2022 Open Enrollment Checklist

2022 Open Enrollment Checklist

2022 Open Enrollment Checklist

To download this entire document as a PDF, click here: Open Enrollment eBook

This Compliance Overview is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice.  Readers should contact legal counsel for legal advice. 

In preparation for open enrollment, Employers should review their plan documents in light of changes for the plan year beginning Jan 1, 2021. Below is an Employer 2 Open Enrollment Checklist including some administrative items to prepare for in 2020. 

Health plan sponsors should also confirm that their open enrollment materials contain certain required participant notices, when applicable—for example, the summary of benefits and coverage (SBC). There are also some participant notices that must be provided annually or upon initial enrollment. To minimize costs and streamline administration, employers should consider including these notices in their open enrollment materials.


Out-of-pocket Maximum

Effective for plan years beginning on or after Jan. 1, 2014, non-grandfathered health plans are subject to limits on cost-sharing for essential health benefits (EHB). The ACA’s out-of-pocket maximum applies to all non-grandfathered group health plans, including self-insured health plans and insured plans.

  • $8,700 for self-only coverage and $17,400 for family coverage out-of-pocket maximum.
  •  $7,050 for self-only coverage and $14,100 for family coverage HSA Maximum. For 2021 plan years, the out-of-pocket maximum limit for HDHPs is $7,000 for self-only coverage and $14,000 for family coverage. 

Preventive Care Benefits 

The ACA requires non-grandfathered health plans to cover certain preventive health services without imposing cost-sharing requirements (that is, deductibles, copayments or coinsurance) for the services. Health plans are required to adjust their first-dollar coverage of preventive care services based on the latest preventive care recommendations. If you have a non-grandfathered plan, you should confirm that your plan covers the latest recommended preventive care services without imposing any cost-sharing.  

More information on the recommended preventive care services is available through the U.S. Preventive Services Task Force and www.HealthCare.gov.

Health FSA Contributions

The ACA imposes a dollar limit on employees’ salary reduction contributions to a health flexible spending account (FSA) offered under a cafeteria plan. An employer may impose its own dollar limit on employees’ salary reduction contributions to a health FSA, as long as the employer’s limit does not exceed the ACA’s maximum limit in effect for the plan year. 

The ACA set the health FSA contribution limit at $2,500. For years after 2013, the dollar limit is indexed for cost-of-living adjustments. For 2022 plan years, the health FSA limit is $2,850. The DFSA Rollover Maximum is $570. 

  • Communicate the health FSA limit to employees as part of the open enrollment process.

HDHP and HSA Limits for 2022

If you offer an HDHP to your employees that is compatible with an HSA, you should confirm that the HDHP’s minimum deductible and out-of-pocket maximum comply with the 2020 limits. The IRS limits for HSA contributions and HDHP cost-sharing increase for 2022. The HSA contribution limits will increase effective Jan. 1, 2022, while the HDHP limits will increase effective for plan years beginning on or after Jan. 1, 2022.

  • Check whether your HDHP’s cost-sharing limits need to be adjusted for the 2022 limits.
  • If you communicate the HSA contribution limits to employees as part of the enrollment process, these enrollment materials should be updated to reflect the increased limits that apply for 2022.

The following table contains the HDHP and HSA limits for 2022 as compared to 2021. It also includes the catch-up contribution limit that applies to HSA-eligible individuals who are age 55 or older, which is not adjusted for inflation and stays the same from year to year.

Type of Limit20212022Change
HSA Contribution LimitSelf-only$3,600$3,650Up $50
Family$7,200$7,300Up $100
HSA Catch-up Contributions (not subject to adjustment for inflation)Age 55 or older$1,000$1,000No change
HDHP Minimum DeductibleSelf-only$1,400$1,400No change
Family$2,800$2,800No change
HDHP Maximum Out-of-pocket Expense Limit (deductibles, copayments and other amounts, but not premiums)Self-only$7,000$7,050Up $50
Family$14,000$14,100Up $100




Applicable Large Employer Status (ALE)

Under the ACA’s employer penalty rules, applicable large employers (ALEs) that do not offer health coverage to their full-time employees (and dependent children) that is affordable and provides minimum value will be subject to penalties if any full-time employee receives a government subsidy for health coverage through an Exchange.

