We wanted to share some important information that may help certain individuals avoid the Insurance Marketplace Fee. We don’t want you to miss this!! 

The U.S. Department of Health and Human Services has compiled a list of “exemptions” that are worth taking a look at.

Exemptions from the Health Insurance Marketplace Fee
If you don’t already have health coverage, the Health Insurance Marketplace offers a way to find and buy health coverage. Starting in 2014, every person in the United States must have minimum health coverage or must pay a fee on their federal tax return. This fee is sometimes called the “individual shared responsibility payment.” In some cases, you may be able to get an exemption from the fee. An exemption means you wouldn’t have to pay the fee.

How much is the fee?
In 2014, the yearly fee is 1% of your income for the year or $95 per person in your household, whichever is higher. The payment for uninsured children under 18 is $47.50 per child. Regardless of the number of people in your household, the most a family would have to pay in 2014 is $285. You make the payment when you file your 2014 taxes, which are due in April 2015.

The fee increases every year. In 2015, it will be 2% of income or $325 per person in your household, whichever is higher. The payment for uninsured children under 18 will be $162.50 per child. In 2016, it will be 2.5% of income or $695 per person, whichever is higher.

Who can get an exemption?

You may not have to pay the fee (qualify for an exemption) if:

• You’re uninsured for less than 3 months of the year.

• The lowest-priced coverage available to you would cost more than 8% of your household income.

• You don’t have to file a tax return because your income is too low.

• You’re a member of a federally recognized American Indian tribe or eligible for services through an Indian Health Services provider.

• You’re a member of a recognized health care sharing ministry.

• You’re a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare.

• You’re incarcerated, and not awaiting the disposition of charges against you.

• You’re not lawfully present in the U.S.

You may qualify for a “hardship” exemption if:

• You were homeless.

• You were evicted in the past 6 months or were facing eviction or foreclosure.

• You received a shut-off notice from a utility company.

• You recently experienced domestic violence.

• You recently experienced the death of a close family member.

• You experienced a fire, flood, or other natural or human-caused disaster that caused substantial damage to your property.

• You filed for bankruptcy in the last 6 months.

• You had medical expenses you couldn’t pay in the last 24 months.

• You experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member.

• You expect to claim a child as a tax dependent who’s been denied coverage in Medicaid and the Children’s Health Insurance Program (CHIP), and another person is required by court order to give medical support to the child. In this case, you don’t have to pay the penalty for the child.

• As a result of an eligibility appeals decision, you’re eligible for enrollment in a qualified health plan (QHP) through the Marketplace, or lower costs on your monthly premiums, or cost-sharing reductions, for a time period when you weren’t enrolled in a QHP through the Marketplace.

• You were found not to be eligible for Medicaid because your state didn’t expand its Medicaid program.

How do I apply for an exemption?
How you apply—and even if you need to apply—depends on which exemption fits your situation.

For an exemption based on coverage being unaffordable, membership in a health care sharing ministry, membership in a federally-recognized tribe, or being incarcerated, you have 2 options to apply:

• Claim these exemptions when you fill out your 2014 federal tax return, which is due by April 15, 2015

• Fill out an exemption application in the Health Insurance Marketplace

Note: If you get an exemption because coverage is unaffordable based on your expected income, you also may qualify to buy catastrophic coverage through the Marketplace. This may be more affordable than your other options.

How do I apply for an exemption? (continued)

For an exemption based on membership in a recognized religious sect whose members object to insurance, eligibility for services through an Indian health care provider, or one of the “hardship” exemptions:

• Fill out an exemption application in the Health Insurance Marketplace

For an exemption if your income will be low enough that you won’t be required to file taxes:

• You don’t need to apply for an exemption. This is true even if you file a federal tax return to get a refund of money withheld from your paycheck. You won’t have to pay this fee.

For an exemption if you have a gap in coverage of less than 3 months, or if you’re not lawfully present in the U.S.:

• You don’t need to apply for an exemption. The Internal Revenue Service will handle this when you file your taxes.

Where can I get more information?

Visit HealthCare.gov, or call the Health Insurance Marketplace call center at 1-800-318-2596 for more information. TTY users should call 1-855-889-4325.

Source: Department of Health and Human Services, Health Insurance Marketplace

 

Enroll your client(s) into the MBPA/MFBA today and receive instant value, financial savings, and important health care reform tools that you and your clients need as you navigate together through health care reform.

