Can Family Health Coverage Be Only Offered to Officer of Company?

Pocket-sized and Big Business organization Wellness Insurance: State & Federal Roles

Updated 9/12/2018

Over the by decade or more, state and federal laws generally required that health coverage providers accept small-scale employers applying for coverage. With groups such as minor businesses, the insurer has adamant a premium toll based on risk factors counterbalanced over the unabridged group, using general data on members of the group, such equally historic period or gender. Small businesses often pay more than for employee wellness benefits because they don't have the buying power of big employers. On boilerplate, pocket-size businesses paid about eight to 18 per centum more than large firms for the same wellness insurance policy. Health coverage providers may charge unlike premiums to small-scale employers based on the manufacture of the employer or on the employer'due south prior health claims. As both workers and small employers feel the financial squeeze, fewer are able to beget to offer, or purchase, health insurance coverage. States most often review or corroborate policies that are offered straight to consumers or to pocket-sized employers. Well-nigh states take had laws that require state-licensed health insuring organizations to provide coverage to pocket-sized employers that want it, with some limitation on the rates that can be charged (e.g., restrictions on how premiums can vary based on age and wellness status).

The Patient Protection and Affordable Intendance Act or ACA (P.50. 111-148) assisted and affected small and large businesses in a number of means.

Minor Business Snapshot: Commencement in 2014, small businesses have been able to participate in small business health options programs or SHOP exchanges. These programs include new state-based health insurance purchasing pools or CO-OPs (in about one-half of the states) where small businesses are able to pool together to buy insurance. Small businesses are defined as those that have no more than 100 employees. States take had the selection of limiting pools to companies with 50 or fewer employees. Companies that are currently defined as pocket-sized businesses and abound beyond the size limit will be "grandfathered in" and treated like those still within the 100 or 50 maximum.

Employer Tax Exemption:The Hidden federal Subsidy That Helps Pay for Health Insurance. Read analysis by The New York Times, 7/7/2017.

POSTPONED: "Cadillac Tax" on High Toll Employer Plans.

On Dec. 18. 2015 an unusual bipartisan action by Congress and the President 2016 postponed the Affordable Care Deed's (ACA) "Cadillac" taxation on high-cost health plans until 2020.  While the filibuster signals bipartisan support and momentum toward total repeal of the taxation, those discussions will continue through the transition to a new administration in 2016. In the meantime, this ii-year filibuster will, at a minimum, provide employers additional time to consider appropriate measures to reduce excise tax exposure.

The legislation also addresses sure excise tax features equally follows:

• The thresholds for triggering the tax will continue to be indexed until the tax goes into effect in 2020 (the thresholds for 2018 were slated to be $10,200 for cocky-only coverage and $27,500 for other than self-just coverage);
• Replacing a "non-deductible" definition, Employers volition be allowed to deduct any "Cadillac" tax payments; and
• The Comptroller General, in consultation with the National Association of Insurance Commissioners, will study suitable benchmarks to use for historic period and gender adjustments to the thresholds triggering the tax.

Other ACA-related changes include a 1-year moratorium on the ACA's almanac fee on wellness insurers' net premiums (for U.s.a. risks) and a 2-twelvemonth halt to the taxation on sales of medical devices. These fees and taxes were probable to be passed on to employers through increased insured plan premiums and provider costs, and thus volition be welcome relief to employers.  [More than]

NCSL explains public employer coverage:
"ACA Requirements for Medium and Big Employers to Offering Health Coverage" - a 2016 updated report applicative to states, country legislatures and local governments equally employers [download full report; 7 pages, PDF]

Small Business organization Health Care Revenue enhancement Credit for Pocket-sized Employers The Store law provisions help modest businesses and small tax-exempt organizations beget the toll of covering their employees' health insurance. If a modest business concern has fewer than 25 employees and provides health insurance information technology may qualify for a small business tax credit of upwardly to 50 per centum (up to 35 percent for non-profits) to offset the cost of insurance, starting with the 2010 federal tax twelvemonth. This can make the cost of providing insurance significantly lower. Prior to 2014, the pocket-size business revenue enhancement credit was 35 percent (up to 25 percent for non-profits) for qualifying businesses.

• State-Run Small Concern Wellness Options Programs: An Update Three Years Post ACA Implementation.
  Read the report on Store insurer participation, enrollment, and use of the online portals. Today, 17 states and the District of Columbia operate a state-run Store alongside an individual insurance marketplace, including Utah and Mississippi, which opted out of running an private market place but congenital their own SHOP.  Many states continue to face challenges in convincing small employers and their brokers that the program offers value not bachelor elsewhere. More information about tax credit uptake and enrollment through the federally run SHOPs would assist policymakers and states make a fair cess of the benefits the SHOPs provide. Published by The Democracy Fund, July 29, 2016.

• Modest Business Wellness Care Tax Credit for Small Employers- IRS explanation of tax credit. Updated 1/xv/2015

Eligibility Rules

• Providing wellness care coverage . A qualifying employer must embrace at to the lowest degree 50 percent of the cost of wellness care coverage for some of its workers based on the single rate.
• Business firm size. A qualifying employer must have less than the equivalent of 25 total-time workers (for example, an employer with fewer than 50 half-time workers may be eligible).
• Boilerplate annual wage. A qualifying employer must pay average annual wages below $fifty,000.
• Both taxable (for profit) and tax-exempt firms qualify.
• Small Business Health Intendance Tax Credit: Frequently Asked Questions - IRS guidance virtually Small-scale Business Health Care Tax Credit.

Minor Business concern Redefined: On October 7, 2015, President Obama signed into law the Protecting Affordable Coverage for Employees (PACE) Human activity. The PACE Act apology the definition of "small-scale employer" in the Affordable Care Act (ACA) and so that information technology would proceed to apply to employers with ane to 50 employees, rather than changing to 1 to 100 employees as of 2016 every bit provided in the original ACA; however, the new legislation also allows states to opt for the 1-to-100 employee definition of modest employer if they choose.

• The Centers for Medicare and Medicaid Services (CMS) released a serial of frequently asked questions explaining how it will implement the PACE Human action (Dated October nineteen, 2015). States may elect to extend the definition of small employer to embrace employers with upward to 100 employees by any ways that is legally binding under land law, every bit long as the definition applies to all insurers, including those in the Small Business concern Health Options Program (SHOP) plan. 46 states and D.C. have retained the 1-50 definition; four states use the 1-100 option - (See MAP beneath)

Modest Business Health Options Programme (SHOP) Exchanges. ⁱ

Pocket-size Business Exchanges have a framework set by federal rules, including options for how employers tin provide contributions toward employee coverage that meet standards for small business tax credits. SHOP Exchanges are designed to serve as a market place for small employers' with one to 100 workers, or upwardly to l workers if a state chooses that approach. Small employers with less than 50 full-time equivalent employees are not required to offer health coverage.

