Health Insurance FAQ from Intrawest

E x c h a n g e s - F r e q u e n t l y A s k e d Q u e s t i o n s

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Health Care Reform - Exchanges

Frequently Asked Questions (FAQs)

What is a health insurance marketplace or exchange?

A marketplace, or exchange, is a website where you can shop for health insurance. You can compare all

of your options and costs side by side and see if you qualify for financial help. All the plans offered in a

marketplace, or exchange, must meet certain rules relating to affordability, required benefits, and

market standards.

What can I do through a health insurance exchange?

Youll be able to:

Shop for health insurance offered by well-known insurance companies.

Choose from health plans grouped by metallic levels: Bronze, Silver, Gold, and Platinum. The

different plans will offer you choices in:

o How much youll pay for coverage (premium amounts)

o How much youll pay out of your own pocket for medical care and prescription drugs

(deductibles, coinsurance, copays, and out-of-pocket maximums)

o Networks of participating doctors, hospitals, labs, and other health care providers

Complete an application to find out if you qualify for financial help.

Enroll in health insurance thats right for you or your family. The federal and state health insurance

marketplaces will begin enrollment in October 2013 for coverage starting January 1, 2014.

What kinds of coverage will be available through the marketplace?

All the plans in the marketplace must cover the same health care services. These services are called

essential health benefits. They include:

Ambulatory, or outpatient, care

Emergency services

Hospitalization

Maternity and newborn care

Mental health and substance abuse disorder services, including behavioral health treatment

Prescription drugs

Rehabilitative and habilitative services and devices, such as physical therapy

Laboratory services

Preventive care services

Pediatric services, including vision and eye care for children

Your costsboth how much youll pay for coverage and how much youll pay when you get medical

caredepends on the plan you choose.


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Keep in mind though, that all the plans in the exchange cover preventive care services at no cost to you.

This means that you wont pay anything for these services as long as you get them from a doctor, lab, or

other provider that is part of your health plans network.

What is the employer mandate? (postponed until 1/1/2015)

All employers with 50 or more employees will be required to offer health insurance to full-time

Employees (30 or more hours per week) or pay a penalty. That doesnt mean you have to buy health

insurance through your employerit just means it must be available to you if youre a full-time

employee.

What is the individual mandate?

On August 27, the Internal Revenue Service (IRS) issued a final rule for the individual mandate provision

of the Patient Protection and Affordable Care Act (PPACA or ACA).

As a reminder, the individual mandate requires most individuals to have minimum essential coverage in

2014 or pay a penalty. The penalty is called a shared responsibility payment. Some individuals may

qualify for an exemption from the mandate so they will not be required to have coverage or pay a

penalty. An individual seeking an exemption may do so in advance through an application submitted to

the Exchange/Marketplace or after the fact with the IRS through the tax filing process. An applicant can

apply for multiple exemptions simultaneously.

What Qualifies as Minimum Essential Coverage?

An individual is considered to have minimum essential coverage for any month in which he or she is

enrolled in one of the following types of coverage for at least one day.

An employer-sponsored group health plan offered in a state, which is defined as the 50 states plus

the District of Columbia. This includes plans offered by, or on behalf of, an employer to an

employee, e.g. multiemployer plans, single employer collectively bargained plans, plans sponsored

by third parties such as professional employer organizations, temporary staffing agency, etc.

An individual health insurance policy offered in the individual market in a state or through an

Exchange/Marketplace in a territory.

A government plan such as Medicare, Medicaid, Childrens Health Insurance Program (CHIP),

TRICARE (a U.S. Department of Defense Military Health System) or veterans coverage

Insured student health coverage

Self-insured student health coverage*

Medicare Advantage plan

State high risk pool coverage*

Coverage for non-U.S. citizens provided by another country**

Refugee medical assistance provided by the Administration for Children and Families


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Coverage for AmeriCorp volunteers**

*Designated as minimum essential coverage for plan/policy years beginning on or before December 31,

2014. For coverage beginning after December 31, 2014, sponsors of high risk pool or self-funded student

health coverage may apply to be recognized as providing minimum essential coverage.