The Michigan Business & Professional Association (MBPA) and Michigan Food & Beverage Association (MFBA) has been expanding the resources we offer so “Now is the Time” to make all of your clients members.

• Special $120.00 Membership Dues Rate – Enroll your clients for just $120.00 annually!

• Health Care Reform Connect™ – This web-based platform with various compliance tools and timely     e-communications will keep you and your client’s knowledgeable about health care reform. Plus – New tools, resources and compliance information is shared frequently.

• ERISA/DOL Compliant Summary Plan Descriptions – Our fully compliant SPDs are available to Members at no charge.

• Affordable COBRA Administration – We offer a low monthly fee through our valued program partner BASIC to help members with COBRA compliance.

• Compliance Resources available – The MBPA can provide the necessary documents, checklists and guidance to help keep your clients compliant with the ACA, ERISA, DOL, etc.

 

 

Membership Programs:

1. NEW – Every Member Counts! Our new quarterly contest gives you credit for each client you enroll as a member. We will tally up your enrolled clients and send a bonus to you each quarter.

2. True Blue – Receive a $250.00 incentive for each 10+ member group signed up with MBPA or MFBA and BCBSM. Clients must be new to MBPA/MFBA and BCBSM.

Qualifications for 10+ Membership Incentive Bonus:

• We must receive a copy of the groups completed membership application with dues payment AND a copy of the group’s completed Part C Agreement (Showing the number of employees) to qualify for the incentive.

• Send all membership applications and Part C agreement paperwork to our Client Services Department at:info@michbusiness.org or to Jennifer Werner at jwerner@michbusiness.org.

The Michigan Business and Professional Association (MBPA) through its health care reform website, Health Care Reform Connect, have been fielding thousands of Affordable Care Act/Marketplace questions.  We have learned that some of these questions are frequent and have been posting them on our health care reform website, which is solely dedicated to getting you the answers you need as you navigate the new health care law.

We wanted to share some newer frequently asked questions, in hopes of possibly answering some questions that you may have, or may come across in the future.  As always, our government relations team is ready to assist with any questions or concerns relating to the Affordable Care Act/Marketplace.

Frequently Asked Questions:

Q: My employer offers health benefits but doesn’t contribute much toward the premium. I can’t manage to pay for my share. Can I submit an application for coverage and subsidies in the Marketplace instead?
A: You can always shop for health coverage in the Marketplace. However, if you’re offered employer health benefits, you can’t be eligible for premium tax credits in the Marketplace unless your employer coverage is considered unaffordable. If your share of the premium for self-only coverage in your employer plan is 9.5% or more of your household income, it is considered unaffordable, and you can apply for premium tax credits in the Marketplace.

Q: When can my eligible employees enroll in Medicaid through the Marketplace?
A: They can enroll in Medicaid or CHIP at any time during the year, not just during Open Enrollment.

Q: I work for a large employer, and they offer health benefits to me. My husband works and has coverage through his job as well. To figure out whether my coverage is affordable, do I just count my income or do I count my husband’s salary, as well?
A: If you are considering applying for premium tax credits for coverage in the Marketplace, the test for whether your employer coverage is affordable is based on the cost of self-only coverage in the lowest cost plan your employer offers, compared to your household income (and not just your salary).

Q: I work part-time for a large employer. Is my employer required to offer me health benefits? What about benefits for my spouse and kids?
A: No, large employers are not required to offer health benefits to part time employees and there is no penalty for large employers that don’t offer health benefits to part-time employees or their dependents. If you work part-time and you are not offered health benefits, you (and your family) can apply for coverage in the Marketplace; and, if your income is between 100% and 400% of the federal poverty level, you can apply for a premium tax credit that may reduce the cost of coverage in the Marketplace.
Note that a part-time employee is one that works, on average, fewer than 30 hours per week. If your hours vary during the year, your employer may have some options in determining your status as a full-time or part-time worker. Your employer can tell you whether you are a full or part-time worker.

Q: My family isn’t eligible for subsidies in the Marketplace because I am eligible for self-only coverage at work that is considered affordable. We do not have the funds to buy Marketplace coverage on our own. Will I have to pay a penalty because my family members are uninsured?
A: No you will not. Since the amount you would have had to pay to actually cover your spouse and kids was more than 8% of your family income, they won’t be penalized for not having health coverage.

