MO educates residents, leaders about ACA
June 7, 2013
KY seeks healthcare navigators
June 11, 2013
MO educates residents, leaders about ACA
June 7, 2013
KY seeks healthcare navigators
June 11, 2013
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Redistribution of Employer Premium Contributions

Article 3 in the ACA Cost Mitigation series
While governmental employers prepare their 2014 health insurance plans to comply with the Affordable Care Act (ACA), one thing about healthcare reform is becoming abundantly clear: Providing affordable coverage to the newly-defined full-time employee will increase employer costs.

Counter measures to combat cost increases will inevitably involve changes to your plan. As part of our cost mitigation series, this article will cover Redistribution of Employer Premium Contributions as one such strategy.

Spousal Coverage Not Mandated
Under ACA, you are obligated to offer coverage to your employees and dependent children, and make employee-only coverage affordable, but there are no mandates requiring spousal coverage.

Spousal Access to Coverage
Statistics show that up to 66% of married couples have dual incomes. Therefore many spouses will have access to affordable plans through their own employment. And for those who are not employed, they will soon have access to health plans through the State or Federal Health Insurance Marketplaces (formerly known as Exchanges). Non-working spouses without access to coverage may even qualify for subsidies such as a premium tax credit and cost-sharing assistance.

Spousal “Carve-Outs”
One way that employers can mitigate the costs under ACA is by redistributing employer premium contributions toward employee-only coverage and away from  spousal coverage.

Possibilities include:

  • Change plan options to include “employee only coverage” and “employee plus child/ren coverage” and exclude “spousal (family) coverage”.
  • Continue to offer spousal coverage, but only if coverage is not available through their own employer.
  • Continue to offer spousal coverage, but charge an additional premium (spousal surcharge).
  • Continue to offer spousal coverage, but reduce or eliminate employer contributions toward those plans.
  • Move to a defined contribution model which specifies a fixed annual employer premium contribution. The employee can pay extra for any extended, “employee-plus” coverage.

Don’t reinvent your health plan every year
Insurance brokers who visit only at renewal time just to take you out to bid yet again are doing you a disservice. Instead, look for agents who partner with you throughout the year and can help you establish a 3-5 year ACA compliant cost-reduction plan.

Crawl. Walk. Run.
Developing a strategic plan doesn’t have to be an overwhelming process, as the early-adopters have already paved the way. The idea is to introduce change slowly, upping the ante every year, to help employees improve health and reduce costs.

For more information on Spousal Carve-Outs, please contact Bill Enright.

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Erin Woulfe
Erin Woulfe
Erin Woulfe likes to write about things that matter. Keeping her finger on the pulse of what’s happening in the public sector world, she blogs about the latest legislative news and employee benefit trends that affect our school, city and county clients. She’s been with NIS since 2002. “I love connecting to our clients and providing them with the tools they need in order to administrate their plan,” says Erin. “Whether that be materials to educate their employees on certain benefits, how to effectively communicate change within an organization or just providing tips and how-to’s to help them make their job easier.”

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