Businesses face change in health insurance rules


PITTSFIELD - Beginning in 2015, large employers could face a financial penalty under the Affordable Care Act for not providing their employees health insurance coverage. Local health officials have noticed a tremor of nervousness in employers due to a lack of knowledge.

"It's causing a lot of stress and anxiety, and it will continue to do that for the next couple of months," said Executive Director Bryan Ayars of Community Health Programs. "The more facts everyone has, the less anxiety there will be."

Ayars said Community Health Programs has focused its attention on educating individuals about their eligibility under the Affordable Care Act. But in 2014, the organization will pay more attention to educating businesses.

Many employers say they don't know much about the Affordable Care Act, according to a 2013 survey from national consulting firm Deloitte, which surveyed companies with more than 50 employees.

While hesitant about trying something new, employers also say the current health care system fails in key areas: in providing information and price transparency and good value for services. "Many employers appear to be adopting a 'wait and see' approach regarding public and private exchanges," according to the report. "It may be that they are watching to see if the exchanges will gain traction, offer a viable solution, or are concerned about the risks of being a 'first mover.' " Under the new federal health care law, large employers with 50 full-time employees or more will be fined for not providing health insurance. Employers can also face an additional fine if their employees spend in excess of 9.5 percent of their family income on the employer coverage. The penalty could be thousands and thousands of dollars, depending on the number of employees.

In Berkshire County, most employers, Ayars said, won't be mandated to provide insurance - nearly 88 percent of the businesses in the county have 20 or fewer employees. That doesn't mean they have time to procrastinate. In the lead-up to a sweeping change in the health care law, there have been media reports of businesses being dropped from their health plans. Health plans have been cancelled because they failed to include federally mandated coverage that includes laboratory, prescription drug and ambulatory services, and other services that cover pediatric, rehabilitative and maternity.

"It has to offer essential benefits," Ayars said. "Some of the information we heard about people being dropped from their coverage is because it isn't [good enough]."

Smaller businesses need to become aware that they could be subsidized for providing insurance.

Many employers' primary concern is about the price, rather than the quality of the health plan, said Gary Kobran, vice president of financial services at Wheeler & Taylor Insurance. One of his clients saw their health plan's cost increase by 38 percent, while other businesses have experienced a decrease.

It's going to be a "challenging time," Kobran said, and employers can make the transition a lot easier by talking to an insurance broker.

Employers may find it helpful to "spend time with a broker, understand the compliance issues, and understand how these changes will affect their choices and make sure they are looking at all the alternatives and arrangements," he said. "They're anxious," he said. "They're hearing a lot of stuff because they know it's a new world out there."

The new health care law includes a lot of complexities, Ayars said, so he said "the insurance broker should be your best friend."

"Trying to stay ahead of the game is always smart," he said. "They are on the horizon. They can't see over the horizon, but they can see what's coming."


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