MBPA continues to strive to keep you up to date as you navigate through health care reform.  If you have any questions you need answered, please contact our team.

Keep Fit to Count as New Enrollment

Recently, you and your customers were notified that Blue Cross® Blue Shield® of Michigan (BCBSM) will sunset all Keep Fit policies as of 12-31-14.  To encourage a successful transition into a qualified health plan (QHP), the Blues would like to offer you the opportunity to enroll your Keep Fit members in a Blue QHP as New to Blue business.  What does that mean?  The individual bonus applies!  You have the chance to make up to $300 per MEMBER for all 2015 enrollments.  If you have questions about your Keep Fit members, please contact a member of the Action Benefits Individual Team at myblue@actionbenefits.com or 248-356-8585.

CMS regulations prevent all carriers from collecting any type of pre-enrollment materials at this time; however, we encourage you to review the Blues 2015 MyBlue Product Comparison and begin discussions with your Keep Fit members to ensure a smooth transition.  

MyBlue Product Comparison
2015 Plan Comparison

New Individual Member Incentives

Below are important details regarding the Blues’ new Individual Member Incentives.  For a complete list of guidelines and additional details, please review the 2015 Agent Commissions and Incentives Guide.

• Agents must register at http://www.bcbsm.com/newsletter/IBU/New_Business.shtml to be eligible for the new member incentives.  Even if you have already registered, we encourage you to confirm your bonus eligibility by attempting to register.

• Agents must submit their 2015 FFM certificates and other required information to the Blues to receive the incentive for on-marketplace enrollments.  If not certified, marketplace members will not be commissionable or counted towards the incentive.

• Agents must enroll active business under their own agent ID numbers. Rollups are not allowed.

• Producing agents must actively facilitate their members’ enrollments to maintain AOR status.

• Incentive programs exclude web-based entities.

• New business incentives will be paid the month after the effective month, following the receipt of the member’s full first month’s premium. Member count is calculated when premium is paid.

Earn Additional Bonus Dollars With CoverageforOne
Save time and make even more money by using your very own customized CoverageForOne website to enroll members.  For each off-marketplace enrollment submitted via CoverageForOne, you will receive a $5.00 bonus payment.  

Some details:

• Agents must enroll business using their CoverageForOne website code to their agent ID number.
• Enrollments include both medical and/or dental policies.
• One $5.00 bonus payment allowed per contract during any six-month period.
• Incentive program excludes web-based entities.

Enrollment bonus payments will be issued following the second month after the contract effective date, once the member has paid their first and second month premiums.

Maintain Your Book of Business
You have worked hard to build your book of business, and the Blues want to ensure that you keep it.  Unlike other carriers who have offered to release you as agent of record (AOR) if they directly enroll YOUR members, the Blues will continue to support you as AOR.  If one of your active member’s contacts the Blues’ activation center, we will verify AOR status.  If the member has an assigned agent, we will share your contact information with the member so that you may continue to actively facilitate their enrollment.

The Blues will encourage this process for the entire 2015 open enrollment period, however, it should be noted that if your member is looking to change their plan with a January 1, 2015 effective date (Keep Fit members included), they must do so by December 15, 2014.  During the week of December 7th only, if an active member contacts the Blues’ activation center to change plans, in an effort to prevent any lapse in coverage, the HPA will facilitate the member’s enrollment, and you will not be retained as AOR.  We recommend that you reach out to all of your members at the beginning of open enrollment, if not sooner, to review their options so that they can make an informed and confident decision prior to December 7th.  All correspondence from BCBSM to your clients lists your contact information, and directs them to contact you for assistance.

In addition, now that the marketplace is consistently sending the agent’s NPN back to the Blues with enrollments, they will no longer be accepting the Health Insurance Marketplace Enrollment Confirmation Form.  This change is effective immediately.

AOR Reminders
As a reminder, below are the guidelines to obtain/retain AOR status.
Enrollment Type    If…   Then…

New to Blue Enrollment During Open Enrollment
Agent may obtain AOR by actively enrolling the member on- or off-marketplace.

Outside Open Enrollment
Agent may obtain AOR by actively enrolling the member on- or off-marketplace due to qualifying event.

Member Enrolls On- or Off-Marketplace With or Without Agent Assistance    
Agent may obtain AOR if NPN/5-digit agent ID is captured at time of enrollment.