The ACA reformed small group marketplace underwriting and coverage, imposing the same guaranteed upshot, modified customs rating, and comprehensive coverage requirements on the small grouping market place that it imposed on the individual market. The ACA farther created the SHOP exchanges to pool the enrollment of small employers, potentially reducing administrative costs, and to offering private employees a option among wellness insurance plans. Finally, it created anew plan to brand revenue enhancement credits available to pocket-sized employers through the Store exchanges that would reimburse up to half of employer contributions towards premiums to pay for employee coverage.

Enrollment: July two, 2015 update:  (adopted/excerpted from Tim Jost, Esq, Health Affairs Blog; alsoKevin Counihan, CEO of the Health Insurance Marketplaces, CMS Weblog)

On July 2, 2015, CMS released for the first fourth dimension numbers on effectuated enrollment in the SHOP exchange program.

With the troubled launch of the private exchanges in the fall of 2013, however, the Store exchange took a back seat. The federally facilitated exchanges essentially delayed the launch of the SHOP substitution for 2014 (although they did offering the tax credits) and delayed offering employee choice in many states for 2015. The federally facilitated exchanges made online enrollment available to small employers in the 33 federally facilitated states beginning with the 2nd open enrollment period in November of 2014. Many of the land exchanges offered Shop exchanges from the time they opened enrollment in 2013.

As of May 2015, approximately 85,000 Americans had 2015 coverage through the SHOP marketplaces through approximately 10,700 pocket-sized employers. These totals do non include employers that enrolled their employees in 2014 simply had not renewed for 2015.Unlike the individual market, where open enrollment is only available in one case a year, employers can enroll in the Store commutation at whatsoever fourth dimension. Approximately 500 employers take been enrolling each month since Nov 2014.

These are small numbers compared to the millions of enrollees in the individual exchange. They may reverberate contest from individual exchanges, which offer many of the aforementioned benefits of the Store commutation.Individual exchanges cannot offer the tax credits, simply the tight tax credit eligibility requirements have limited their usefulness to small employers. In any issue, the SHOP exchanges are launched and growing, and continue to take potential for making better coverage available to modest employers and their employees.

Large Employers (100+)  mandated to offer wellness coverage

The Obama Assistants has modified the ACA statutory requirement that large employers (initially applied to those with 100 or more total-time equivalent employees) take to offer health insurance or coverage, a ane year date change from the original Jan. 1, 2014, at present to Jan. 1, 2015.  This change was appear July 2, 2013, and modified in February 2014, described below.

Employers with 50-99 workers given until 2016 to offering coverage. On February. x, 2014, the Treasury Department extended by one additional yr the requirement that employers with between 50-99 workers run into the mandate to offer health insurance, a category that includes nearly seven percent of the private workforce. The new rules also will require 70 percent of workers to be covered in that get-go year. Read the Treasury fact sheet hither [two pp.] and terminal rule here [227 pp.].

How the policy affects employers:

• These substantive policy changes accept an impact on states and employers in every region. Minor Businesses with fewer than fifty employees: (about 96% of all employers): Under the Affordable Care Act, companies that have fewer than 50 employees arenon required to provide coverage or fill up out any forms in 2015, or in any year, under the Affordable Care Human activity.

• Larger employers with 100 or more employees (nigh 2% of employers): The overwhelming majority of these companies with 100 or more employees already offering quality coverage.  Today's rules phase in the pct of full-time workers that employers need to offering coverage to from 70 per centum in 2015 to 95 per centum in 2016 and beyond. Employers in this category that do non meet these standards volition brand an employer responsibility payment for 2015.

• Employers with 50 to 99 employees (virtually ii% of employers): Companies with fifty-99 employees that do not nevertheless provide quality, affordable health insurance to their full-time workers were to study on their workers and coverage in 2015, simply had until 2016 before any employer responsibleness payments could apply.

POSTPONED Permanently?: "Cadillac Tax"

The So-Chosen "Cadillac Tax" on Employers with High-Cost Plans (2020 and beyond)    Excerpt from Health Leaders magazine, October 13, 2014
The tax on loftier-cost health plans, which are ofttimes referred to every bit Cadillac plans, is expected to bear on a considerable share of the plans provided by healthcare organizations for their own employees, as much as 39% by 2020. The implications are pregnant because the excess-benefits tax requires the employer to pay twoscore% on the value of the portion of the plan that exceeds thresholds set past the Patient Protection and Affordable Intendance Act. Employers likewise need to consider that the tax is measured every bit a direct function of programme price, and non actuarial plan value, and that a number of factors can drive excise-revenue enhancement exposure.

On Dec. eighteen. 2015 an unusual bipartisan action past Congress and the President 2016 postponed the Affordable Intendance Act's (ACA) "Cadillac" taxation on high-toll health plansuntil 2020.  While the delay signals bipartisan back up and momentum toward full repeal of the tax, those discussions will continue through the transition to a new administration in 2016. In the concurrently, this two-year filibuster will, at a minimum, provide employers additional fourth dimension to consider appropriate measures to reduce excise taxation exposure.

The legislation also addresses certain excise tax features every bit follows:

• The thresholds for triggering the tax volition continue to be indexed until the tax goes into effect in 2020 (the thresholds for 2018 were slated to be $ten,200 for self-only coverage and $27,500 for other than self-but coverage);
• Replacing a "non-deductible" definition, Employers will be immune to deduct any "Cadillac" revenue enhancement payments; and
• The Comptroller General, in consultation with the National Clan of Insurance Commissioners, will study suitable benchmarks to utilise for age and gender adjustments to the thresholds triggering the tax.

Other ACA-related changes include a one-year moratorium on the ACA'southward almanac fee on health insurers' net premiums (for US risks) and a two-year halt to the tax on sales of medical devices. These fees and taxes were likely to exist passed on to employers through increased insured plan premiums and provider costs, and thus will be welcome relief to employers.

