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.