**Coverage provided by another country and coverage for AmeriCorps volunteers are no longer

automatically deemed minimum essential coverage. However, individuals may apply to have their

coverage recognized as minimum essential coverage.

How will Penalties be Determined and Paid?

Starting January 1, 2014, you must have health insurance, or youll pay a penalty. The first penalties will

be due when individuals file their 2014 tax returns in 2015. A penalty is the greater of either a specified

dollar amount or percentage of income. The annual penalties for 2014 through 2016 are noted below.

Beginning in 2017, penalties will increase based on the cost of living.

2014: Greater of $95 per adult and $47.50 per child under age 18, maximum of $285 per family, or

1% of income over the tax-filing threshold

2015: Greater of $325 per adult and $162.50 per child under age 18, maximum of $975 per family,

or 2% over the tax-filing threshold

2016: Greater of $695 per adult and $347.50 per child under age 18, maximum of $2,085 per family,

or 2.5% over the tax-filing threshold

If the penalty applies for less than a full calendar year, the penalty will be 1/12 of the annual amount per

month without coverage.

Who is Exempt from Paying the Penalty?

The final rule confirmed the broad exemption categories.

Individuals who cannot afford coverage

Taxpayers with income below the tax filing threshold. A taxpayer is not required to file a federal

income tax return solely to claim the exemption, and may apply for exemption via the

Exchange/Marketplace.

Individuals who qualify for a hardship exemption

Individuals who have a gap in minimum essential coverage of less than three consecutive months in

a calendar year, with the continuous period beginning no earlier than January 1, 2014

Members of religious groups that object to coverage on religious principles

Members of health care sharing ministries

Individuals in prison


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Individuals who are not U.S. citizens and not lawfully present in the United States as defined by

Health and Human Services

U.S. citizens residing in a foreign country who meet certain IRS tests

Individuals who are not members of a federally recognized Native American tribe, but who are

eligible for services from the federal Indian Health Service

Will Marketplaces be verifying income of consumers as part of the eligibility process?

Yes. Marketplaces will always use data from tax filings and Social Security data to verify household

income information provided on an application, and in many cases, will also use current wage

information that is available electronically. The multi-step process begins when an application filer

applies for insurance affordability programs (including advance payments of the premium tax credit and

cost-sharing reductions) through the Marketplace and affirms or inputs their projected annual

household income. The applicants inputted projected annual household income is then compared with

information available from the Internal Revenue Service (IRS) and Social Security Administration (SSA). If

the data submitted as part of the application cannot be verified using IRS and SSA data, then the

information is compared with wage information from employers provided by Equifax. If Equifax data

does not substantiate the inputted information, the Marketplace will request an explanation or

additional documentation to substantiate the applicants household income.

How will I prove I have health insurance?

Youll get a certificate from your insurance company that says you have the minimum coverage. In 2014,

youll have to submit a form with your federal tax return proving you have insurance.

How will prescription drugs be covered?

When you buy health insurance through a marketplace, you also get prescription drug coverage. Your

prescription drug coverage is provided by your medical insurance company with help from a pharmacy

benefit manager. Each company has its own rules about how drugs are covered.

If you or a family member takes medication, call the medical insurance companies available through

your state or federal marketplace before you enroll to find out how they will handle your prescription

drug(s). By doing homework before you enroll, you can choose an insurer knowing it will cover your

prescription drugs in a way that is acceptable to you.

Here are some questions to ask:

Will I have a combined annual deductible? If yes, youll have to pay the full cost of your medical

and drug expenses until the deductiblethe amount you pay before you and the insurance

company start sharing costsis met.


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Is my drug on the formulary? Insurance carriers have a list of preferred drugs, or formulary. If an

insurance carrier considers your drug non-preferred, make sure youre comfortable with the cost, or

the alternative medication and its cost.

