Open Enrollment 2015

     The 2015 Open Enrollment Period is rapidly approaching, November 15^th, 2014 – February 15^th , 2015.  I will be contacting you during this time to ensure your health insurance needs are taken care of.  If a change in carrier or benefits needs to be made, this will be the time to do it.  To ensure my clientele is handled properly and in a timely manner, I am releasing the below information highlighting the “need to knows.”  Please take a few minutes to read the information and come up with any questions or concerns you may have regarding your unique situation.  Premiums under the Patient Protection and Affordable Care act are expected to increase by an average of 7.5% in 2015 (PricewaterhouseCoopers Health Research Institute).   The highest proposed rate increase thus far came in Nevada, where consumers might see their premiums rise by 36%.  Planning for 2015 is a necessity.

     I ask that you please take into consideration your Friends, Family, and Business networks relative to the below information.  Referrals are the best way to expand the business and help improve the lives of other individuals.  We will be working with On (subsidized) and Off (no tax credit) Exchange Policies again for 2015.  Mosaic Employee Benefits established a goal of helping 100 new families between November 2014 and February 2015.  With your help, we can make that possible.  Keep in mind we also work with and offer Employer Sponsored Plans!

State Licenses: Ohio, Michigan, South Carolina, Kentucky, and Texas

Individual Health Insurance Carriers: Aetna, Anthem, Assurant, Blue Cross Blue Shield, Celtic, Cigna, IHC short term,  Golden Rule / United Health One, Humana, InHealth Mutual, Medical Mutual, Priority Health

Eric M. O’Brien

7650 Rivers Edge Drive

Columbus, Ohio 43235

614.431.4302

OPEN ENROLLMENT: NOVEMBER 15^th 2014 – FEBRUARY 15^th 2015

As of November 15, 2014, we may access the Federally-facilitated Marketplaces to enroll consumers in Individual Marketplace and Small Business Health Options Program (SHOP) plans for the 2015 plan year.  Please pay special attention to the rules and regulations, some of which have changed for 2015. This Open Enrollment Period applies to all individuals who do not receive their health insurance through their employer, tax credit/subsidy or no tax credit/subsidy!

When Enrollments Take Effect During The Initial Enrollment Period (*may vary by carrier)

Enrollment Selection Received                    Date Insurance Begins

11/15/14 – 12/15/14                                         January 1^st 2015

12/16/14 – 1/15/15                                           February 1^st 2015

1/16/15-2/15/15                                                March 1^st 2015

2014 Tax Year

·         The annual individual shared responsibility payment is the greater of

o    1% of the taxpayer’s household income that is above the tax return filing threshold for the taxpayer’s filing status, or

o    The taxpayer’s flat dollar amount, which is $95 per adult and $47.50 per child, limited to a family maximum of $285.

·         However the total payment amount is capped at the cost of the national average premium for a Bronze level health plan available through the Marketplaces in 2014.

2015 Tax Year

·         The annual individual responsibility payment is the greater of

o    2% of the taxpayer’s household income that is above the tax return filing threshold for the taxpayer’s filing status, or

o    The taxpayer’s flat dollar amount, which is $325 per adult and $162.50 per child, limited to a family maximum of $975.

·         However the total payment amount is capped at the cost of the national average premium for a Bronze level health plan available through the Marketplaces in 2015.

***The calculations above represent the amount of the payment for not having health insurance coverage for the entire year. Individuals will owe 1/12^th of the annual payment for each month they (or their dependents) do not have coverage and are not exempt.

Under certain circumstances, an individual may be exempt from the individual responsibility requirement. These circumstances include the following:

·         The individual is uninsured for less than three months of the year

·         The lowest-priced coverage available to the consumer would cost more than 8% of the consumer's household income

·         The individual does not have to file a tax return because his or her income is too low

·         The individual is a member of a federally recognized tribe or eligible for services through an Indian health care provider

·         The individual is a member of a health care sharing ministry

·         The individual is a member of a recognized religious sect with religious objections to insurance, including Social Security and Medicare

·         The individual is incarcerated, and is not awaiting the disposition of charges

·         The individual is not lawfully present in the United States

·         The individual has experienced a hardship (defined below):

ü  Becomes homeless

ü  Has been evicted in the past six months, or is facing eviction or foreclosure

ü  Has received a shut-off notice from a utility company

ü  Recently experienced domestic violence

ü  Recently experienced the death of a close family member

ü  Recently experienced a fire, flood, or other natural or human-caused disaster  resulting in substantial damage to individual property

ü  Filed for bankruptcy in the last six months

ü  Incurred medical expenses in the last 24 months that resulted in substantial debt

ü  Experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family member

ü  Expects to claim a child as a tax dependent who has been denied coverage in Medicaid and CHIP, and another person is required by court order to give medical support to the child. In this case, the individual would not have to make a payment for the child

ü  As a result of an eligibility appeals decision, is determined eligible for enrollment in a QHP through a Marketplace, the premium tax credit, or cost-sharing reductions for a period of time during which he or she was not enrolled in a QHP through a Marketplace