Existing Blue Member – Change in Member’s Benefits

Agent may obtain AOR by actively enrolling the member into a different plan on- or off-marketplace.

No Change in Member’s Benefits    No AOR update allowed.

Member Takes No Action During Open Enrollment

Agent will remain AOR both on- or off-marketplace as long as member remains active.
Member Changes benefits On- or Off-Marketplace Without Agent Assistance    Agent may obtain AOR if NPN/5-digit agent ID is captured at time of enrollment.
Group to Individual Member    Agent Submits Drop Notification Form     Agent may retain AOR for all members within the group regardless of enrollment channel unless member actively enrolls through another agent.

Agent Does Not Submit Drop Notification Form    Agent may obtain AOR by actively enrolling the on- or off-marketplace.

To actively enroll a member is defined as facilitating the member’s enrollment in its entirety, and ensuring agent NPN and/or 5-digit agent ID code has been captured upon submission.

Note: Existing Blue members originally enrolled directly with the Blues are eligible for an agent to become AOR if the agent actively facilitates a change in the member’s benefits and is coded properly on the new application.

The Department of Labor (DOL) and the Internal Revenue Service (IRS) are both increasing their enforcement efforts with random audits and imposing considerable financial penalties when they discover that a worker has been classified incorrectly.

It is crucial that business owners correctly determine whether the individuals providing services are employees or independent contractors.  In most cases, you must withhold income taxes, withhold and pay Social Security and Medicare taxes, and pay unemployment tax on wages paid to an employee. You do not normally have to withhold or pay any taxes on payments to independent contractors.

Getting it right the first time and avoiding unintended penalties will save you much time and money. Please see below for some helpful tips from the IRS website: (http://www.irs.gov/Businesses/Small-Businesses-&-Self-Employed/Independent-Contractor-Self-Employed-or-Employee)

Determining Whether the Individuals Providing Services are Employees or Independent Contractors
Before you can determine how to treat payments you make for services, you must first know the business relationship that exists between you and the person performing the services. The person performing the services may be:

• An independent contractor
• An employee (common-law employee)
• A statutory employee
• A statutory non-employee

In determining whether the person providing service is an employee or an independent contractor, all information that provides evidence of the degree of control and independence must be considered.

Common Law Rules
Facts that provide evidence of the degree of control and independence fall into three categories:

1. Behavioral: Does the company control or have the right to control what the worker does and how the worker does his or her job?

2. Financial: Are the business aspects of the worker’s job controlled by the payer? (these include things like how worker is paid, whether expenses are reimbursed, who provides tools/supplies, etc.)

3. Type of Relationship: Are there written contracts or employee type benefits (i.e. pension plan, insurance, vacation pay, etc.)? Will the relationship continue and is the work performed a key aspect of the business?

Businesses must weigh all these factors when determining whether a worker is an employee or independent contractor. Some factors may indicate that the worker is an employee, while other factors indicate that the worker is an independent contractor. There is no “magic” or set number of factors that “makes” the worker an employee or an independent contractor, and no one factor stands alone in making this determination. Also, factors which are relevant in one situation may not be relevant in another. The keys are to look at the entire relationship, consider the degree or extent of the right to direct and control, and finally, to document each of the factors used in coming up with the determination.

Form SS-8
If, after reviewing the three categories of evidence, it is still unclear whether a worker is an employee or an independent contractor, Form SS-8, Determination of Worker Status for Purposes of Federal Employment Taxes and Income Tax Withholding (PDF) can be filed with the IRS. The form may be filed by either the business or the worker. The IRS will review the facts and circumstances and officially determine the worker’s status.

Be aware that it can take at least six months to get a determination, but a business that continually hires the same types of workers to perform particular services may want to consider filing the Form SS-8.

Employment Tax Obligations
Once a determination is made (whether by the business or by the IRS), the next step is filing the appropriate forms and paying the associated taxes.
• Forms and associated taxes for independent contractors
• Forms and associated taxes for employees

Employment Tax Guidelines
There are specific employment tax guidelines that must be followed for certain industries.
• Employment Tax Guidelines: Classifying Certain Van Operators in the Moving Industry
• Employment Tax Procedures: Classification of Workers within the Limousine Industry

As always, our government relations team is ready to help and answer any questions you may have. We also welcome your feedback!  Our contact information:  email: bbochniak@michbusiness.org or by phone: (888) 277-6464.