Will I receive a new ID card?

No, you will not receive a new ID for the extension.

Will I be credited for any use of deductible or out of pocket expenses during the period of extension?

On January 1, 2014, the deductible and out of pocket amounts for your 2013 health plan will reset to zero, as they would at the beginning of any plan year. If you have selected the same carrier for your 2014 Vermont Health Connect plan, any deductible and out of pocket amounts accumulated from January 1, 2014 until the end of the extension period will apply to your 2014 Vermont Health Connect plan.

My employer offered the full menu of plan options through Vermont Health Connect; how does this announcement impact me?

You will have your current 2013 health plan extended until the premium processing and payment functions of Vermont Health Connect are available. Once those functions are available, your choice for 2014 Vermont Health Connect coverage will be honored and new plans will begin. Your employer will be notified as soon as the premium processing and payment functions are available.

I’m a sole-proprietor with no employees; does this impact me?

Due to changes in federal law, most sole-proprietors will no longer purchase health insurance as a business in 2014. Rather, you will purchase individual or family coverage. This applies to sole-proprietors without employees or whose only employee is a spouse. While your situation is different from a small business, you also have the option to extend your current health coverage plan. You should have received a notice from your insurance carrier explaining your options in early November. If you did not respond, your current 2013 insurance plan has already been extended through March 31, 2014. You can enroll in an individual or family plan through Vermont Health Connect prior to December 23rd for coverage that takes effect on January 1, or any time thereafter to obtain your new coverage. To ensure you obtain coverage effective April 1, 2014 and avoid a lapse in coverage, you must enroll no later than March 15th, 2014.

I am offering coverage for the first time through Vermont Health Connect. What are my options?

You should immediately inform your employees that their Vermont Health Connect plan start date has been delayed. However, they will not have a gap in coverage. The employee then has two choices for this interim period between January 1 and up to March 31: 1. Contact their carrier and extend their current individual plan up through March 31, 2014. 2. Enroll now through Vermont Health Connect as an individual/family. They can enroll on-line at Vermonthealthconnect.gov or by phone by calling our toll-Free Customer Support Center at 1-855-899-9600.

Will my billing cycle change if my plan is extended?

No. Billing for January will follow the same schedule you currently have with your insurance carrier.

Who should I call with questions around the extension of my 2013 plan?

Contact your insurance carrier directly. Blue Cross Blue Shield: 1-800-255-4550, www.BCBSVT.com/exchangebenefits MVP Health Care: 1-888-687-9872, www.DiscoverMVP.com

I have elected to offer Dental Insurance to my employees for 2014, what does this mean for them?

Your employees will be enrolled in their dental plan selection and you will be billed directly by Delta Dental.

What will happen to the deductible and out of pocket limits for the extension period? Will my employees be credited for any use of deductible or out of pocket expenses during the period of extension?

On January 1, 2014, the deductible and out of pocket amounts for your 2013 health plan will reset to zero, as they would at the beginning of any plan year. If your employees have selected the same carrier for their 2014 Vermont Health Connect plan, any deductible and out of pocket amounts accumulated from January 1, 2014 until the end of the extension period will apply to their 2014 Vermont Health Connect plan.

What are Cost-Sharing Reductions?

If you purchase coverage as an individual (not through your employer) and your household income is less than 300% FPL ($34,470 for an individual or $70,650 for a family of four), you may be eligible for help to reduce your out-of-pocket medical expenses. In order to qualify for these cost-sharing reductions, you must purchase a silver-level plan on Vermont Health Connect.

What happens if I start offering coverage with 49 full-time employees and later hire more?

If a small employer (50 or fewer employees) offers coverage to employees through Vermont Health Connect and then hires over 50 full-time employees, the business will still be treated as a small employer, and therefore continue to offer coverage through Vermont Health Connect, until the employer no longer chooses to offer an employer plan.

If a business does not offer health insurance and its employees buy health plans through Vermont Health Connect on their own, can the business still contribute to an HSA?

Yes. Both Blue Cross Blue Shield of VT and MVP Health Care offer high deductible health plans through Vermont Health Connect that may be paired with HSAs. For more details on HSAs, FSAs, and HRAs, please visit Vermont Health Connect's Tax-Favored Accounts Fact Sheet.

