New Health Plans
All new health plans (unless grandfathered) will include defined essential health benefits in order to be considered a "Qualified Health Plan". Each plan is categorized into one of four tiers: Bronze, Silver, Gold or Platinum. The tiers cover on average 60% (Bronze), 70% (Silver), 80% (Gold) or 90% (Platinum) of the cost of medical care. Each insurance company has flexibility to design its own plans within the framework of each tier and price it accordingly. However, the law requires that plans spend at least 80% of all premium dollars on medical care or return the difference to members.
Small Business Health Options Program (SHOP)
A new option is available to small business owners (under 50 employees) to purchase group coverage through the SHOP. Purchasing through the SHOP affords several benefits. 1) Access to possible tax credits if you have fewer than 25 employees and they earn on average less than $50,000 per year. 2) Multiple company options. The employer decides the metal tier of coverage, but employees are free to choose any plan from any company within that tier. 3) SHOP attempts to negotiate improved pricing for group coverage with the intent of saving you money.
On Tuesday July 2, 2013, the Obama Administration posted a blog on employer requirements and the Patient Protection and Affordable Care Act (ACA, P.L. 111-148), as amended. Based on the White House blog, the administration (1) plans to revamp employer reporting requirements, and therefore suspend employer reporting requirements for 2014, and (2) because employer payments are dependent on the reporting requirements, no payments will be collected in 2014. The Administration noted that these changes were in response to employers' concerns about the reporting requirement.