Read More than:
"The Cadillac Tax: an Excise Tax on High Value Health Insurance Plans" - past Vermont Legislative Joint Fiscal Office. Online at: http://www.leg.state.vt.us/jfo/issue_briefs_and_memos/Cadillac%20tax%2025nov2014.pdf  - 11/25/2014

"The Cost of Spousal Wellness Coverage"

A 2014 study examines what can happen when companies looking to salvage health costs in 2014 require working spouses to become health insurance through their own employer.  Authors detect the move has some unexpected consequences, according to a new written report by the nonpartisan Employee Benefit Research Institute (EBRI).

The federal Patient Protection and Affordable Care Act (PPACA) requires that employers with 50 or more workers provide health coverage to workers and dependent children until they reach age 26. It does not, withal, crave employers to provide health coverage to spouses, whether or not they are eligible for other health insurance. In 2011, primary health insurance policyholders spent an average of $5,430 on health care services, compared with $six,609 for spouses. This can make them a target for employers looking to control their wellness benefit costs. [Full report online, 7 pp., PDF]

• Description of ACA statutory requirements for employers, (detailed below) originally issued 2010.
• U.South. . Treasury Department Announcement: "Standing to Implement the ACA in a Careful, Thoughtful Fashion" - weblog mail service by Mark J. Mazur, Assistant Secretarial assistant for Tax Policy at the U.Southward.. Department of the Treasury. vii/two/2013.
• "Why liberals are abandoning the Obamacare employer mandate" - commodity by Politico Pro, 7/15/2014
  More than and more liberal activists and policy experts who help shape Democratic thinking on health care have ended that penalizing businesses if they don't offer health insurance is an unnecessary chemical element of the Affordable Care Act that may exercise more impairment than good. Amongst them are experts at the Urban Institute and the Commonwealth Fund and prominent academics like legal scholar Tim Jost.
• Implementing Wellness Reform: A One-Twelvemonth Employer Mandate Delay - Health Diplomacy blog by Professor Tim Jost, 7/3/2013.>
• Exemptions from the Individual Mandate to accept health insurance - Cited from U.South.. Treasury Department, updated half-dozen/23/2013.

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Guidance on Shop Exchanges - (Includes archive history 2013-xiv)

The Centers for Medicare and Medicaid Services (CMS) issued guidance  in 2013 in the grade of oftentimes-asked questions (FAQs) addressing Small Concern Health Options Program SHOP)-Only Marketplaces. The get-go question asked addresses whether a country may operate a SHOP while the individual market place Marketplace is operated every bit a Federally-facilitated Marketplace (FFM)? The guidance states that it is CMS' intention to propose through rule that, for 2014, a state that submitted a Blueprint to operate a land-based marketplace and received conditional approval may request to operate a state-based SHOP while the individual market Marketplace is operated as an FFM. All states had the same option starting in 2015.

In  2013, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining program integrity guidelines for the Health Insurance Marketplace (Marketplace) and premium stabilization programs.  The policies offer clarity on oversight of various premium stabilization and affordability programs, build on state options regarding the Small Business Health Options Program, and provide technical clarifications.  The HHS fact canvas is online hither.

Small Business Wellness Options Plan (SHOP): Some Features Delayed.

States Implementing or Delaying Employee Choice in 2015

On May 27, 2014, a last rule "taking the next stride" in implementing "employee choice" in the Pocket-size Concern Health Options Program (SHOP) was published by the Department of Health and Human Services (HHS).  "Employee choice" provides employers the opportunity to allow employees to choose any health program at the actuarial value, or "metal," level selected by the employer.  State Insurance Commissioners were given an opportunity to submit a written recommendation to the SHOP that employee choice non be implemented in that state in 2015 if the State Insurance Commissioner concluded that not implementing employee choice would be in the all-time involvement of small group market place consumers in his or her state.

An HHS tabular array provides a tally: in total, xviii states with a Federally-facilitated Shop will allow for this transition relief in 2015. The remaining xiv states with a Federally-facilitated Store will join nigh State-based SHOPs and have employee pick bachelor to modest businesses in 2015. In 2015, well-nigh two-thirds of Americans will alive in states where small business organisation workers can choose a health plan rather than accept their employer exercise it for them.

The following states with federally-facilitated exchanges (FFMs) implemented Employee Selection in 2015:Arkansas, Florida, Georgia, Indiana, Iowa, Missouri, Nebraska, North Dakota, Ohio, Tennessee, Texas, Virginia, Wisconsin and Wyoming. Modest-Employer ("SHOP") Commutation Problems- Plant for Health Policy Solutions, 5/2011.  A report  "describes and assesses distinguishing dimensions important to the design of a successful SHOP Commutation program.
SHOPping Around- Setting up State Wellness Care Exchanges for Pocket-sized Businesses: A Roadmap- Centre for American Progress, 7/2011.

one-  The CBO estimates that 24 million people will purchase their own coverage through the Exchanges in 2019. An additional five one thousand thousand people are expected to receive health insurance through the Exchanges considering they work for an employer who allows all of their workers to choose amidst wellness insurance plans offered from the Commutation (though these individuals are not eligible for subsidies). While this puts the projected full number of individuals receiving coverage through the Exchanges in 2019 at 29 million, the CBO estimates consider these 5 million individuals covered by employment-based insurance.

Early Retirees and Employer Incentives   -- The ACA provides financial aid to employers that proceed coverage for early retirees, age 55-64 [HHS Fact Canvas]

State Decisions on Allowing Mid-Sized Employers (51-100) to Delay a Motility to the Pocket-size-Group Insurance Marketplace (June 2015 update)

Commencement January 1, 2016, the ACA expands the definition of "small employer" to hateful a business that employs between two and 100 employees. Experts fear this change could consequence in premium increases for some mid-sized employers with between 51 and 100 employees, which are currently included in the large-grouping marketplace, considering they will become newly bailiwick to several small-grouping market reforms.
A June 2015 analysis by The Commonwealth Fund describes states' choices and deadlines.  Requirements include applying coverage rating rules such equally not charging people more for preexisting atmospheric condition and the requirement to cover a minimum set of essential health benefits. As a effect, some policymakers and others have chosen for the delay or repeal of this provision.

