So correct me if I'm wrong please but my understanding is that employers forming group plans will not have to offer spouse and defendants coverage in 2014? My Rogers Benefit Rep is telling me that is not true. He is telling me that they don't have to offer spouses but have to offer coverage to children? I think he is trying to protect his group plans from dissolving and going to IFP GI . Obviously this makes a huge difference when it comes to subsidy eligibility. Am I missing something??
Group Dependent Coverage
- Thread starter foxmarble
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Re: Group Dependnt Coverage
It's too bad the Rogers rep is correct. The family glitch will keep many from subsidies, since children cannot be carved out of the eligibility class for a group plan. Spouses can be carved out. So, if children are eligible for an employer-sponsored group plan, and if the group plan is affordable and adequate, then the children are not eligible for a subsidy.
Even worse, that "affordable" calculation is based on the premium for "self-only" coverage (employee-only), not including the premium to add dependents. So, if the employee's share of the premium for self-only coverage is less than 9.5% of HOUSEHOLD income, then it's affordable. If the group plan is also adequate (at least 60% actuarial value), then all eligible members are blocked from getting a subsidy. The only hope for that family to get any subsidy dollars is if the employer specifically carved out spouses from the eligibility class.
It's too bad the Rogers rep is correct. The family glitch will keep many from subsidies, since children cannot be carved out of the eligibility class for a group plan. Spouses can be carved out. So, if children are eligible for an employer-sponsored group plan, and if the group plan is affordable and adequate, then the children are not eligible for a subsidy.
Even worse, that "affordable" calculation is based on the premium for "self-only" coverage (employee-only), not including the premium to add dependents. So, if the employee's share of the premium for self-only coverage is less than 9.5% of HOUSEHOLD income, then it's affordable. If the group plan is also adequate (at least 60% actuarial value), then all eligible members are blocked from getting a subsidy. The only hope for that family to get any subsidy dollars is if the employer specifically carved out spouses from the eligibility class.
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