To qualify as an ALE, an employer must employ, on average, at least 50 full-time employees, including full-time equivalent employees (FTEs), on business days during the preceding calendar year. All employers that employ at least 50 full-time employees, including FTEs, are subject to the ACA’s pay or play rules.

  • Determine your ALE status for 2022
  • Calculate the number of full-time employees for all 12 calendar months of 2020. A full-time employee is an employee who is employed on average for at least 30 hours of service per week.
  • Calculate the number of FTEs for all 12 calendar months of 2021 by calculating the aggregate number of hours of service (but not more than 120 hours of service for any employee) for all employees who were not full-time employees for that month and dividing the total hours of service by 120.
  • Add the number of full-time employees and FTEs (including fractions) calculated above for all 12 calendar months of 2021.
  • Add up the monthly numbers from the preceding step and divide the sum by 12. Disregard fractions.
  • If your result is 50 or more, you are likely an ALE for 2022.

Identify Full-time Employees

All full-time employees must be offered affordable minimum value coverage.  A full-time employee is an employee who was employed on average at least 30 hours of service per week. The final regulations generally treat 130 hours of service in a calendar month as the monthly equivalent of 30 hours of service per week. The IRS has provided two methods for determining full-time employee status—the monthly measurement method and the look-back measurement method.

  • Determine which method you are going to use to determine full-time status
  • The monthly measurement method involves a month-to-month analysis where full-time employees are identified based on their hours of service for each month. This method is not based on averaging hours of service over a prior measurement method. Month-to-month measuring may cause practical difficulties for employers, particularly if there are employees with varying hours or employment schedules, and could result in employees moving in and out of employer coverage on a monthly
  • The look-back measurement method allows an employer to determine full-time status based on average hours worked by an employee in a prior period. This method involves a measurement period for counting/averaging hours of service, an administrative period that allows time for enrollment and disenrollment, and a stability period when coverage may need to be provided, depending on an employee’s average hours of service during the measurement 

Audit FTEs for FMLA Compliance

Audit your FTEs to determine if you have reached or exceeded 50 employees and are required to comply with the Family Medical Leave Act (FMLA) in 2022. Employers covered by the FMLA are obligated to provide their employees with certain important FMLA notices, so both employees and the employer have a shared understanding of the terms of the FMLA leave. Note that FMLA compliance requirements are different from ACA compliance. 

Offer of Coverage 

An ALE may be liable for a penalty under the pay or play rules if it does not offer coverage to “substantially all” (95%) full-time employees (and dependents) and any one of its full-time employees receives a premium tax credit or cost-sharing reduction for coverage purchased through an Exchange. For employees who are offered health coverage that is affordable and provides minimum value are generally not eligible for these Exchange subsidies.  The IRS lowered the 2022 employer health plan affordability threshold, or cost-sharing limit, to 9.61% of an employee’s income. The threshold in 2021 was 9.83%. 

  • Offer minimum essential coverage to all full-time employees
  • Ensure that at least one of those plans provides minimum value (60% actuarial value)
  • Ensure that the minimum value plan offered is affordable to all full-time employees by ensuring that the employee contribution for the lowest cost single minimum value plan does not exceed 78% of an employee’s earnings based on the employee’s W-2 wages, the employee’s rate of pay, or the federal poverty level for a single individual.

Reporting of Coverage

The ACA requires ALEs to report information to the IRS and to employees regarding the employer-sponsored health coverage on Form 1095-C. The IRS will use the information that ALEs report to verify employer-sponsored coverage and to administer the employer shared responsibility provisions (Code Section 6056).

In addition, the ACA requires every health insurance issuer, sponsor of a self-insured health plan, a government agency that administers government-sponsored health insurance programs and any other entity that provides minimum essential coverage (MEC) to file an annual return with the IRS and individuals reporting information for each individual who is provided with this coverage (Code Section 6055). 

