Massachusetts Overview of Health Insurance Marketplaces

Massachusetts Overview of Health Insurance Marketplaces

THIS NOTICE IS REQUIRED BY THE NATIONAL HEALTH REFORM LAW (ALSO KNOWN AS THE AFFORDABLE CARE ACT OR ACA)

This notice is meant to help you understand health insurance Marketplaces, which were set up to make it easier for consumers to compare health insurance plans and enroll in coverage. In Massachusetts, the state Marketplace is known as the Massachusetts Health Connector. Your employer is required by law (§ 1512 of the ACA, which creates 29 U.S.C. 218b) to provide you the information contained in this notice. You may or may not qualify for subsidized health insurance through the Health Connector. If you are offered coverage by your employer that is considered “affordable” and meets a “minimum value” standard according to federal definitions (see below), you most likely will not qualify for the subsidized coverage offered through the Health Connector described in this notice. However, it may still be helpful for you to read and understand the information included here. Please ask your employer for more information if you have questions.

Overview:
As a result of the Affordable Care Act (ACA), there is an easy way for many individuals and small businesses in Massachusetts to buy health insurance: the Massachusetts Health Connector. This notice provides some basic information about the Health Connector, and how coverage available through the Health Connector relates to any coverage that may be offered by your employer. You can find out more by visiting MAhealthconnector.org.

What is the Massachusetts Health Connector?
The Health Connector is our state’s health insurance Marketplace. It helps individuals, families, and small businesses find health insurance that meets their needs and fits their budget. The Health Connector offers “one-stop shopping” to easily find and compare private health insurance options from the state’s leading health and dental insurance companies. Some individuals and families may also qualify for a federal tax credit that lowers their monthly premium right away, as well as cost sharing reductions that can lower out-of-pocket expenses. This tax credit is enabled by §36B of the Internal Revenue Code.

The next open enrollment for individuals and families to buy health insurance coverage through the Health Connector is scheduled to begin on November 1, 2016, and run through January 31, 2017. Individuals and families who experience a qualifying event can shop outside of open enrollment periods. You can find out more by visiting MAhealthconnector.org or calling 1-877 MA ENROLL  (1-877-623-6765).

Can I qualify for federal and state assistance that reduces my health insurance premiums and out-of-pocket expenses through the Health Connector?
Depending on your income, you may qualify for federal and/or state tax credits and other subsidies that reduce your premiums and lower your out-of-pocket expenses if you shop through the Health Connector. You can find out more about the income criteria for qualifying for these subsidies by visiting MAhealthconnector.org or calling 1-877 MA ENROLL (1-877-623-6765)

Does access to employer-sponsored coverage affect my eligibility for help paying for coverage through the Health Connector?
An offer of health coverage from your employer could affect your eligibility for subsidies through the Health Connector. If your income meets the eligibility criteria, you will qualify for subsidies through the Health Connector   if:

1. Your employer does not offer coverage to you, or
2. Your employer does offer you coverage, but:

X Your employer’s offer of coverage for just you (not including other family members) would require you to spend more than a certain percentage of your household income or the coverage your employer provides does not meet the “minimum value” standard set by federal law (which says that the plan offered has to cover at least 60 percent of total allowed costs).

If you have coverage through your employer but are interested in shopping through the Health Connector, be sure to check with your employer on the rules around    how and when you can disenroll from your employer’s group coverage. If you purchase a health plan through the Health Connector instead of accepting health coverage offered by your employer, please note that you will lose the employer contribution (if any) for your health insurance. Also, the amount that you and your employer contribute to your employer-sponsored health insurance is often excluded from federal and state income taxes.

Please note: You can find the most up to date percentages used to calculate affordability here: www.mahealthconnector.org/esi-affordability-calculator.

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EMPLOYER-SPONSORED HEALTH COVERAGE
This section will help you collect information about any health coverage offered by your employer.  If you decide to complete an application for coverage in the Marketplace, you will be asked to provide this information.

Does this employer offer employer-sponsored health insurance coverage that is affordable and meets a minimum value standard (according to federal standards) to at least some of its employees? Note: Whether a plan meets “minimum value” can be found on the plan’s Summary of Benefits and Coverage (SBC).

Check one:       Yes       No

If yes, and if the employee receiving this notice qualifies for such benefits, they can find out more by contacting:  UMass Amherst Human Resources, 325 Whitmore Administration Building, Amherst MA 01003 / AskHR [at] umass [dot] edu (AskHR[at]umass[dot]edu) / telephone: 413.545.6115.

If no, or if employee receiving notice does not qualify for such benefits, the Health Connector can help employees evaluate coverage options, cost and eligibility. Please visit MAhealthconnector.org for more information, including an online application for health insurance coverage.

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