What happens to me if my business decides not to offer health coverage to my employees?

Depending on the size of your business, you might be subject to a state assessment, a federal assessment (starting in 2015) or both. If your business has fewer than 50 full-time equivalent employees (“FTEs”), then you will not be obligated to pay a federal assessment if you choose not to offer health coverage. Like larger businesses, however, you will still be required to pay a Vermont assessment of approximately $40 per month for each uncovered FTE, just as you did in past years – although there is no penalty for the first four uncovered FTEs. Because many small businesses are accustomed to contributing hundreds of dollars per employee per month toward the cost of health care, the decision to drop coverage might leave you with considerably more money on your balance sheet. That, in turn, will lead to more choices. Do you increase employee compensation? If so, do you do so in the form of bonuses or other perks? These decisions will vary from employer to employer based on their particular circumstances. Businesses with 50 or more FTEs will be subject to a federal assessment for not offering adequate coverage beginning in 2015. It is important to note that whether an employer is subject to this assessment depends on the number of its FTEs, as defined by the IRS. This is not the same as determining if your business qualifies as a small business in Vermont. In other words, a business that employs 40 full-time workers and 40 half-time workers would be considered a small business for the purpose of qualifying to use Vermont Health Connect, but might not be considered a small business for the purposes of avoiding the federal assessment for not offering coverage. If you are unsure how to count your employees, consult the IRS or an attorney.

What happens to my employees if I decide not to offer health coverage?

If you decide not to offer health coverage, your employees and their families will be able to purchase coverage through Vermont Health Connect. If they need help doing so, they can use the Vermont-based call center or certified Navigators. Employees in most Vermont households that use Vermont Health Connect (those with incomes up to 400 percent of the federal poverty level or $94,200 for a family of four) will be eligible for premium tax credits and/or cost-sharing subsidies to help pay for out-of-pocket costs. These two forms of financial assistance are not available to Vermonters in employer-sponsored plans.

If I decide to offer health coverage, is there a minimum contribution that I am required to make?

In Vermont in 2014, there is no minimum employer contribution requirement. However, in order to receive the federal small business tax credit, the employer must offer at least a 50% contribution to employee premiums. In addition, business owners will want to consider the impact on their employees. Because an offer of health coverage could prevent an employee from receiving tax credits that she could otherwise qualify for, an employee might be better off with no offer of coverage at all than she'd be with a small contribution from her employer.

How will the health coverage work if I decide to keep coverage for my employees?

Small business employers who participate in Vermont Health Connect will have the option of choosing between different plan menus. In the Blue Cross Blue Shield or MVP menu, the employer selects a single insurer and decides how much to contribute, then each employee can select any tier of qualified health plan from that provider. In the other option, the “full menu," employees can select any plan from any insurer. Regardless of which menu you choose, you will only have to pay one bill each month. Vermont Health Connect will aggregate all of your employees’ premiums, calculate your contribution, then divide and disburse your contribution to each of the insurance companies.

What types of businesses do you expect to keep offering coverage? What types will drop?

A village market staffed by lower and middle-income employees (up to 400% of federal poverty level, or household income of $94,200 for a family if four) might consider dropping coverage in order to allow the employees to take advantage of federal tax credits. A law firm with high-income partners, on the other hand, might decide to continue their employer-sponsored insurance. Businesses with a mix of employee incomes will have a tougher decision. These businesses will likely want to consult Vermont Health Connect’s decision tools, such as the Small Employer Estimator, or have a certified Navigator or registered brokers walk through the process of deciding what is best for each of their particular situations.

My business qualifies as a small business. Should I offer coverage to my employees, or not?