State Options for Large Employers and Exchanges

States tin can cull to enact stronger consumer protections than these minimum standards for rating and selected other consumer protections.  Starting in 2017, states have the pick of allowing health insurance issuers that offer coverage in the large group market to offer such coverage through the ACA Marketplace.  For states that choose this option, these rating rules too will apply to all large group health insurance coverage.  These rules standardize how health insurance issuers can price products, bringing a new level of transparency and fairness to premium pricing.  (Source: CCIIO/CMS Fact Sheet, February 2013)

Employer Requirements to Offer Coverage (Includes Annal References)

Medium and Large Employers (with l or more than full time employees [FTEs]) [Note delayed deadlines, announced July 2, 2013 and Feb 10, 2014 past the Treasury Department]	Employers with 50 or more employees, including for-profit, non-profit and government entity employers, generally are required to offer wellness insurance to each total-fourth dimension employee.A For employers with 50-99 FTEs, this requirement has been delayed for ii years, to January i, 2016, based on Treasury Department rules released Feb 10, 2014. [linked above] For employers with 100 or more FTEs, this requirement has been delayed for one year, to January 1, 2015, according to Treasury Section announcements in July 2013. The offered insurance must run into the minimum essential coverage (MEC) requirement, defined as "Bronze level" where the health insurer plan volition pay at least 60 per centum of the cost of each wellness service or treatment; higher levels of coverage include "Silver" with 70% insurer payment, "Gold" at fourscore% insurer payment and "Platinum" at 90% are permitted. Such employers who do not offering coverage and practice accept at to the lowest degree i full-time employee who receives a premium tax credit will be assessed a fee of $ii,000 per total-time employee, but this excludes the beginning 30 employees from the assessment.  Such employers that offering coverage but that take at least one full-time employees receiving a premium taxation credit (bachelor upward to 400% almanac FPL) volition be required to pay the bottom of $iii,000 for each employee receiving a premium credit or $2,000 for each full-time employee, excluding the first 30 employees.  These provisions are constructive January 1, 2014. IRS Regulations, Issued December 28, 2012; released December 31, 2012: [Includes excerpts] FAQs addressing Employer Health Intendance Arrangements , describing how marketplace reforms apply to employer payment plans. The FAQs specifically address arrangements where an employer does not institute a health insurance program for their employees, but reimburses them for premiums they pay for health insurance, and are considered to exist a grouping wellness plan. Treasury updated April 2015. Treasury Section and the IRS proposed regulations (REG-138006-12) on the Employer Shared Responsibility provisions [total text = 144 pages] Starting in 2014 (only postponed until Jan. ane, 2015, or January 1. 2016), tax lawmaking Section 4980H, added by ACA, will crave employers with at least 50 total-time and/or total-fourth dimension equivalent employees to offering affordable health care coverage that provides a minimum level of coverage, or pay a penalty. According to Section 4980H, an employee is considered to be full time if he or she works at least 30 hours per week, and the proposed regulations "would treat 130 hours of service in a month as the monthly equivalent of 30 hours of service per week." "Coverage for an employee nether an employer-sponsored programme is affordable if the employee's required contribution for self-only coverage does not exceed 9.5 pct of the employee's household income." Nether the rules, employers must offer coverage to employees (postponed until Jan. 1, 2015) and must offering coverage to dependents too, starting in 2015.  The proposed regulations ascertain an employee'south dependents for purposes of section 4980H equally an employee's child who is nether 26 years of historic period. "Dependent does not include the spouse of an employee." [Source: Proposed Regs., p. 56] If an employer offers MEC nether an eligible employer-sponsored plan to its full-time employees (and their dependents), information technology volition not exist subject to the penalization under section 4980H(a), regardless of whether the coverage it offers is affordable to the employees or provides minimum value. "A number of employers currently offer coverage merely to their employees, and not to dependents. For these employers, expanding their health plans to add together dependent coverage will require substantial revisions to their plans." The IRS planned to grant a i-year reprieve to employers who fail to offer coverage to dependents of full-time employees, provided they take steps in 2014 to come into compliance. Sources & Commentary: IRS spider web study: http://world wide web.irs.gov/uac/Affordable-Intendance-Act-Tax-Provisions , 12/28/2012. The NY Times published this analysis: "The rules, though labeled a proposal, are more meaning than most proposed regulations. The Internal Acquirement Service said employers could rely on them in making plans for 2014." 1/1/2013 " IRS Releases Proposed ACA Rules on Employer Shared Responsibility " BNA Tax News, 12/31/2012.
Footnotes and explanations	A - To exist subject area to the Employer Shared Responsibleness provisions, an employer must utilise at least 50 full-time employees or a combination of full-time and part-time employees that equals at least l (for example, 40 total-time employees employed 30 or more than hours per week on average plus xx half-time employees employed xv hours per week on average are equivalent to l full-time employees).  Employers will determine each year, based on their current number of employees, whether they will be considered a large employer for the next twelvemonth. For example, if an employer has at to the lowest degree l full-time employees, (including full-time equivalents) for 2013, it volition be considered a large employer for 2014.[Source: Q & A, Question #iv,  past IRS, 12/28/2012]
Under l employees	PPACA exempts all employers with up to 50 full-time employees from any of the penalties or taxes applied above to 50+ employers.
Over 200 Employees	ACA Automated ENROLLMENT REPEALED.  On Nov. ii, 2015 the President signed a congressional enacted provision to repeal section 1511 of the ACA. That provision required employers that employ more than 200 employees and that offer health insurance to automatically enroll new employees in a health plan. Department 1511 further requires employers to give employees discover that they tin opt out of the plans in which they are automobile-enrolled in at any time. This was meant to encourage enrollment in coverage by employees who might otherwise non practice then if they had to initiate enrollment on their own.        Implementing the provision, which has been by and large opposed by business organization interests, has been a very low priority for the assistants, and its repeal will not seriously bear on the general scheme of the ACA. The Section of Labor (DOL) guidance, issued in 2012, stated that information technology would not be fix to implement the provision given the demand to coordinate implementation of the provision with other more important provisions such as the employer mandate and the ban on waiting periods exceeding ninety days. It projected no deadline for implementing the provision. DOL reiterated that employers did not need to comply with the provision until it issued rules.        According to the Health Affairs Blog, the Congressional Upkeep Office (CBO) projects that repeal of this provision would reduce the number of people covered by employer-sponsored insurance by 750,000 beginning in 2017 when the provision might offset exist enforced.# #  CBO estimated that ninety percentage of these people would remain uninsured. Repeal would reduce the budget arrears past $7.9 billion over the 2016-2025 catamenia because employees would receive more taxable income rather than health benefits, which are not taxable, and because of increased individual responsibility punishment payments.

