Healthcare Reform

The Patient Protection and Affordable Care Act (PPACA), more commonly known as Healthcare Reform provides new coverage options to an estimated 30 million new members while implementing several changes that affect individual and employer-sponsored health plans. With new government mandates come many new complexities for ensuring appropriate plan implementation, integrity processing, education and compliance.

Sheridan Benefits will remove the fear of the unknown as we are on the forefront of Healthcare Reform. Our certified specialists will review the major provisions of the law affecting employers and their group health plans, providing the right information in easy to understand terms to ensure compliance with State and Federal mandates.

Federal Health Care Plans

Bronze Plan
A health plan available through state health exchanges. It covers up to 60% of the cost of essential benefits, while the patient pays 40%.
Silver Plan
A health plan available through state health exchanges. It covers up to 70% of the cost of essential benefits, while the patient pays 30%.
Gold Plan
A health plan available through state health exchanges. It covers up to 80% of the cost of essential benefits, while the patient pays 20%.
Platinum Plan
A health plan available through state health exchanges. It covers up to 90% of the cost of essential benefits, while the patient pays 10%.

Key Phrases and Terms of 'Obamacare'

Affordable care act (aca)
The Patient Protection and Affordable Care Act (PPACA) – also known as the Affordable Care Act or ACA – is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010. The legislation includes a long list of health-related provisions that began taking effect in 2010 and will "continue to be rolled out over the next four years." Key provisions are intended to extend coverage to millions of uninsured Americans, to implement measures that will lower health care costs and improve system efficiency, and to eliminate industry practices that include rescission and denial of coverage due to pre-existing conditions.
Patient Protection and Affordable Care Act (PPACA)
The Patient Protection and Affordable Care Act (PPACA) – also known as the Affordable Care Act or ACA – is the landmark health reform legislation passed by the 111th Congress and signed into law by President Barack Obama in March 2010. The legislation includes a long list of health-related provisions that began taking effect in 2010 and will “continue to be rolled out over the next four years.” Key provisions are intended to extend coverage to millions of uninsured Americans, to implement measures that will lower health care costs and improve system efficiency, and to eliminate industry practices that include rescission and denial of coverage due to pre-existing conditions.
Exchange
A health insurance exchange mechanism is a key provision of the Affordable Care Act, established to provide a selection of competing providers, each offering different qualified plans. All qualified plans must meet standards established and enforced by the Health Choices Administration. For instance, participating plans will not be allowed to discriminate against applicants based on health history (pre-existing conditions) or future risk. Competition between the plan providers would, in theory, encourage the providers to improve the quality and pricing of offered plans.
Health insurance exchange
A health insurance exchange – or health insurance marketplace – is a key provision of health reform legislation, established to provide a selection of competing providers, each offering different qualified plans. All qualified plans must meet standards established and enforced by the Health Choices Administration. For instance, participating plans will not be allowed to discriminate against applicants based on health history (pre-existing conditions) or future risk. Competition between the plan providers would, in theory, encourage the providers to improve the quality and pricing of offered plans.
Individual mandate
The individual mandate provision of the recently passed health reform legislation requires citizens to have insurance coverage that meets minimum standards set as part of health insurance exchanges, including guaranteed access to affordable coverage, essential benefits and other consumer protections. The legislation imposes a tax penalty on individuals – with some exceptions – who do not purchase coverage.
Individual subsidies
Individual subsidies – or individual affordability credits – are included in the health reform legislation to help ensure the goals of the legislation's individual mandate. Legislation provides premium subsidies on a sliding scale to eligible individuals and families with incomes up to four times the federal poverty level to help them purchase coverage through the health insurance exchanges. Related terms: individual affordability credits, subsidies

To see if you are eligible for a subsidy please visit http://info.nystateofhealth.ny.gov/calculator
Penalty
Under the individual mandate provision of the Affordable Care Act, Americans will be required to purchase health insurance, starting in 2014. Those who, for whatever reason, decide to not purchase coverage, would face a tax that's built into the law. Fortunately, all but a small percentage of Americans won't need to be concerned about the penalty.

The penalty in 2014 is calculated one of 2 ways. In general, individuals will pay whichever of the following amounts is higher:

1% of the individual's yearly household income above his or her applicable filing threshold (the amount of gross income that triggers the requirement to file a federal income tax return). The maximum penalty is the national average yearly premium for a bronze plan. The monthly national average premium for bronze plans offered through Health Insurance Exchanges in 2014 is $204 per individual and $1,020 for a family with five or more members, $95 per person for the year ($47.50 per child under 18). The maximum penalty per family using this method is $285.

The fee increases every year. In 2015, it increases to 2% of income or $325 per person. In 2016 and later years, the fee is 2.5% of income or $695 per person. After that it is adjusted for inflation.

If an individual is uninsured for just part of the year, 1/12 of the yearly penalty applies to each month the individual is uninsured. (If an individual is uninsured for less than 3 months, the individual does not have to make a payment.)
Small Business Health Care Tax Credits
Employer tax credits – or Small Business Health Care Tax Credits – provide a tax credit of up to 35 percent of small business premium costs in 2010 – with that rate increasing to 50 percent in 2014. Who's eligible? Employers with fewer than 25 full-time workers and average annual wages less than $50,000. Read more about the credit.