  • Determine which reporting requirements apply to you and your health plans
  • Determine the information you will need for reporting and coordinate internal and external resources to help compile the required data for the   1094-C and 1095-C
  • Complete the appropriate forms for the 2020 reporting year. Furnish statements to individuals on or before January 31, 2021 has been extended to March 2, 2021 IRS Notice 2020-76., and file returns with the IRS on or before February 28, 2020 (March 31, 2020, if filing electronically).
ACA RequirementDeadline
1095 forms delivered to employeesJan. 31 (extended to March 2)
Paper filing with IRS*Feb. 28
Electronic filing with IRSMarch 31

Comparative Effectiveness Research Fee (PCORI)

Sponsors of self-funded plans and health insurance issuers of fully insured plans are required to pay a fee each year, by July 31st, to fund comparative effectiveness research. Fees will increase to $2.45 per covered life in 2020 and are next due July 31, 2021.

W-2 Reporting

Healthcare Reform requires employers to report the aggregate cost of employer-sponsored group health plan coverage on their employees’ Forms W-2. This reporting requirement was originally effective for the 2011 tax year. However, the IRS later made reporting optional for 2011 for all employers.

The IRS further delayed the reporting requirement for small employers (those that file fewer than 250 Forms W-2) by making it optional for these employers until further guidance is issued. For the larger employers, the reporting requirement was mandatory for the 2012 Forms W-2 and continues.


Summary of Benefits and Coverage 

The ACA requires health plans and health insurance issuers to provide an SBC to applicants and enrollees to help them understand their coverage and make coverage decisions. Plans and issuers must provide the SBC to participants and beneficiaries who enroll or re-enroll during an open enrollment period. The SBC also must be provided to participants and beneficiaries who enroll other than through an open enrollment period (including those who are newly eligible for coverage and special enrollees).

The SBC template and related materials are available from the Department of Labor (DOL).

  • In connection with a plan’s 2020 open enrollment period, the SBC should be included with the plan’s application materials. If coverage automatically renews for current participants, the SBC must generally be provided no later than 30 days before the beginning of the new plan year.
  • For self-funded plans, the plan administrator is responsible for providing the SBC. For insured plans, both the plan and the issuer are obligated to provide the SBC, although this obligation is satisfied for both parties if either one provides the SBC. Thus, if you have an insured plan, you should confirm that your health insurance issuer will assume responsibility for providing the SBCs.

Grandfathered Plan Notice

If you have a grandfathered plan, make sure to include information about the plan’s grandfathered status in plan materials describing the coverage under the plan, such as SPDs and open enrollment materials. Model language is available from the DOL. 

Notice of Patient Protections

Under the ACA, non-grandfathered group health plans and issuers that require designation of a participating primary care provider must permit each participant, beneficiary and enrollee to designate any available participating primary care provider (including a pediatrician for children). Also, plans and issuers that provide obstetrical/gynecological care and require a designation of a participating primary care provider may not require preauthorization or referral for obstetrical/gynecological care.

If a non-grandfathered plan requires participants to designate a participating primary care provider, the plan or issuer must provide a notice of these patient protections whenever the SPD or similar description of benefits is provided to a participant. If your plan is subject to this notice requirement, you should confirm that it is included in the plan’s open enrollment materials. Model language is available from the DOL.



Group health plan sponsors should consider including the following enrollment and annual notices with the plan’s open enrollment materials. 

  • Initial COBRA Notice 

The Consolidated Omnibus Budget Reconciliation Act (COBRA) applies to employers with 20 or more employees that sponsor group health plans.  Plan administrators must provide an initial COBRA notice to new participants and certain dependents within 90 days after plan coverage begins. The initial COBRA notice may be incorporated into the plan’s SPD.  A model initial COBRA notice is available from the DOL.

  • Notice of HIPAA Special Enrollment Rights

At or prior to the time of enrollment, a group health plan must provide each eligible employee with a notice of his or her special enrollment rights under HIPAA.  This notice may be included in the plan’s SPD.   Model language for this disclosure is available on the DOL’s website.

  • Annual CHIPRA Notice

Group health plans covering residents in a state that provides a premium subsidy to low-income children and their families to help pay for employer-sponsored coverage must send an annual  notice about the available assistance to all employees residing in that state. The DOL has provided a model notice.

  • WHCRA Notice

Plans and issuers must provide notice of participants’ rights to mastectomy-related benefits under the Women’s Health and Cancer Rights Act (WHCRA) at the time of enrollment and on an annual basis.  Model language for this disclosure is available on the DOL’s website.

