Defined Contribution/Employee Choice in SHOP

[RayNY]

http://www.cms.gov/CCIIO/Programs-a...ownloads/job-aid-assisting-employers-shop.pdf

Most recent CMS/CCIIO fact sheet, presumably only applies to FFE states. No date given, but the "last modified" date is 9-11-13.

Clearly indicates choosing a reference plan, employer contribution, etc.

Last I heard, defined contribution/employee choice was delayed by a year (as of April 2013 announcements). Can anyone confirm if this is still true, or provide a more recent citation stating otherwise?

Anyone have a list of which non-FFE states will allow this year one?

Also, nice tidbit in that article, #9 states that in FF-SHOP's the 70% employee participation requirement is waived for companies applying 11-15 through 12-15. No reason to convert everyone to PT anymore! Just a smaller OEP window.

 

[kennethbroyles]

I am looking for an answer... Can dependents choose to go to the Individual Marketplace if they want too. My Head is mush right now.. and I cant find this answer. I think this brings up... "If, And's or But's." Maybe a reference?

Thanks

 

[Duaine]

I am looking for an answer... Can dependents choose to go to the Individual Marketplace if they want too. My Head is mush right now.. and I cant find this answer. I think this brings up... "If, And's or But's." Maybe a reference?

Thanks

This is an explanation of what will happen to spouses and dependents if one of the couple has "affordable" coverage through group. I would like to see if anyone else has a better outline or example.

See attachment.

 

[agentinsure]

Am I reading that correctly? According to that pdf you have there the 9.5% of hh income is relevant only to the employee's cost of coverage to be construed "affordable". I was led to believe the total premium for the household was counted, not just the premium of the employee. Im confused now, and discouraged. If I read that correctly and they are only using the employees' premium to define affordable at up to 9.5%, that is going to really suck.

Anyone here care to explore this further?

 

[djs]

No further exploring needed, you have it correct.
This is one of the MANY reasons people should read bills before they pass them.

If you don't work, then 9.5% is for the family. If you do work, then 9.5% is for you only.

Dan

 

[Ann H]

Am I reading that correctly? According to that pdf you have there the 9.5% of hh income is relevant only to the employee's cost of coverage to be construed "affordable". I was led to believe the total premium for the household was counted, not just the premium of the employee. Im confused now, and discouraged. If I read that correctly and they are only using the employees' premium to define affordable at up to 9.5%, that is going to really suck.

Anyone here care to explore this further?

Yes this is true. Just Google "family glitch" and you will find many articles about it. Search for it on this forum and you will find what we have posted on this subject many times.

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http://www.cms.gov/CCIIO/Programs-a...ownloads/job-aid-assisting-employers-shop.pdf

Most recent CMS/CCIIO fact sheet, presumably only applies to FFE states. No date given, but the "last modified" date is 9-11-13.

Clearly indicates choosing a reference plan, employer contribution, etc.

Last I heard, defined contribution/employee choice was delayed by a year (as of April 2013 announcements). Can anyone confirm if this is still true, or provide a more recent citation stating otherwise?

Anyone have a list of which non-FFE states will allow this year one?

Also, nice tidbit in that article, #9 states that in FF-SHOP's the 70% employee participation requirement is waived for companies applying 11-15 through 12-15. No reason to convert everyone to PT anymore! Just a smaller OEP window.

Hi Ray - yes, the FFE delayed the SHOP multi-choice option. I don't know of any states that are going ahead with it.

It's not only the SHOP that can allow a group to waive participation and contribution requirements if they have the short enrollment period. Off-exchange group plans must allow that, too, with the same short OEP. You won't find many carriers announcing it, though, because it made carriers really upset.

 

[kahlestyle]

Ann,
Does the participation exception apply to state run too, like CA?

 

[RayNY]

Ann, I had heard that carriers can no longer enforce "minimum participation" guidelines beyond the "70% SHOP" requirement (that's waived Nov 15-Dec 15).

If one was to do a defined contribution off-exchange structure, wouldn't that result in a bunch of separate bills that would have to be reconciled by the employer? I'm just thinking of the horror story that 5 bills from 5 carriers for 20 employees on 20 different plans with 20 different rates would cause.

I did a bit of digging, looks like NY has stated they will be supporting it year one:
http://www.nystateofhealth.ny.gov/s...Marketplace Choice and Value Fact Sheet_0.pdf