Health Care Reform
Employer shared responsibility
ACA provisions require that Kansas businesses offer affordable, minimum value coverage to their full-time employees and their dependents. This is often referred to as employer shared responsibility or "Play or Pay.” Businesses with fewer than 50 employees are not affected by the employer mandate provisions.
Businesses with more than 50 full time employees
Must offer coverage to 95 percent of full time employees as of the first day of the plan year starting after Jan. 1, 2016.
Provision details and questions and answers
MEC and ALE reporting requirements
You can find detailed information on the Minimum Essential Coverage (MEC) and Applicable Large Employer (ALE) reporting requirements at the IRS website.
SBC and the Uniform Glossary
The SBC summarizes the key features of a health plan, such as the covered benefits, cost-sharing provisions and coverage limitations. SBCs include a standardized plan comparison tool called "coverage examples," similar to the familiar Nutrition Facts labels required for packaged goods.
The Uniform Glossary is a set of terms written in plain language that helps consumers understand some of the most common but confusing jargon used in health insurance.
SHOP (Small Business Health Options Program)
Employers with fewer than 50 employees may contact Blue Cross directly to enroll in SHOP coverage. To be eligible, your business organization must:
- Be located in Kansas
- Have at least one eligible employee (not a sole proprietor)
- Have 50 or fewer full-time equivalent employees
- Offer coverage through SHOP to all full-time employees
Small employers must complete and print the SHOP application. If you plan to claim the Small Business Health Care Tax Credit, you'll need to get an official eligibility determination from the SHOP Marketplace.
How much is your Small Business Health Care Tax Credit worth?
If you're eligible, your tax credit may be worth up to 50 percent of your premium contributions. To find out if you're eligible and how much your tax credit might be worth, visit these links:
- SHOP Tax Credit Estimator
- SHOP Full-time Equivalent Calculator
- Things to Know about the tax credit and applying for SHOP
More SHOP information and assistance
- Find detailed SHOP information.
- Call the government Help Center at 800-706-7893.
- A Spanish help line is also available at 800-706-7893.
Notice of coverage
Kansas businesses have the responsibility to inform all current employees about the availability of the Health Insurance Marketplace.
Employers that offer medical coverage to some or all of their employees should provide the “Employee Notice of Coverage Options,” using this model notice (also en español). The notice must be provided in writing and may be delivered electronically if ERISA standards for electronic delivery are met.
Comparative effectiveness research fee
Fully insured and self insured plans will be assessed $2 per participant to fund comparative effectiveness research. This research was established to assess the most effective treatments for certain conditions and to share that information with health care providers.
Employer tax credit
One of the early provisions of the Affordable Care Act enabled qualified small businesses to be eligible for a tax credit or employer-paid health and dental premiums. In 2014, the tax credit increased to 50 percent of premiums paid by eligible small businesses and 35 percent of premiums paid by eligible tax-exempt organizations. You can learn all the tax credit details at healthcare.gov, or by visiting the IRS website.
Employee Wellness Discounts
Many Kansas employers provide incentives for their workers to remain healthy and/or prevent harmful health issues. Such incentives and rewards can’t exceed 30 percent of the total cost of an employee’s health benefits coverage.