Employer Role in Health Exchange Application

Employers should become familiar with the Health Insurance Exchange application, because employers will have to provide certain information as part of the Employer Coverage Tool.

Beginning October 1, 2013, individuals may apply to purchase health insurance through a state-based Exchange with coverage effective January 1, 2014. The application includes an Employer Coverage Tool that is used to determine if the individual is eligible for a subsidy toward the Exchange-based coverage.

The Employer Coverage Tool asks for information about the employer’s health plan eligibility, waiting periods, premiums for coverage, wellness programs, minimum value, and potential changes for the upcoming plan year. Individuals are instructed to take the Employer Coverage Tool to the employer for help in answering the questions, which are required complete the Exchange application process. Requested information includes:

• The employees before-tax wages and frequency of payment;
• Average number of hours worked each week;
• Income changes from month to month and if income is expected to change;
• Eligibility for coverage and waiting period, if any;
• If the employer’s plan meets minimum value;
• How much the employee would have to pay in premiums for self-only coverage under the lowest-cost health plan offered;
• If the employer has a wellness program with incentives, how much the employee would have to pay if he received the maximum discount for any tobacco-cessation program; and
• Changes to the plan contemplated for the new plan year.

Employers should review the form now to make sure they are prepared to answer the questions when the Exchange application process opens in October.