  • NMHPA Notice

Plan administrators must include a statement within the Summary Plan Description (SPD) timeframe describing requirements relating to any hospital length of stay in connection with childbirth for a mother or newborn child under the Newborns’ and Mothers’ Health Protections Act. Model language for this disclosure is available on the DOL’s website.

  • Medicare Part D Notices

Group health plan sponsors must provide a notice of creditable or non-creditable prescription drug coverage to Medicare Part D eligible individuals who are covered by, or who apply for, prescription drug coverage under the health plan. This creditable coverage notice alerts the individuals as to whether or not their prescription drug coverage is at least as good as the Medicare Part D coverage. The notice generally must be provided at various times, including when an individual enrolls in the plan and each year before Oct. 15th (when the Medicare annual open enrollment period begins).  Model notices are available on the Centers for Medicare and Medicaid Services’ website.

  • HIPAA Privacy Notice

The HIPAA Privacy Rule requires covered entities (including group health plans and issuers) to provide a Notice of Privacy Practices (or Privacy Notice) to each individual who is the subject of protected health information (PHI). Health plans are required to send the Privacy Notice at certain times, including to new enrollees at the time of enrollment. Also, at least once every three years, health plans must either redistribute the Privacy Notice or notify participants that the Privacy Notice is available and explain how to obtain a copy.

Self-insured health plans are required to maintain and provide their own Privacy Notices. Special rules, however, apply for fully insured plans. Under these rules, the health insurance issuer, and not the health plan itself, is primarily responsible for the Privacy Notice.

Model Privacy Notices are available through the Department of Health and Human Services

  • Summary Plan Description (SPD)

Plan administrators must provide an SPD to new participants within 90 days after plan coverage begins. Any changes that are made to the plan should be reflected in an updated SPD booklet or described to participants through a summary of material modifications (SMM).

Also, an updated SPD must be furnished every five years if changes are made to SPD information or the plan is amended. Otherwise, a new SPD must be provided every 10 years. 

Summary Annual Report

Plan administrators that are required to file a Form 5500 (> 100 participants in plan) must provide participants with a narrative summary of the information in the Form 5500, called a summary annual report (SAR). The plan administrator generally must provide the SAR within nine months of the close of the plan year. If an extension of time to file the Form 5500 is obtained, the plan administrator must furnish the SAR within two months after the close of the extension period.

Wellness Program Notices 

Group health plans that include wellness programs may be required to provide certain notices regarding the program’s design. As a general rule, these notices should be provided when the wellness program is communicated to employees and before employees provide any health-related information or undergo medical examinations.

  • HIPAA Wellness Program Notice—HIPAA imposes a notice requirement on health-contingent wellness programs that are offered under group health plans. Health-contingent wellness plans require individuals to satisfy standards related to health factors (for example, not smoking) in order to obtain rewards. The notice must disclose the availability of a reasonable alternative standard to qualify for the reward (and, if applicable, the possibility of waiver of the otherwise applicable standard) in all plan materials describing the terms of a health-contingent wellness program. Final regulations provide sample language that can be used to satisfy this requirement.
  • ADA Wellness Program Notice—Employers with 15 or more employees are subject to the Americans with Disabilities Act (ADA). Wellness programs that include health-related questions or medical examinations must comply with the ADA’s requirements, including an employee notice requirement. Employers must give participating employees a notice that tells them what information will be collected as part of the wellness program, with whom it will be shared and for what purpose, the limits on disclosure and the way information will be kept confidential. The Equal Employment Opportunity Commission (EEOC) has provided a sample notice to help employers comply with this ADA requirement.




Enhance Your Employee Benefits Package.  A competitive benefits package is key to keeping and attracting top talent.  Assess your current benefits package and consider making necessary adjustments to include options, such as expanded mental health support, for example. 


Review Employee Records.  The fourth quarter is a good time to review your employee records and check record retention guidelines. Don’t forget to dispose of outdated termination and outdated job applications properly. With W2s around the corner, make sure all addresses and information are updated.

Develop and Distribute Your 2022 Calendar.  Create and distribute a calendar outlining important dates, vacation time, pay dates, and company-observed holidays for 2022. 