Sources : CMS/CCIIO notices and guidance, 7/2/2012, 2/10/2014; vi/ii/2014; Summary of Health Reform Law, Kaiser Family Foundation 4/23/2013

ACA statutory exemptions from the requirement to obtain minimum essential coverage

In that location are statutory exemptions for nine categories of individuals, based on the definitions below.  Additional exemptions accept been added by regulations, issued 2012-2018. (#x and higher up)

Sources: Treasury Department - Questions and Answers on the Private Shared Responsibleness Provision - Updated 2015
Individual Shared Responsibleness Provision – Exemptions: Claiming or Reporting - IRS - Updated 2015
The Individual Shared Responsibleness Provision- A consumer and taxpayer explanation - IRS - Updated  2015

1. Religious conscience: Persons who are a member of a religious sect that is recognized equally conscientiously opposed to accepting any insurance benefits. The Social Security Administration administers the process for recognizing these sects co-ordinate to the criteria in the law.
2. Unaffordable coverage options:  Persons who tin't afford coverage because the minimum amount that must be paid for the premiums is more than eight pct of their household incomes.
3. Hardship: A Health Insurance Market, besides known every bit an Affordable Insurance Substitution, has certified that a person has suffered a hardship that makes him/her unable to obtain coverage. This category has recently been expanded to include those who are homeless, facing eviction or foreclosure, victims of domestic violence, and victims of floods, fires and other disasters.
4. Wellness care sharing ministry: Persons who are a member of a recognized health care sharing ministry building.
5. Indian tribes: Persons who are a member of a federally recognized Indian tribe.
6. No filing requirement: Persons whose household income is below the minimum threshold for filing a tax render. The requirement to file a federal tax return depends on a person'south filing status, age, and types and amounts of income. Requirements are detailed in the IRS Interactive Tax Assistant (ITA).
7. Short coverage gap:  Persons who went without coverage for less than 3 consecutive months during the year. In general, a gap in coverage that lasts less than three months qualifies as a short coverage gap. If an individual has two short coverage gaps during a year, the short coverage gap exemption but applies to the first or before gap.
8. Incarceration: Persons who are in a jail, prison, or like penal institution or correctional facility later the disposition of charges against them.
9. Not lawfully present:  Persons who are neither a U.Southward. citizen, a U.S. national, nor an conflicting lawfully nowadays in the U.S.
   OTHER REGULATORY EXEMPTIONS
10. Coverage gap due to Medicaid not expanded:  Any person or family residing in a state that has declared information technology has not expanded the land Medicaid program to 138 pct of federal poverty (FPL), and having an annual income below 100 per centum of that FPL.
11. Canceled policies: People whose 2013-14 policies were canceled and consider the available alternative policies "unaffordable."
12. Other hardships: a more open up-ended exemption for persons who have other, unspecified hardships in obtaining insurance.  This requires a written appeal to HHS or an HHS-authorized state dominance.

2017: Trump HHS Listing of Hardship Exemptions, with links to details, forms, and instructions. [Updated 7/22/2017]

one. You were homeless

2.     You were evicted or were facing eviction or foreclosure

3.     Yous received a shut-off notice from a utility company

4.     You experienced domestic violence

five.     You experienced the death of a family unit member

6.     Y'all experienced a burn down, alluvion, or other natural or human being-caused disaster that caused substantial damage to your holding

vii.     You filed for bankruptcy

viii.     You had medical expenses you couldn't pay that resulted in substantial debt ^//

9.     Yous experienced unexpected increases in necessary expenses due to caring for an ill, disabled, or aging family fellow member

ten. You claim a child as a tax dependent who's been denied coverage for Medicaid and Scrap for 2017, and another person is required past court club to give medical support to the child. In this case you don't have to pay the punishment for the kid.

11. As a result of an eligibility appeals conclusion, you lot're eligible for enrollment in a qualified health program (QHP) through the Marketplace, lower costs on your monthly premiums, or cost-sharing reductions for a fourth dimension catamenia when you weren't enrolled in a QHP through the Marketplace in 2016

12. You were determined ineligible for Medicaid because your state didn't aggrandize eligibility for Medicaid in 2017 under the Affordable Care Act

13. Your "grandfathered" individual insurance plan (a plan you've had since March 23, 2010 or before) was canceled considering information technology doesn't run across the requirements of the Affordable Care Act and you believe other Marketplace plans are unaffordable

fourteen. You had some other hardship. If y'all experienced another hardship obtaining health insurance, use this form to describe your hardship and apply for an exemption.

2018-2019 Expedited Mandate Exemption Procedure by HHS/CMS
On Sep. 12, 2018"CMS/CCIIO  announced a new way for consumers to claim a hardship exemption from the shared responsibility payment for 2018 on a federal income taxation return without obtaining an exemption certificate number from the Exchange. Consumers can claim hardship exemptions either through the FFE (federal exchange) using the existing application processes or on a federal income tax return for circumstances like a natural disaster, deprivation of food, shelter, clothing, or other necessities, and/or other events the Secretary has determined constitute a hardship with regard to the capability to obtain health coverage. HHS will continue to procedure these exemptions nether the current regulations for exemptions applied for through the FFE and for all Country-based Exchanges (SBEs) that choose to have exemptions processed by HHS."
♦ Printing Release is alive online    ♦ Hardship Exemption Guidance:

Fiscal touch on of the private mandate (2017 data)(compiled 2017 by the Washington Mail service):

• The current penalty for non having coverage is $695 per adult and $347.fifty per child — up to $2,085 per family — or 2.v percent of family unit income, whichever is greater. Roughly half dozen.v million taxpayers paid a fine for being uninsured in 2015, according to the Internal Revenue Service, though the fine that yr was $470 per developed.
• The Congressional Budget Part projected in a December 2016 report that abolishing the private mandate could leave an boosted 15 meg Americans uninsured by 2026, while saving the federal government $416 billion in subsidies to ACA consumers and Medicaid payments.

Rate Review Provides Savings for Pocket-size Business concern Health Policies

Pocket-size Group Marketplace:  In the small group marketplace, analysis of the information from 35 states indicates that the implemented rate increases are approximately 19 percent lower than the rates originally requested past insurance companies.[6]  This difference equates to approximately $866 million in savings to consumers based on 2012 small grouping market premium information.  For the 35 states, eighteen.7 pct of total covered lives had rate requests reduced or denied.  Extrapolating to the total number of 18.1 million covered lives in the modest group market, an estimated 3.iv 1000000 individuals had rate requests reduced or denied.
As with the individual market data, the small-scale group premium data are based on MLR data from 50 states and the District of Columbia,[vii] whereas the average difference between rate changes requested and rate changes implemented is taken from ASPE's analysis of 35 states in the small group market using RRG data and data from Florida, a non-grant country.  Over again, the results were extrapolated to approximate a national savings total for the small group market as a result of charge per unit review.

