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Obamacare: What Are Actuarial Levels?

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by Rebecca Scott, Marketing Intern
Insurance sold to businesses and individuals must comply with different levels of health insurance coverage established by the ACA, commonly known as Obamacare. These levels are called “actuarial” because they are based on how much of the insurance they actually cover. Four different levels of health insurance have been established under Obamacare:  the Bronze, Silver, Gold, and Platinum plans.  Small businesses and individuals will be able to buy one of these plans at their state exchange.
These different levels help your small business buy the minimum coverage that you are required to have under the Obamacare “Pay or Play” mandate. Obamacare requires your business to cover at least 60% of your employees’ health expenses. The Bronze plan covers 60% of expenses. So, if your business purchases the Bronze plan, you will fulfill the requirement.  However, if your business is considered a large employer, you won’t be able to purchase these levels of coverage through a state health insurance exchange until 2017.
However, if you have fewer than 25 employees, you are considered a small employer, and you will be able to buy one of the four levels of health insurance through your state health exchange for business. These exchanges, called Small Business Health Options Programs (SHOPs), will open in 2016 for businesses with up to 50 full-time employees. If you have over 50 full-time and full-time equivalent employees, you are considered a large employer and will have to wait until 2017 to be able to buy one of the four levels of health insurance through your state health insurance exchange
The actuarial levels must cover these ten essential health benefits:
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity & newborn care
5. Mental health & substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative & habilitative services & devices
8. Laboratory services
9. Preventive & wellness services & chronic disease management, &
10. Pediatric services, including oral & vision care
Let us help you!
Time Forge will  keep you organized and stress free through this entire process. We will help you determine if you are a large employer or a small employer by giving you the ability to look back and show part-time and full-time employees, plus their hours scheduled vs. hours worked, with averages. To find out more about Obamacare and how it will affect you as an employer, and how we can help you, take a look at our eBook, Obamacare: A Handbook for Employers.

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