2015 Nov 5, 2015 Oct 1, 2015 Nov 5, 2015 Nov 13, 2015

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This is for renewal employer groups offering through DC Health Link:

Broker Resources

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2016 Employer Renewals

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2016 Carriers & Plans

A variety of health plans, including: HMOs, POSs, PPOs and HSA-Compatible Products

There are also 2 multi-state small business plans offered through CareFirst BlueCross BlueShield.

2016 Proposed

Plans

Individual & Family

Marketplace

Small Business

Marketplace

Aetna — 18 plans

CareFirst 15 plans 53 plans

Kaiser Permanente 11 plans 24 plans

United Healthcare — 41 plans

TOTAL 26 plans 136 plans

Below are the number of plans filed through DISB for plan year 2016. To review the plans and proposed rates please go to disb.dc.gov.

Frequently Asked Questions

• Does DC Healthlink plan on going back to composite ratings?

– No, composite ratings are no longer allowed under new federal regulations

• How are brokers assigned by employers through DC Health Link?

– Brokers are assigned through by selecting “Broker Agency” and searching then

using the “select” function.

• Will brokers automatically be assigned for conversion groups?

– Yes this will pre-populate into the employer’s account from the information

provided by the carriers.

• Do employers have to fill out a new application at renewal?

– Employers MUST go back into the system at renewal and review their plan

offerings for the upcoming plan year. Unlike employees, employers must take

action at renewal time.

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Contact Information

Producer Relations Team dchl.producer@dc.gov

Small Business Support Team employer.hbx@dc.gov

855-532-5465

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Thank you! To learn more:

Visit us at

www.DCHealthLink.com

Download the mobile app on iTunes or Google play:

DC Health Link - Small Biz

Follow us on Twitter:

@DCHealthLink

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