1. I have multiple companies but most of them are part time workers, do I need to provide medical insurance to them?If your total full time equivalent employees (FTE) are over 101, then you must provide group medical insurance to your employees. Please refer to “Eligibility Requirement” for part time employees' working hour calculation formula
2. Our company has employees outside of California, can they use our company's medical plan?Yes. But since California's HMO plan is for employees in California only, your company can set up a PPO plan for out-of-state employees to cover everyone's needs.
3. Is there a way to help my company save taxes and at the same time benefit my employees?Yes. If a company can set up a Premium Only Plan (POP), medical expenses that the company paid for employees and the employees' insurance premium payments are both tax deductible.
4. How much premiums are employers required paying for employee and employee's dependents?If it's group medical plan, employer are required to pay at least 50% of employee's premium. For employee's dependents, dental and vision plans, such requirement is not mandatory (depending on employer's benefit package).
5. Our company has more than 101 full time employees; will we be penalized if we do not provide medical insurance?Yes! Per ACA regulation, a Large Group company has to provide to at least 95% of its employees a medical plan that is in compliance to the minimum essential coverage plan or will be subject to penalty.
6. Can my company reimburse employees' individual medical plan's premium?No. According to ACA, if the company reimburses employees' individual medical plan's premium, the company will be facing penalty at $100/day/person, or $36500/year/person, whichever is lower will be the penalty amount.
7. If employee left the company, can he or she join COBRA or CAL-COBRA?Yes. After the employee left, he/she can elect to join COBRA for 18 months, and once COBRA lapsed, he/she can continue to elect to join CAL-COBRA for an additional 18 month.
8. What's the difference between group dental insurance plan and individual dental insurance plan?Compare to individual dental plan, group dental plan's greatest advantage is “no waiting period”. For individual dental plan, a simple tooth extraction or filling, for example, need to wait for 6 months in order to receive treatment and crown will need to wait for 12 months. In addition, group dental insurance plan can select to have additional feature like orthodontic, in which individual plan does not and cannot be added.
9. Our company provides group medical insurance. What are the regulations for new hire's insurance effective date?Due to Health Care Reform, starting 1-1-2015, employer needs to enroll an eligible new hire within 90 calendar days. The effective date for new hire's insurance plan can be any of the followings:
10. What is 1094C and 1095C Form?1094C form is filed by employer to the IRS to report company's full time and part time employees' status in the last year. 1095C form is prepared and provided by the employer to the employees. It shows employee's insurance coverage information in the past year. The form must be provided to all employees before March 31st every year and employer must file all 1095C and 1094C to IRS at the same time.
How to file:Via Mail:For large company that has 250 or less 1095C
|Target||Situation||Penalty Amount||Penalty Target|
|All Employers||Company reimburses/pays for employees' individual plan.||$100/day/person; up to $36,500/person||Employer|
|Small Group Employers (50-100 full time employees)||Company does NOT provide medical insurance at all||$2,000/year/person (penalty assess from the 31st full time employee, the first 30 full time employees are exempted)||Employer|
|Small Group Employers (50-100 full time employees)||Company's insurance does NOT meet ACA requirement; or the insurance provided is not “affordable”||$2,000/year/person (same as above) ；$3,000/year/person (if full time employee applied through Covered CA and received subsidy), whicheveris lowerwill be the penalty amount||Employer|
|Large Group Employers (more than 101 full time employees)||Company does NOT provide medical insurance at all||$2,000/year/person, first 30 employees are exempted||Employer|
|Large Group Employers (more than 101 full time employees)||Company's insurance does NOT meet ACA requirement; or the insurance provided is not “affordable”||$2,000/year/person (same as above)$3,000/year/person)if full time employee applied through Covered CA and received subsidy), whicheveris lowerwill be the penalty amount||Employer|
|Type||Small Group||Small Group||Large Group|
|Full Time Employees||2-19||20 and more||101 and more|
|COBRA||Not Applicable||18 or 36 month||18 or 36 month|
|CAL-COBRA||Up to 36 month||If Federal COBRA was 18 month, 18 more months of CAL-COBRA is available||If Federal COBRA was 18 month, 18 more months of CAL-COBRA is available|
|Target (individual/company)||Applicable Form||Issuer|
|Individual and Family Plan with Covered CA(On-Exchange)||1095A||Covered California|
|Individual and family plan without Covered CA (Off-Exchange), MediCare, and Medi-CAL||1095B||Insurance Carriers, Medi-Care, Medi-CAL offices|
|Employees with Small group medical Plan||1095B||Insurance Carriers|
|Employees with Large Group Medical Plan||1095C||Employer|