For the 47% of Vermont small businesses that offer insurance, the keep-drop question is a critical one. Unfortunately, there is not a one-size-fits-all answer. The State cannot determine what is best for your business and your employees. Vermont Health Connect offers tools such as the Small Employer Estimator to help you decide whether to renew group coverage. If you decide to renew, these tools – along with certified Navigators and registered brokers – can help you determine which plans to renew and how to do it. Visit Vermont Health Connect’s website for more information. If you are among the 53% of Vermont small businesses that don’t offer insurance, you are able to use these same tools to decide whether to start offering employer sponsored insurance through the Exchange. What other questions should I ask as I decide whether to keep or drop coverage? Here are some major questions for an employer to consider: Do you offer insurance today? How much do you spend today on insurance? How much do your employees spend on insurance today? Would your employees be better off purchasing insurance through VHC than under your current plan? Would you be subject to the federal penalty? Cost? Would you be subject to a state assessment? Cost?

Who counts as a seasonal employee?

Seasonal employees are defined as employees who work fewer than 120 days during the year.

How can I determine if my business qualifies to use Vermont Health Connect?

For the purposes of qualifying to use Vermont Health Connect in 2014, a business is a small business if it employs 50 or fewer full-time employees. An employee is a full-time employee if she works 30 or more hours per week. Anyone who works less than 30 hours per week is not counted.

I need help understanding Vermont Health Connect and how it works.

How do I know which plan is right for my business and/or my employees?

I've heard that many businesses are required to tell their employees about health insurance options before October 1, but I'm not sure 1) if this requirement applies to my business, 2) what exactly I'm supposed to tell my employees, and 3) whether this means that I need to decide this month whether to offer coverage in 2014?

VermontHealthConnect.gov can help you answer all three questions.  First of all, yes, the Fair Labor Standards Act (FLSA) requires applicable employers to provide employees with a written notice of their health insurance coverage options by October 1, 2013. Our Employee Notices page explains which businesses are subject to the requirement.

Regarding what the notice needs to include, our Employee Notices page has a list of requirements as well as links to sample notices for you to download and adapt.

Finally, rest assured that you are not are not required to declare if you will be offering insurance in 2014, only what you are currently offering. While we encourage you to make your decision about 2014 coverage over the course of the next several weeks in order to give your employees plenty of time to make their decisions, you certainly don't have to make this decision by October 1 and you are not required by the FLSA to do so.
 

FLSA Employee Notices: healthconnect.vermont.gov/notices

More Vermont Health Connect FAQs: healthconnect.vermont.gov/about_us/faq

When will the rates and plan designs be final?

The rates and plan designs are final and now posted on the Vermont Health Connect website.  Click HERE for details.

Can an employee choose to opt-out of the employer-offered plan and go into the Exchange as an Individual and get government subsidies and tax credits?

Employees may choose to opt-out of their employer plan and enter the Exchange as an Individual but the only way they will get government subsidies and tax credits is if their employer plan is determined unaffordable.

If an employer has employees in other states (NJ, MD, etc.), can the employee of a Vermont employer can get their insurance in Vermont or their home state? Would the employer pay a bill from the other state’s Exchange?

Vermont employers will be able to offer their out-of-state employees plans through Vermont Health Connect. It’s up to employers to make sure the plan options they pick for their employees covers the network out-of-state employees will utilize. Employers can also offer plans on out-of-state Exchanges (where the employee resides), if the plans on Vermont Health Connect lack necessary networks.

Can a business that decides not to offer coverage still get help paying for a broker who comes into to help employees sign up individually?

Yes.  At the very least, individuals could be invoiced and bring in their broker invoices to their employer for them to pay, if an employer agrees.  We will work with the selected TPA to find a more simplified and direct way to bill the employer who makes this choice.  

Must a small employer continue to offer employer-sponsored health coverage through Vermont Health Connect?

No, a small employer does not have to continue offering coverage.  A small employer could choose to stop offering employer-sponsored coverage and their employees may be eligible for coverage as Individuals in Vermont Health Connect. If interested in continuing employer-sponsored coverage, small employers may only purchase coverage through Vermont Health Connect in 2014. 

Will sole proprietors use Vermont Health Connect as individuals or as employers? What about their family members who may also be employees?

Sole proprietors are considered individuals and will access health coverage through Vermont Health Connect accordingly. Family members who are employees will also access coverage as individuals.  If a sole proprietor has one or more employees who are not family members, he/she may sponsor employer coverage for the non-family member employees. If the sole proprietor offers coverage to all of his/her full time employees, the sole proprietor and his/her family may participate in the employer plan (assuming the employer meets all other eligibility criteria). 

