Amherst Chamber of CommerceAmherst Chamber of Commerce

Health Care Reform

What Does It Mean - What Do You Need To Do

By Colleen DiPirro



We get asked that question every day and every day we are getting answers to these and dozens more questions.  Health Care Reform as a result of the Affordable Care Act (ACA) is beginning to take shape and we have a better understanding of how it will impact our subscribers and members as well as how we will assist them during this transition.




Chamber Board Chairman David Donavon is the vice president of sales for Independent Health.  In a recent article in Business First, he framed many of the aspects of the new law in an understandable and logical format which I will reference in this column.  But, first, every resident of the United States needs to understand the foundation of the ACA.  Beginning during open enrollment October 1, 2013 for coverage beginning January 1, 2014 employers and employees will go to the health benefit exchange to select their coverage.  These exchanges, done online, will provide individuals and small businesses a platform that includes plan benefits and associated costs and it is through the exchange that you will purchase your insurance. 




There are two categories of exchanges: public and private.  The majority of our members will participate in the public exchanges which are being developed by the New York State Department of Health.    New York's public exchange is for individuals and for employees of small businesses.  The Amherst Chamber of Commerce is ramping up to service our members in both categories.




In the individual category, we will walk you through the online application process and explain the different benefit plans and costs to assist you in selecting the best plan for your needs and your budget.  Premiums will be based on your 2012 Income.  Essentially, a family of four making $80,000 or less a year will be qualified for a sliding premium subsidy.  As your trusted advisor, you can rely on us to provide you with timely and professional support during this new and onerous process.




Employers that would like to continue to provide health insurance will utilize the Small Business Health Options Program (SHOP).  Under SHOP, employers need to determine what plan options they will offer, how much they want to contribute to the employees plans and when they would like to make the plans effective.  The small business decision maker will decide how many products they want to offer their employees and from which carriers.  As stated in earlier articles, the tiers are catastrophic, bronze, silver, gold and platinum with increased costs for increased benefits.  Once the employer makes these decisions, the employee will do the shopping on the exchange and select their coverage based on the offerings.




This is really a Cliff Notes description of the exchange process.  Our goal is to provide our members with a general foundation of understanding of the newly creating marketplace so that as we get closer to the 'go live' date, you will have the basic knowledge necessary to make the right choice for you and your employees.  There are many more components of the ACA such as Premium Tax Credits, Subsidy rates, penalty's for non-participation and enrollment periods that will be addressed in subsequent articles.




But, be assured, the Amherst Chamber of Commerce is on it!  We are here today to service you and answer your questions and will remain your trusted advisor moving forward. 

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