Charge per unit Change Requested Versus Rate Change Implemented in the Minor Group Market

Archive Case: Small Group Market Rate Change, 2012	Requested	Implemented
Number of rate filings in 35 states	772	772
Number of covered lives afflicted by these rate filings	10,938,053	ten,938,053
Average rate change for 35 states	five.8%	4.7%
Average rate alter when request >=x% for 35 states	xvi.iii%	9.7%
% filings with rate modify requested >=10% for 35 states	14.0%	eleven.seven%
% covered lives with charge per unit change requested >=10% for 35 states	14.7%	9.3%
% covered lives with rate change request reduced or denied		18.seven%
Full covered lives with rate change request reduced or denied based on 18.ane million total covered lives for all states		3.iv meg
Full U.South. savings based on $78.7 billion full premiums for all states		$866 million
Sources:  Revised State Charge per unit Review Grant (RRG) data and data from state websites plus data from Florida (non-grant country)

Total premiums in the individual and small group markets were lower by an estimated $ane.2 billion compared to the full premiums initially requested.

Annal: State Consumer Protection Examples and Initiatives from the Decade before the ACA

For more contempo state examples, delight visit NCSL's Health Insurance Reform Enacted Laws Related to the ACA, 2011-2014.

• Pocket-sized Group Guaranteed Issue - 2013 [links verified 6/29/2017]
• Pocket-size Group Rate Restrictions -2013
• Pocket-sized Group Pre-Ex Condition Exclusion - 2013
• Individual Market Portability Rules.- includes pre-exising weather condition-2013
• Rate Review, Private and Small-scale Grouping  -2012

Source for Pocket-size Group Tables: State Health Facts, Kaiser Family Foundation online.

