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ACA FAQs

Q: Am I required to offer health insurance to my employees?

A: Beginning in 2015, businesses with 100 or more employees will either have to offer health insurance to their full time employees or pay a penalty. Business with 50-100 employees will have an extra year to phase in health care coverage for employees who work more than 30 hours per week. This mandate for "medium-sized employers" will take effect in January 2016. Employers with fewer than 50 employees are not required to offer health insurance to their employees.

Q: What is the penalty for a business if they do not provide insurance to their employees?

A: Businesses with 51 or more full time employees will be fined $2,000 per employee (excluding the first 30 employees) if they do not offer coverage for employees who average 30 or more hours per week. There is no penalty for part time employees not offered coverage.

Q: Can an employee be denied coverage for a pre-existing condition?

A: Beginning in 2014, all health insurance plans must guarantee the availability and renewal of coverage regardless of health status.

Q: Can individuals be dropped from health insurance coverage?

A: Health insurance issuers cannot drop an individuals’ health insurance except in cases of fraud, misrepresentation of material facts, or nonpayment.

Q: Am I eligible for small business tax credits?

A: To qualify for these tax credits your business must have an average annual wage of $50,000 or below, have less than 25 employees and pay at least half of the cost of their employee’s health insurance.

Q: What is the tax credit?

A: Beginning in 2014 eligible employers may receive a tax credit of 50% of the employer’s contribution towards insurance premiums.  Tax exempt businesses may receive 35% tax credit.

Q: What is a Qualified Health Plan?

A: The ACA requires that all health care plans provide essential benefits which are: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substantive use disorder services, including behavioral health treatment, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventative and wellness services and chronic disease management, and pediatric services, including oral and vision care.

Q: How long can children stay on their parent’s health insurance plan?

A: Under the ACA, the federal government allows children to remain on their parent’s health insurance plan until age 26. 

Q: What is the Health Benefit Exchange?

A: The ACA sets up Health Benefits Exchanges, which are online marketplaces which allow individuals and small businesses to shop and enroll in health insurance plans.  Each state must have an operating Exchange by January 2014.  Kentucky is operating a state based exchange, which was created by Governor Steve Beshear on July 17, 2012 and is operated by the Cabinet of Health and Family Services.

Q: When is open enrollment for the Kentucky Health Benefit Exchange?

A: October 1, 2013

Q: What is the SHOP?

A: Within the Kentucky Health Benefit Exchange, there is a Small Business Health Option Programs (SHOPs) which will offer small businesses (100 employees or under) Qualified Health Plans and their employees can choose the plans that fit their needs and budget.

Q: Are there any new taxes?

A: Yes. Beginning in 2013, individuals earning more than $200,000 ($250,000 for joint filers) will pay an additional 0.9 percent tax for Medicare and 3.8 percent tax on investment income.