The "Plans" section stores and displays employer sponsored Health Insurance Plans.
It is important to add each plan by calendar year, even if the plan is not based off of a calendar year.
When determining minimum value and affordability, the IRS calculates against the employee monthly contribution cost.
Adding a Plan
If a plan has multiple contribution rates, each must be added as it's own unique plan.
Example: Plan X has a $150 and a $200 employee contribution based on a qualifying factor. Plan X would have to be set up twice for required IRS tracking. This is often seen in age-banded plans.
Plans can be added manually or by "Import Wizard".
To add manually: select "Add new record".
Plan Name: Input a unique plan name. Include the plan year in the description for ease of tracking
Example: Gold Plan 2017, Exclusive Plan 2017, HMO 2017, PPO 2017
Carrier: Enter the name of the benefit provider for the plan. Example: Aetna or Blue Cross Blue Shield.
Min Coverage: Check this box to indicate if the employer sponsored health plan meets minimum essential coverage. Minimum essential coverage (MEC) is a key component of the Affordable Care Act. Health-insurance coverage that meets the minimum standard of the small- or large-group market within the state is considered to offer minimum essential coverage (MEC).
Min Value: Select this box to indicate if the plan meets minimum value. An employer-sponsored plan provides minimum value if it covers at least 60 percent of the cost of medical expenses
Waiting Period Type: From the drop down menu, select the measurement of time an employee must wait before being able to participate in company benefit offerings. Drop down options include: Days, Weeks or Months. The timeframe is determined by the employer.
Waiting Period: Enter the number of days, weeks or months of the waiting period.
Waiting Period Begins on Following Calendar Month: Check this box if the waiting period begins the first day of the month following the month of employment.
Example – An employee is hired at any time during the month of July and eligible for benefits effective August 1.
Start Date: Enter the start date of the health insurance plan year
End Date: Enter the end date of the health insurance plan year
Annual Cost: Enter the annual cost of the plan. This field is not required. It is informational only.
Monthly Cost: Enter the monthly cost of the plan for the Employee Only Tier.
If the total monthly cost is variable, input each month’s cost in the month field grid. If the plan is not a calendar year plan, the months will display based on the actual plan year. Calendar Year and Non-Calendar year plans, reference the plan start date field.
Non-Calendar Year Plan with variable costs by month:
Select all the available coverage tiers associated with the plan. This includes:
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