State	Description/ Additional Information
Colorado	Colorado enacted the Off-white Accountable Insurance Rates Act, H 1389; information technology requires individual and small-scale group wellness insurance carriers to file with the Commissioner of Insurance a detailed description of their rating, underwriting and renewal practices; requires approval by the commissioner for sure rate increases.  It was signed June v, 2008.
Florida	Florida Rolls Out Health Program Comparison Spider web Site- Florida launched an insurance comparison Spider web site that allows residents to check the benefits and premiums for modest employer wellness plans offered in the state, the South Florida Business Journal reported on June 26, 2006.
Kansas	Existing Kansas Taxation Credit Complements New Federal Credit.  Businesses may authorize for the country credit if they employ between ii and 50 people and have non contributed to health insurance premiums or health savings accounts for their employees in the preceding two years. The credit tin can be worth $70 per calendar month per employee for the get-go twelvemonth, $50 for the second year and $35 for the third and final year of eligibility.  This benefit can exist added to the federal tax credit that eligible small businesses tin claim starting this twelvemonth. (Report by Kansas Health Institute News, 1/x/2011)
Kentucky	Kentucky's House passed HB 445 & HB 380 in 2006, as the Insurance Coverage, Affordability and Relief to Small Employers (ICARE) Program to make health insurance more affordable for small employer groups; including country subsidies, aimed equally a 4-year pilot project for employer groups with two to 25 employees.
Maryland	On November nineteen, 2007, the Working Families and Small Business Health Coverage Act (Senate Bill half-dozen) was signed into law, offer subsidies to small businesses to start the cost of providing coverage to employers and expanding Medicaid eligibility to certain adult populations. Provisions included in the new law include: The provision of subsidies to small employers and employees of small employers if the employer:  a) has not offered a wellness benefit plan within the prior 12 months; b) has ii to ix eligible employees; c) meets sure depression-wage requirements to be established through regulation; d) establishes a Section 125 payroll deduction program to allow for pre-taxation premium contributions; and eastward) agrees to offer a wellness do good that is designed to foreclose disease, reduce poor clinical outcomes, and promote health behaviors and lifestyle choices. The expansion of Medicaid eligibility upward to 116 percent of the Federal Poverty Level (FPL) for parents and caretaker relatives with a dependent child living at domicile. The phase-in over four years of Medicaid eligibility up to 116 percent FPL for childless adults—enrollment may be capped and benefits may be limited based on available funding; and The legislation is financed through a combination of full general funds, hospital uncompensated care savings, a one-time surplus from the state's high risk puddle, and federal funds. The availability of full general funds for the childless adult expansion depends on the adoption, through public referendum, to add together a new article to the Maryland Constitution to authorize video lottery terminal gaming (slot machines) in the state. The state wanted to focus on its smallest businesses considering that is where the lack of wellness insurance is almost acute, says John Colmers, secretary of the Maryland Department of Health and Mental Hygiene. Reimbursement goes direct to the health insurer, so agents still go full commission on their auction, but the employer gets a beak that'south half the size information technology would otherwise be. As of Jan 2009, about 550 individuals are enrolled; the department is hoping to enroll 1,500 businesses during the yr. In add-on, the Governor, through an October 2007 executive social club, created the Maryland Wellness Quality and Cost Council. Health care help: New for 2009- CNN Money, 1/09.
Montana	Insure Montana is the programme launched in January 2006 to begin addressing the problem of uninsured Montanans.  This is a two office program that is designed to help small-scale businesses with the toll of health insurance, whether they have provided health insurance previously or non. Pocket-sized businesses with 2-9 employees that are currently providing health insurance to their employees are eligible for refundable tax credits.  For businesses that were previously unable to afford health insurance for their employees, Insure Montana provides health insurance coverage through a small business concern purchasing puddle. Over 1550 small businesses were enrolled and ten,000 lives were covered as of August 2007 and a new applicants waiting list was started due to funding constraints. As of January 2009, both the tax credit and purchasing pool programs were at full capacity because of limited funding. Pocket-sized businesses applying for either are beingness put on a waiting list. The program is entirely funded through increases in Montana's tobacco tax, but that's non enough. The state auditor'south office has requested boosted funding - about $12.5 million for the next two years to cover those waiting and new applicants. Health care help: New for 2009- CNN Money, 1/09.
New Hampshire	New Hampshire governor signs HealthFirst insurance plan. The HealthFirst initiative will require major insurance carriers to offer a standard wellness programme for businesses with up to 50 employees. Premium costs will be controlled by focusing on prevention, managing chronic conditions and promoting best practices.   A committee whose members include small business owners will design the wellness program with a target premium of 10 percent of the prior year's median wage, currently about $262 a month. An actuary will appraise whether the program can be offered for the target cost before insurers are asked to provide it, starting October 2009, five/08. The New Hampshire Small Employer Health Reinsurance Pool selected Pool Administrators Inc. as the administrator for the New Hampshire Small Employer Health Reinsurance Puddle.  Small Employer Wellness Carriers are able to reinsure with the pool effective January 1, 2006.
New Mexico	New United mexican states State Coverage Insurance- A 2005 law for uninsured employed adults. A unique public–private partnership that provides affordable health insurance products for pocket-size employers (with 50 or fewer employees) who accept previously been unable to afford coverage for their employees. Employers are expected to contribute $75 per employee per month, and employees pay premiums up to $35 per month and copayments.  37,000 individuals were enrolled as of June 2009. "Pocket-sized Business organization Participation in the New Mexico State Coverage Insurance Program: Evaluation Results." - The Hilltop Institute (Academy of Maryland) Analysis Brief, 2/9/10.
New York	New York'due south HealthPass offers small businesses and sole proprietors a wide range of attractive wellness insurance options that enable eligible employees to choose a programme that best fits their medical needs and budgets. HealthPass serves small businesses and non-profit organizations in New York Metropolis, Long Island, Westchester, Rockland, Orangish, Dutchess, and Putnam counties. More than two,500 employers currently offer HealthPass plans to their employees and families. It operates equally a partnership amidst the New York Business organisation Group on Wellness, the Metropolis of New York, and the health insurance industry; enrollment surpassed 20,000 members as of seven/9/2008. Healthy New York: a program to provide publicly-funded or other type of financed reinsurance for private coverage to assume a portion of insurer'south high-cost claims. The state subsidizes cost for high-cost people using more the $5,000 per yr, with the goal of lowering premiums for all, based on the knowledge that 20 per centum of people account for 80 percent of health care spending. The country requires all HMOs to offer the Good for you NY production. Applicants may now choose a benefit package with a limited prescription drug benefit or i without prescription drugs. Small firms with depression-wage workers, low income self-employed and uninsured workers without admission to employer sponsored insurance may enroll.
Ohio	Rep. Jim Raussen reported that SB 5 initially would have immune small employers to offering health care plans that didn't include all of the country'due south coverage requirements, in hopes of creating a more affordable health insurance product for pocket-sized businesses.   Those and so-chosen "mandate-lite" provisions have been removed from the bill because other states' experience showed few businesses bought the product, and the savings were only well-nigh three to v percent, Raussen said.  Senate Bill 5 at present more often than not includes provisions to allow small businesses to create alliances to purchase health insurance.  This bill became law in March 2007.
Oklahoma	Governor Henry signed a law on June 4, 2007, targeting working Oklahomans by expanding "Insure Oklahoma," a program that helps small businesses provide health insurance for their employees.  Under Business firm beak 1225, the police expands eligibility in the program from businesses with 50 employees to those with 250 or fewer workers. Under the program, the state pays sixty pct of the insurance costs, the employer pays 25 percent and the employee pays the remaining 15 percent. The bill besides would expand eligibility in the program to workers who earn 185 percentage of the federal poverty level to a 250-percent threshold.  As of September 2008, the program has about 10,000 employees enrolled — most of whom were uninsured before — that is far below expectations for a program that could accommodate four times that amount. The Oklahoma Employer/Employee Partnership for Insurance Coverage (O-Epic) program was created to aid small businesses in offering their employees health insurance. Participating employers with 250 or fewer employees must contribute 25 pct of the employee's premium and must offer a qualified O-Epic program. The country funds 60 percent of the insurance costs, and the employee pays the remaining 15 percent. Participating employees have incomes below 250 percentage of poverty. Qualifying O-EPIC plans are required to cover country-defined basic benefits and accept maximum out-of-pocket spending limits.
Rhode Isle	On July iii, 2007 Senate Neb 448 was signed into police force, establishing a state-wide requirement that employers offer employees the opportunity to buy health insurance with pre-tax income.  The state Insurance Commissioner notes that 39 pct of Rhode Island workers do non have admission to employer-sponsored insurance.  Neither the state nor employers are required to contribute to the purchase cost, but the state estimates a savings of "up to forty percent" of the premium price, depending on revenue enhancement bracket.
Due south Carolina	Governor Mark Sanford on February 19, 2008 signed a bill, S.588 (Act No. 180), that gives small businesses more flexibility to provide wellness insurance for their employees.  The bill allows a group of at to the lowest degree 10 small-scale businesses to bring together together and negotiate cheaper insurance rates than an individual business.  Current state law allowed businesses to bring together together for wellness insurance but sets a minimum of 1,000 employees. The new constabulary defines pocket-sized business every bit 2-fifty employees, and permits an employer of one to qualify bailiwick to split up pricing terms. Gov. Sanford Praises Passage of Modest Business Healthcare Neb, News Release, 2/19/08.
Tennessee	In Tennessee, SB 4014 of 2008 allows pocket-size businesses of 2 to fifty employees to pool together for the purpose of negotiating meliorate insurance rates, creating a small business organisation cooperative. The nib is designed to encourage more small employers to purchase wellness insurance and to requite them predictability and stability in health-insurance rates.  Information technology was signed May 28, 2008. CoverTennessee -  A market based public/private partnership plan for small employers and uninsured workers with incomes below 250 percent of FPL. ($25.5k /twelvemonth for i; $51.6k for family of 4).  Cover Tennessee is guaranteed access to basic, major medical coverage for $150 a calendar month with the price shared equally by the individual, employer, and state authorities.  Tennessee tripled its revenue enhancement on cigarettes to produce $239 million in new revenue for FY 2008.  The premium for coverage is shared amidst the employer, employee, and state, with each party contributing ane/3 of the costs of the premium.   CoverTN plan benefits are "very limited in nature compared to traditional insurance. For instance, these plans do not have an out-of-pocket maximum, and therefore practice non protect against the potential of catastrophic medical costs. In other words, in that location is no limit to the corporeality of medical bills a fellow member might accept to pay for a major illness or injury, such as affliction treatment, or injuries sustained in an automobile accident for instance. Therefore, CoverTN is not a low-cost alternative to traditional insurance coverage." 2008 Expansion:  Beginning Jan. 1, 2008, more than Tennesseans volition be eligible for CoverTN, the premium subsidy program for the working uninsured. When CoverTN was launched about six months ago, information technology covered workers who earned up to $41,000 in small businesses with 25 employees or less. The state pays ane-3rd of the premiums, the employer may choose to pay one-3rd and the employee one-third. If the employer chooses not to participate, the employee may pay two-thirds. Premiums for the basic benefit plan are virtually $150 a month and coverage is portable. The state plans to expand the plan past opening information technology to individuals with annual incomes of up to $43,000, and in companies with upwardly to 50 employees. About 13,000 Tennesseans are currently enrolled, and administrators hope to increase enrollment to 100,000 past 2010.
Texas	In 2007, the Senate passed and a House committee gave favorable recommendation to SB 922, which would encourage counties to test models for modest business organization coverage. Intended to maximize flexibility and local command, the legislation would enable county commissions to institute local or regional health-care programs, which could offer insurance or wellness services.  The state Health and Human Services Commission would utilize general revenues to provide outset-upwards grants to vii of these programs, which could include health savings accounts and high-deductible plans. The grants would average $150,000 each, for a total cost of $1.05 million in FY 2008. In addition, the local/regional programs could apply for additional funds from a "wellness opportunity puddle," created nether an 1115 waiver from Medicaid.  Information technology is expected that employers, employees and the state would jointly share the toll of premiums or health-intendance services. The programs would exist required to allow whatever individual who receives state premium assistance to enroll.   The beak did not pass the Business firm. Incentives could boost employee wellness care- Senate studies tax breaks to aid small-scale firms provide insurance. The incentive under consideration will probably be in the class of larger tax deductions for companies that offer health care plans to their employees. Dallas Morning News, 2/i/07.
Utah	Program Assists Uninsured to Go Health Coverage.  Considering of passage of HB276 in 2006, the Utah Department of Wellness launched a new rebate programme for wellness insurance premiums that would reduce the number of uninsured citizens in Utah by helping workers pay for their employer- sponsored health insurance. Qualified workers can receive rebates up to $150 per developed and $100 per child to assistance pay the monthly premium of an employer-sponsored health care program. HB276 provided $267,000 in land funding for the programme and allows matching federal Medicaid money. Utah also created the Utah Health Exchange, an net-based state program, comparing insurance options and providing greater transparency of insurance programme benefits, serving the individual and small group markets. The substitution allows employees to combine defined contributions from one or more employers along with pre-tax personal contributions to purchase insurance that also is portable. All pocket-size employers with ii to l people volition have access to the commutation January 1, while large employer groups will have to wait until 2012. Utah'south exchange differs from and then-called health insurance purchasing cooperatives set up by groups of small employers in some states to employ their collective purchasing power to reduce premiums.  Many of those cooperatives remained small and did not concluding long.  As report past Workforce Management, "Every bit the premium went up and the practiced risk left the group, you'd end up in this death screw and the group died," says Larry Boress, president of the Midwest Business Group on Wellness.  The Utah exchange is intended to practice what the purchasing cooperatives could not—simplify health program assistants, offer employees more choice and go along wellness intendance costs fixed.  "What'southward revolutionary virtually the Utah commutation is the defined-contribution piece for business concern," says Samuel C. Gibbs, a senior vice president with Mountain View, California-based eHealth, an online health insurance portal. Utah is using eHealth'southward Cyberspace platform for a similar insurance exchange for individuals.  Utah's  law now allows employers to contribute a fixed-dollar amount to a person'southward health insurance, enabling them to customize their contribution for each private, and ship one check once a calendar month to the exchange ambassador. A separate role of this reform creates NetCare, a depression-cost mandate-free insurance option for insurers to offering to the individual and small-business organisation markets and for those eligible for COBRA, mini-COBRA or conversion coverage."  Enrollment launched August 19, 2009, based on HB 188, enacted into law in March 2009.  In the two-calendar week enrollment flow that closed at the end of August, 136 businesses employing a combined 2,333 workers signed upwardly. The boilerplate size of companies enrolled is 17 employees. What Utah'due south Health Reform Means to Small-scale Business - BusinessWeek, ix/04/09. Utah Exchange May Offering New U.S. Health Intendance Insurance Model- Workforce Management, 9/17/09.
Washington	A 2007 constabulary, HB 1569 established the Washington Wellness Insurance Partnership. Similar to the "Connector" machinery created in Massachusetts, the Partnership will offering benefits assistants to small employers that take at to the lowest degree one employee who earns less than 200 percent of the federal poverty level (FPL). The Partnership also volition provide sliding-scale premium subsidies to individuals who earn less than 200 pct of the FPL. It besides authorizes evaluating the inclusion of additional health insurance markets in the health insurance partnership and studying the impact of health insurance mandates.  Information technology became law 5/2/07 as Chapter No. 2007-260. Program implementation has been halted due to a budget deficit. (as of August 2009)
West Virginia	W Virginia Small Business Plan - A 2004 police force (S.B. 143) intended to help uninsured small businesses provide coverage for their employees. This is a public-private partnership between the West Virginia Public Employees Insurance Bureau (PEIA) and participating insurance carriers by allowing carriers access to PEIA's provider reimbursement rates. The blueprint of this plan included coverage in both chief care and major medical at a toll that is twenty-25 percentage lower than the retail rates.