Review and Update Employee Handbook. Review your employee handbook to make sure it is up-to-date and addresses areas, such as employment law mandates, new COVID-related policies, guidelines for remote working, privacy policies, compensation and performance reviews, social media policies, attendance, and time-off, break periods, benefits, and procedures for termination, discipline, workplace safety, and emergency procedures.

PLEASE NOTE: This information is for general reference purposes only. Because laws, regulations, and filing deadlines are likely to change, please check with the appropriate organizations or government agencies for the latest information and consult your employment attorney and/or benefits advisor regarding your responsibilities. In addition, your business may be exempt from certain requirements and/or be subject to different requirements under the laws of your state. (Updated Oct. 3, 2021)

Contact us at (855) 667-4621 or email us at info@medicalsolutionscorp.com


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NYS Individual Marketplace 2015 FAQ

NYS Individual Marketplace 2015 FAQ

NYS Individual Marketplace 2015 FAQ

NYS Obamacare 2015 FAQ

Open enrollment for the 2015 New York individual market season is right around the corner. Below are answers to commonly asked questions pertaining to individual market coverage for residents of New York State:

Q: What is the New York State of Health (NYSOH) exchange website?
A:  NYSOH provides NYS residents living between 139%-400% of the Federal Poverty Level, access to lower cost health insurance by supplying them with tax credit premium subsidies. Additional Cost Sharing subsidies are available to those living between 139%-250% of the FPL. All subsidy programs are subject to eligibility requirements. Additionally, NYSOH is where individuals can enroll in Medicaid (for those living below 139% of the FPL).

Q: Is the NYSOH government health insurance? Is that what “Obamacare” means?
A: No. Individual health insurance is a relationship between a consumer, and a private health insurance company. NYOSH slips in between this relationship by forwarding tax credit money to the carrier on behalf of the subsidy-eligible consumer, and then the carrier bills the consumer for the difference in premium owed. “Obamacare” is simply the nickname of the new health insurance law, which (in part) assists individuals in obtaining health insurance.

Q: Do I have to have health insurance?
A: Yes. As part of the individual mandate, all US citizens must enroll in Affordable Care Act-compliant health insurance…be it through your employer, the individual market, Medicare, or Medicaid. Citizens not enrolled in coverage will be fined by the IRS (less those who qualify for exemptions).

Q: What is the fine for not having health insurance?
A: In 2015, the fine is 2% of household income per uninsured month. In 2016, this increases to 2.5% of household income per uninsured month.

Q: Do I have to enroll in individual coverage through NYSOH?
A: No. Only people in need of tax credit subsidy assistance must enroll through the NYSOH exchange website.

Q: What if I don’t earn enough income to qualify for subsidy assistance for on-exchange health plans?
A: People in NY living below 139% of the FPL will be eligible for Medicaid. Medicaid enrollments are conducted on the NYSOH website.

Q: If I am over the subsidy income limit threshold, how do I apply for coverage outside of the NYSOH website?
A: You can enroll directly with a carrier, or, by contacting a licensed insurance broker for assistance. Off-exchange carrier applications are extremely simplified, requiring only a 1-2 page paper/PDF application to be completed in most cases, and with no government intervention.

Q: Can brokers assist me with my individual coverage written through the NYSOH website as well?
A: Yes. Licensed brokers, who are also certified to write health plans on the exchange, can be found in the Broker directory on the NYSOH website. You can search using a specific broker’s first and last name, by selecting a specific Agency from the drop down list, or you can enter your ZIP Code to find one in your region.

Q: Do brokers charge fees for helping me secure an individual health plan?
A: Brokers are not allowed to charge fees for assisting individuals with writing their health insurance.

Q: How do brokers get paid?
A: Every time you pay your health insurance bill, a portion of your payment is allocated towards compensating a broker (just like with your auto or homeowners insurance). Most carriers pay broker commissions on the back end, which is completely transparent to the consumer. If no broker is utilized by the consumer, the carrier retains the commission. This means that whether you use a broker or not, you’ll be paying for one anyway.