ü  Was determined ineligible for Medicaid because his or her state did not expand eligibility for Medicaid under the Affordable Care Act

ü  Lost insurance coverage because his or her individual plan was cancelled and believes other available coverage options are unaffordable

ü  Experiences another hardship in obtaining health insurance

Updated Tax Credit Guidelines for 2015 (FPL – Federal Poverty Level)

Household Size	100%	138%	150%	200%	250%	300%	400%
1	$11,670	$16,105	$17,505	$23,340	$29,175	$35,010	$46,680
2	15,730	21,707	23,595	31,460	39,325	47,190	62,920
3	19,790	27,310	29,685	39,580	49,475	59,370	79,160
4	23,850	32,913	35,775	47,700	59,625	71,550	95,400
5	27,910	38,516	41,865	55,820	69,775	83,730	111,640
6	31,970	44,119	47,955	63,940	79,925	95,910	127,880
7	36,030	49,721	54,045	72,060	90,075	108,090	144,120
8	40,090	55,324	60,135	80,180	100,225	120,270	160,360

If Applying for a Tax Credit, the Marketplace verifies data for individuals seeking coverage through the Marketplace, including verification of:

·         Social Security Number (SSN) (if applicant has an SSN)

·         Citizenship or lawful presence

·         Incarceration status

·         Membership in a federally-recognized Indian tribe or status as a shareholder in an Alaska Native Corporation (if applicable)

·         Household income for consumers seeking eligibility for insurance affordability programs

o    Annual household income for premium tax credit/cost-sharing reduction eligibility

o    Current monthly household income for Medicaid/CHIP eligibility

·         Access to minimum essential coverage

Individuals enrolling in a QHP through an Individual Marketplace may be eligible for the premium tax credit, which reduces the cost of premiums for themselves and their tax dependents. An individual may choose to apply the tax credit towards QHP premium costs on an advance basis – with reconciliation at the end of the year – or to receive the credit on his or her federal tax return filed for the plan year. Advance payments are paid directly to QHP issuers on a monthly basis.

• Individuals eligible for a premium tax credit who do not receive an advance payment of the premium tax credit may claim the credit on their income tax return filed for the plan year. Individuals who are married at the end of the plan year are required to file a tax return and may not use the “Married Filing Separately” filing status on the tax return to receive a premium tax credit.
• Eligibility for the premium tax credit is based on household income, family size, and access to other minimum essential coverage.
• As a result of the Defense of Marriage Act (DOMA) ruling in 2013, the eligibility rules with respect to the premium tax credit treat same-sex spouses in the same manner as opposite-sex spouses, so long as the taxpayer and his or her spouse do not file a tax return with a filling status of “Married Filing Separately” for the taxable year.

Special Enrollment Period (60days) Qualification – An individual or family may apply for new coverage outside the open enrollment period if they experience:

Termination of Employment¹	Date eligibility for existing Minimum Essential Coverage is lost	Letter from employer on company stationary, letter must verify date of termination
Reduction in Hours Worked¹	Date eligibility for existing Minimum Essential Coverage is lost	Letter from employer on company stationary, letter must verify date of reduction in hours
Divorce¹	Date eligibility for existing Minimum Essential Coverage is lost	Divorce decree
Death of Spouse/Parent¹	Date eligibility for existing Minimum Essential Coverage is lost	Death certificate
Dependent Reaching Limiting Age¹	Date eligibility for existing Minimum Essential Coverage is lost	Benefit book displaying limiting age requirement
No Longer Qualify for Medicaid or CHIP¹	Date eligibility for existing Minimum Essential Coverage is lost	Termination of coverage letter for Medicaid or CHIP, letter must include termination date
Expiration of COBRA benefits¹	Date eligibility for existing Minimum Essential Coverage is lost	Documentation of COBRA expiration, letter must include termination date
Marriage¹ (addition of spouse)	Date of Marriage	Marriage License
Birth² (addition of new child)	Date of Birth	Birth certificate
Adoption² (addition of new child)	Date of Adoption	Adoption papers/Legal Guardianship papers
Placement for Adoption²	Date of Placement	Adoption papers/Legal Guardianship papers
Placement into Foster Home²	Date of Placement	Legal Guardianship papers
New Permanent Resident of Ohio³	Date of Permanent Move	Documentation required for both prior and new address:• Utility bill• Lease agreement• Mortgage paperwork• Letter from employer if move based on employment
Newly Ineligible for Federal Subsidy³	Date Notified of New Eligibility Status	Newly ineligible for subsidy, the individual may apply in the off-exchange market, MM will require termination of subsidy document which must include date subsidy will terminate.
Existing Individual Policy being Terminated¹ (not including termination in case of rescission)	Date Policy will be Terminated	Copy of termination letter which displays date of termination
Existing Individual Policy Renewal Date¹	Date Renewal is Effective	Copy of renewal which displays renewal effective date