Healthcare Reform

Healthcare Reform, the Affordable Care Act

How it affects Individuals and Businesses

Sure Life Insurance can keep you informed of all of the latest changes in Healthcare Reform to ensure you are prepared, especially when it comes to the most recent healthcare reform, the Affordable Care Act (ACA)

The ACA, also known as OBAMA CARE, is currently being implemented and is probably the nation’s most significant change in the laws that govern healthcare. 

Below you will find some (but certainly not all) highlights of the new law and how it may impact employers and individuals under 65.  


Highlights of the ACA

For Individuals and Businesses

Tax Penalties

EMPLOYERS: Employers who have more than 50 full-time equivalent employees must offer those employees benefits that pay for 60% of the minimum essential benefits. If you are in non-compliance, you will incur a penalty of $2,140 per year multiplied by the number of full-time employees, and excludes the first 30 employees. Additionally, the penalty is increased each year by the growth in insurance premiums. However, note you may also incur a penalty when at least one of your employees receives a premium tax credit in the Health Insurance Marketplace (Exchange).

INDIVIDUALS: Following is information on the Individual Mandate of the ACA. However, note the tax penalty for individuals has been recently repealed. The penalty, prior to 2019, affects individuals who failed to obtain qualifying health insurance. Individuals could have coverage through their employer, or through an individual policy to satisfy the requirement. If an individual did not have qualifying health insurance, the tax penalty will be $695 for adults. Additionally, the penalty is $347.50 for each child. However, the maximum family penalty is the greater of 2.5% of income, or three times the adult penalty, which is $2,085. Consequently, your penalty will be applied on your annual tax return.

New Approval Guidelines

No pre-existing clause. Insurance companies can no longer increase rates or deny coverage because of a pre-existing condition.

Dependents up to age 26 may be added to an insurance policy for both individuals and employer coverage.

Gender is no longer a factor in determining rates.

Renewal rates are the same as new business rates.

Waiting period should not exceed 90 days.

Open Enrollment Period

Individuals must purchase their health insurance during the annual open enrollment period NOV 1 to DEC 15th annually. Failure to do so may result in having to wait until the next open enrollment to purchase coverage. You may qualify for special enrollment if you have any of the following circumstances:
-change in legal marital status
-a change in the number of dependants
-a change in place of residence and the current carrier is not available
-significant cost or coverage change
-a change in coverage of a spouse or dependant
a COBRA qualifying event
-legal judgements, decrees and orders
entitlement to Medicare or Medicaid

Qualifying Coverage

To be in compliance with the new healthcare reform laws and avoid costly penalties, you must purchase Insurance coverage that pays at least 60% of the costs of the following “essential benefits.” CLICK HERE FOR A LIST OF THE ESSENTIAL BENEFITS

Premium Tax Credits

Business and Individuals who purchase their health insurance through the new Health Insurance Marketplace and/or SHOP may be eligible for tax credits which are applied as a discount on your monthly insurance premium. To see if you are eligible for a tax credit (premium subsidy), please click the appropriate link below.

Individuals click here
Businesses click here

Related Resources

To help you with Healthcare Reform

The consultants of SureLife Insurance are continually educating themselves to stay abreast of new laws, regulations and legislation within the healthcare and healthcare insurance industries.  We can help you stay compliant, while reducing costs.


Contact Us for More Info