Can an employer differentiate their contributions to a single versus family plan?

Yes.

For employer contributions, can they be a percentage of plan costs or a fixed dollar amount?

Only fixed dollar amounts are allowed with Vermont Health Connect plans.

When an employer determines the plans they will offer to employees, can they choose to fund just one specific plan?

No.  An employer can only choose: 

1) offer all plans from one carrier, or 
2) offer all plans from both carriers.

Will the employer assessment change in 2014?

The Administration is not proposing a change in the employer assessment for 2014. The federal Affordable Care Act is changing some of the ways we access – and pay for - health care in Vermont, but the philosophy that health care is a shared responsibility is not changing. Businesses, individuals and families all contribute to the cost of health care in the current system and will all continue to do so in 2014 and beyond.

This is not to say that all contribute equally. In fact, businesses that provide health care spend an average of more than $550 per enrolled employee each month. Businesses that contribute via the employer assessment, on the other hand, pay less than $40 per month ($476 per year).
Nonetheless, the current law is a step toward a level playing field between employers who offer health coverage and those who don’t. It also serves to support affordable access to health coverage for low- and middle income Vermonters. Current law applies to employers who 1) do not offer insurance at all, 2) do not offer insurance to all employees, or 3) offer insurance, but the employee(s) doesn’t enroll and is uninsured.

What is the role of brokers and Navigators?

The State is committed to providing small businesses with the support needed to enroll their employees in Vermont Health Connect. Just as today, all businesses will be able use a broker to enroll in a company health plan, whether it’s through Vermont Health Connect or not. Businesses that use Vermont Health Connect to enroll in company health plans will have the additional option of using in-person assisters called Navigators to walk them through the process. Both registered brokers and certified Navigators will be fully trained on Vermont Health Connect.

The State has received federal grant funding to subsidize traditional broker fee payments to support small businesses that want to continue their relationship with their broker. The funding may be utilized to subsidize broker assistance for small group employers with a January 1, 2014 renewal date. In January 2013, the State also received a federal grant to fund the Navigator program.

I own a business in Vermont but employ workers who live in New Hampshire. What does this mean for me?

Vermont employers will be able to offer their out-of-state employees plans through Vermont Health Connect.  It’s up to employers to make sure the plan options they pick for their employees, or that the employee chooses, has health care providers their employees will need in the state they live or work in. Employers can also offer plans on out-of-state Exchanges (where the employee’s primary worksite is located).

It is anticipated that insurance companies will offer the same, or similar, networks in 2014 as they currently offer. Before open-enrollment (beginning October 2013), you will have time to review these plans.

Can I offer employer-sponsored insurance to my managers and let the rest of my staff shop on the Exchange?

No, if you offer employer-sponsored insurance to any full-time employees, then you must offer it to all of your full-time employees (those working 30 or more hours per week).

Are owners included in the employee calculation?

No. Self-employed persons and partners are not employees. They are not included in the employee calculation.

How are employers with a unionized workforce going to provide coverage in 2014?

Use this chart to find your answer. If you have additional questions, please email one of our Navigators

Anissa Lewis - (802) 989-4844 or navlewis2013@gmail.com

Tim Davis - (802( 324-1920 or navdavis2013@gmail.com

Is an employee who uses his spouse’s coverage counted in a businesses’ Full Time Equivalent (FTE) calculation?

Yes, for purposes of determining if an employer is eligible for small group coverage.

What happens if I start offering coverage with 49 full-time employees and later hire more?

If a small employer (50 or fewer employees) offers coverage to employees through Vermont Health Connect and then hires over 50 full-time employees, the business will still be treated as a small employer, and therefore continue to offer coverage through Vermont Health Connect, until it no longer offers coverage to employees through Vermont Health Connect.

What happens to me if my business decides not to offer health coverage to my employees?

Depending on the size of your business, you might be subject to a state assessment, a federal assessment or both. If your business has fewer than 50 full-time equivalent employees (“FTEs”), then you will not be obligated to pay a federal assessment if you choose not to offer health coverage. Like larger businesses, however, you will still be required to pay a Vermont assessment of approximately $40 per month for each uncovered FTE – although there is no penalty for the first four uncovered FTEs.