Q: Don’t Navigators already provide these broker services?
A: No. Sometimes referred to as “in person assistors” or “experts” by the NYSOH, Navigators are not licensed to write health insurance. They are trained employees or contracted agencies of the NYS government (funded by Federal grant money) to help individuals navigate the enrollment process on the NYSOH website only. They are not required by federal law to undergo criminal background checks, nor are they licensed by the NYS Department of Financial Services, which means they cannot make plan recommendations to health insurance consumers.

Q: Can a certified broker process my NYSOH enrollment for me?
A: Yes. Brokers that are certified to write business on the NYSOH exchange website can drive the entire online enrollment process for the consumer. You just need to authorize a broker through your NYSOH account by logging in, and then clicking “Find a Navigator/Broker” towards the bottom left side of your NYSOH account home page. Once authorized, the broker you have selected will receive an email from the NYSOH that you are in need of assistance, and can now enroll you on your behalf.

Q: When can I enroll in individual health insurance?
A: Like Medicare, the individual health insurance market is setup to have an open enrollment season. The individual market open enrollment window is from 11/15/14 through 2/15/15.

Q. Are there any exceptions to the open enrollment period?

A. Enrollment in Medicaid, Child Health Plus and the Small Business Marketplace continues all year.

Have a Qualifying Event?


Enroll Now using our online shopping tool where you can compare plans and prices and enroll

Find us on the Health Insurance Marketplace where you may qualify for help to pay for your health insurance.  Qualifying Events for Exchange Marketplace. 76 percent of the uninsured are unaware of the looming March 31 sign-up deadline. Contact us at (855)667-4621.


Q: Can I enroll in coverage outside of the open enrollment season?
A: Consumers can enroll in individual coverage outside the open enrollment season so long as a “Qualifying Life Event” exists. Examples of such events include the loss of a job, marriage, divorce, birth of a child, a change in subsidy eligibility, and others. Written proof of the QLE will be required when enrolling outside of the open enrollment season as established by the US Department of Health and Human Services.

Q: If I am subsidy eligible, and my income changes, what do I do?
A: Consumers enrolled through the exchange who receive tax credits must notify the NYSOH Marketplace whenever a change of income is experienced. You can contact the marketplace call center at 855-355-5777 to update your income information.

Q: Am I limited to certain insurance companies if I am subsidy-eligible?
A: No. Consumers who are subsidy-eligible may pick any plan they wish that is available on the NYSOH exchange website. However, subsidy-eligible individuals may not apply those tax credits towards health plans written outside of the NYSOH website (for example, Oxford Liberty plans, which are only available outside of the NYSOH Marketplace).

Q: I have completed the income portion of my on-exchange application, and I’m now ready to pick a plan. How can I find out more specific information pertaining to the available options in the market?
A:  A licensed insurance broker can help you understand the available health plans in the market, and can make plan recommendations specific to your needs and financial situation.

Q: I started my current individual plan in July 2014. Do I have to renew my plan on January 1st 2015?
A: Yes. All individual market plans have calendar year deductible and maximum out of pocket accumulation periods, which resets on January 1st of any given year. So for example, if you lost your job (and your health insurance) effective 12/1/14, and then you enroll for individual coverage effective 12/1/14, you must renew your individual plan the following month (for 1/1/15) at the new carrier plan structures and rates.

Q: I already have individual market based health insurance. Can I change plans during the open enrollment season?
A: Yes. Existing individual health insurance policyholders may change their plan during the open enrollment season. You may also change carriers should you wish to find a better solution for your needs. Talk to your licensed insurance broker about the available plan options in the market for 2015.

Q: My employer is offering me a health plan that I am not interested in. Can I waive my employer health plan and replace it with an individual plan, and receive tax credit subsidy assistance?
A: The answer to the first part of the question is yes. Employees can choose to opt out of employer-sponsored health insurance, and can replace their coverage in the individual market.

With regards to receiving tax credit subsidies in these situations, yes, an individual can receive tax credit subsidies to help pay the cost of individual health insurance. However, in addition to the employee needing to meet tax credit eligibility requirements as discussed earlier, one of two additional conditions must be met to be eligible to receive subsidy assistance: 1) The employer’s health plan does not meet the minimum actuarial value of 60%, or 2) The employee’s single rate cost (self-only coverage, no dependents) for employer-sponsored coverage exceeds 9.5% of their household adjusted gross income (defined as “unaffordable” under the health care law).