State Subsidized Enrollment: Results Are Mixed
In the summer of 2007, NCSL compiled an informal survey summary of actual numbers of residents who enrolled in state initiated small-business programs.  Enrollment experience is unlike state-to-land.  Historically, employer participation in government created subsidized programs has not been all-encompassing.  States have had more success with enrolling individuals at the employee level and not going through the employer. Participation is also very much related to outreach and marketing.  For more than information nerveless past NCSL's Principal Care Projection, please visit State Programs to Subsidize or Reduce the Toll of Wellness Insurance for Small Businesses.

NCSL Online Resource

• Country Legislation on Health Savings Accounts- NCSL study, updated 2014
• State Legislation Relating to Disclosure of Hospital and Health Charges- NCSL Report, updated 2014

Archives:

• State Programs to Subsidize or Reduce the Toll of Health Insurance for Small Businesses and Individuals- NCSL'south Master Care Project, 2009.
• State COBRA Expansions for Small Businesses- 39 states and DC expand COBRA regulations to pocket-sized businesses (two-19 employees). The 2009 federal stimulus law expanded benefits and offered new opportunities for country coordination, 12/2009.

NOTE: NCSL provides links to other Web sites from time to time for information purposes only. Providing these links does not necessarily indicate NCSL's support or endorsement of the site.

Compiled by Richard Cauchi, NCSL Wellness Plan-Denver.  Before research conducted past Steve Landess (2012-13)

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Source: https://www.ncsl.org/research/health/small-business-health-insurance.aspx

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