Because many small businesses are accustomed to contributing hundreds of dollars per employee per month toward the cost of health care, the decision to drop coverage might leave you with considerably more money on your balance sheet. That, in turn, will lead to more choices. Do you increase employee compensation? If so, do you do so in the form of bonuses or other perks? These decisions will vary from employer to employer based on their particular circumstances.

Businesses with 50 or more FTEs will be subject to a federal assessment for not offering adequate coverage. It is important to note that whether an employer is subject to this assessment depends on the number of its FTEs, as defined by the IRS. This is not the same as determining if your business qualifies as a small business in Vermont. In other words, a business that employs 40 full-time workers and 40 half-time workers would be considered a small business for the purpose of qualifying to use Vermont Health Connect, but might not be considered a small business for the purposes of avoiding the federal assessment for not offering coverage. If you are unsure how to count your employees, consult the IRS or an attorney.

What happens to my employees if I decide not to offer health coverage?

If you decide not to offer health coverage, your employees and their families will be able to purchase coverage through Vermont Health Connect.  If they need help doing so, they can use the Vermont-based call center or certified Navigators. Employees in most Vermont households (those with incomes up to 400 percent of the federal poverty level or $94,200 for a family of four) will be eligible for premium tax credits and/or cost-sharing subsidies to help pay for out-of-pocket costs.  These two forms of financial assistance are not available to Vermonters in employer-sponsored plans.

How will the health coverage work if I decide to keep coverage?

Small business employers who participate in the Exchange will have the option of choosing between different models. In one model, the employer selects a single insurer and decides how much to contribute, then each employee can select any tier of qualified health plan from that provider. In the other model, the “full choice” model, employees can select any plan from any provider.

Regardless of which model you choose, you will only have to pay one bill each month. Vermont Health Connect will aggregate all of your employees’ premiums, calculate your contribution, then divide and disburse your contribution to each of the providers.

What types of businesses do you expect to keep offering coverage? What types will drop?

A village market staffed by lower and middle-income employees (up to 400% of federal poverty level, or household income of $94,200 for a family if four) might consider dropping coverage in order to allow the employees to take advantage of federal tax credits. A law firm with high-income partners, on the other hand, might decide to continue their employer-sponsored insurance. Businesses with a mix of employee incomes will have a tougher decision. These businesses will likely want to consult Vermont Health Connect’s decision tools, along with certified Navigators and registered brokers, to walk through the process of deciding what is best for each of their particular situations.

My business qualifies as a small business. Should I offer coverage to my employees or not?

For the 47% of Vermont small businesses that offer insurance, the keep-drop question is a critical one. Unfortunately, there is not a one-size-fits-all answer. The State cannot determine what is best for your business and your employees. What we can, and will, do is develop tools to help you decide whether to renew group coverage. If you decide to renew, these tools – along with certified Navigators and registered brokers – can help you determine which plans to renew and how to do it.

If you are among the 53% of Vermont small businesses that don’t offer insurance, you will be able to use these same tools to decide whether to start offering employer sponsored insurance through the Exchange.

Who counts as a seasonal employee?

Seasonal employees are defined as employees who work fewer than 120 days during the year.

How can I determine if my business qualifies to use Vermont Health Connect?

For the purposes of qualifying to use Vermont Health Connect in 2014, a business is a small business if it employs 50 or fewer full-time employees. An employee is a full-time employee if she works 30 or more hours per week. Anyone who works less than 30 hours per week is not counted. 

Vermont Businesses for Social Responsibility(VBSR), Vermont Retail Association(VRA) & Vermont Medical Society(VMS) have teamed up!

These associations will be working together to provide Vermont businesses and their employees with the knowledge and tools needed to compare and choose a quality, affordable, and comprehensive health plan as the state transitions to Vermont Health Connect.  

As a group, we have a strong track record of working together to serve small business and we welcome the opportunity to work as a strategic partner with Vermont Health Connect, and coordinate with other Navigator Organizations to fulfill the goals of the project.