Q: I’m applying for a tax credit subsidy. How do I determine my adjusted gross income?
A: Your adjusted gross income can be found on line 37 of your 1040 tax return. Subsidy applicants who have a steady income can use this figure as a guide when determining tax credit eligibility for the upcoming tax year.

Those that do not have a steady income (e.g. sole proprietors, freelancers, single-person businesses, etc.) should speak with their accountants to determine their estimated adjusted gross income for the upcoming tax year.

Q: I was determined Medicaid eligible after applying for tax credit subsidy on the NYSOH website. However, my doctors do not take Medicaid. Can I opt out of medicaid and get a subsidized individual health plan instead?
A: You may choose to opt out of Medicaid if you wish. However, those who are Medicaid eligible will not qualify for tax credit subsidies for individual health plans. You can enroll in a health plan, but you must pay the full price of the plan.

Q: I was determined subsidy eligible, and I want to pick a plan to enroll in through the NYSOH website. Can I put my children on my health plan with my spouse and I?
A: No. Those who are subsidy eligible must insure their dependent children through a Child Health Plus plan. CHP (or “chip”) plans are selected during the plan check out process at the end of the NYSOH application. Only the applicant and spouse will qualify for a private health plan with subsidy assistance. If you choose to opt your children out of CHP, you and your spouse will lose subsidy eligibility for your private health plan.

Q: How can I find out if my doctors take a particular health plan?
A: Your licensed insurance broker can provide you with carrier-specific tools to look up providers in particular networks.

Q: How can I get a copy of the full benefit summary for a particular health plan I’m interested in?
A: Your licensed insurance broker can provide you with electronic benefit summaries for most health plans upon request.

Q: How can I find a licensed broker to assist me?
A:  Licensed insurance brokers, and who are also certified to write on-exchange plans, can be found in the Broker directory on the NYSOH website. You can search using a specific broker’s first and last name, by selecting a specific Agency from the drop down list, or you can enter your ZIP Code to find one in your region.

For more information  regarding  both Exchanges –   Individual Exchanges or SHOP  please contact our team at Millennium Medical Solutions Corp  (855)667-4621.   We have Spanish, Russian, and Hebrew speakers available.  Quotes can also be viewed on our site.
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Obamacare Simplified Using Youtoon

Obamacare Simplified Using Youtoon

Obamacare Simplified Using Youtoon by Kaiser is just what the Doctor ordered.  With less than 60 days to go to the October 1, 2013  Health Exchanges Open Enrollment Period  what better way to ease the confusion than a 7 minute cartoon?

CMS maintains the HealthCare.gov website, and this is where individuals can find more information on health insurance exchanges, the enrollment for which begins on October 1, 2013. Depending on which state individuals reside in, one may be able to enroll in an exchange plan, or may be directed to their state’s own exchange enrollment site. Employers can also use this site to learn about the Small Business Health Options Program (SHOP) which can help them provide coverage for employees.

Several resources have been made available to help people weed through the information and to make you aware of what requirements and deadlines apply to you. The Kaiser Family Foundation (KFF) brought some levity to the topic by creating an animated video explaining the upcoming changes in health coverage under the ACA.  Narrated by Charlie Gibson, “The YouToons Get Ready for Obamacare,” explains what is and isn’t changing under the law and is posted on the KFF site, along with other resources on the topic. KFF President, Drew Altman, was quoted as saying, ’[t]his cartoon is meant to demystify a complex law and explain what it means for you, whether you support or oppose Obamacare.”

Obamacare Simplified Using Youtoon


Our HealthCare Reform Resource

NYS Approves Health Insurance Exchange Rates

Health Exchange FAQ
Click Above

Federal government health care site: www.healthcare.gov

Kaiser Health Reform Subsidy Calculator:http://healthreform.kff.org/subsidycalculator.aspx

For a comparison and additional questions  on which  Exchange – Individual or  SHOP Exchanges is right for you  please contact our team at Millennium Medical Solutions Corp.   Stay tuned for updates as more information gets released. We’re inside of 45 days until exchanges open, and information will be coming quickly in the next few months.  Sign up for latest news updates.

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