Will I have a step therapy program? If yes, youll need to try using a generic alternative before your

drug will be covered.

Will generic drugs be mandatory? Because many brand-name drugs are expensive, some insurance

carriers dont cover them at all if a generic is available.

Note: Even if generic drugs arent mandatory, theyre an easy way to save money. Generic drugs

meet the same FDA standards as brand-name drugs but cost much less. Ask your doctor if a generic

drug is right for you.

Will there be quantity limits? Certain drugs have quantity limits to reduce costs and encourage

proper use. Ask if a limit applies to your drug(s).

Will prior authorization be required? If yes, the insurance carrier will need more information

before deciding whether to cover your drug. Ask the carrier what you need to do to get it approved.

Will pharmacies be easy to access? Each insurance carrier has a network of participating

pharmacies. Check your medical insurance carriers directory to find an in-network pharmacy close

to you.

Can I get help paying for health insurance?

If youre going to buy insurance through a state or federal health insurance exchange, financial help may

be available.

You can use the below link by entering in income level, age, and family size to get an estimate of your

eligibility for subsidies.

http://kff.org/interactive/subsidy-calculator/

What if I have health insurance options through my employer?

Youll have the option to get insurance through your employer or a health insurance exchange. The

choice is yours. Before you choose a plan:

Think about your health care needs.

o Do you see the doctor fairly often and take one or more prescription drugs for an

ongoing condition, such as high blood pressure or diabetes? Or do you only see the

doctor once or twice a year for checkups and the occasional illness?

o The answers to these questions can help you decide which option presents the best

coverage and value for you and your family.

Review all the options that are available to you.

o Depending on your situation, you may also be eligible for coverage through Medicare or

Medicaid. Or your children may be eligible for coverage through the Childrens Health

Insurance Program (CHIP) in your state.


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If, after reviewing all your options, you decide to buy coverage through an exchange, you may qualify for

financial help if your income is low or modest.

However, you will not qualify for financial help if you choose to buy insurance through an exchange and

your employer offers you coverage that is:

Considered affordable (how much you pay for coverage is less than 9.5% of your income); and

Meets coverage standards as required by law.

What are the rules for Benefit Eligibility for all Staff?

ACA requires that Intrawest track hours for both the eligibility period (Intrawest can use a period from 3

to 12 months and has chosen 12 months) and the stability period. The stability period must be equal to

the eligibility period. Once the initial eligibility period is calculated and if an employee is benefit eligible

the stability period will run concurrently with the next eligibility period. So the eligibility period is being

calculated every 12 months worked. If the break is greater than 6 months then the eligibility period is

reset and begins again. If the break is less than 6 months, the eligibility period is continuous.

Hours Worked Benefits Eligible Hours

Benefits Eligible

Period

(Stability Period)

Example 1

Measurement/

Look Back

Period Oct 13

Oct 14

Benefits Period

Nov 1, 2014 to

Oct 31, 2015

Measurement Period

Oct 14 to Oct 15

This runs concurrently

with the Stability Period

Benefits would

begin or

terminate on Nov

1, 2015

Current Regular

EE A 1170 Y 980 N

Current Seasonal

EE B 900 N 1200 Y

Example 2

Measurement/

Look Back

Period July 1 to

June 30

Benefits period

August 1 to July

30

Hours (Measurement

Period) July to June

Benefits period

would be August

1 to July 30

New Hire June -

seasonal 1200 Y 980 N


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What is a measurement period?

The measurement period is 12 continuous months in which your hours are tracked to see if you work

and average of 30 or more hours per week for at least 9 months. Once you reach a continuous 12

month period where you have an average of 30 or more hours worked per week for at least 9 on the

preceding 12 months you will be benefits eligible. The measurement period begins on date of hire or

rehire if break is greater than 6 months. If break is less than 6 months the initial measurement period

continues.

What is a stability period?

The stability period is the period following the measurement period. Once you are in the stability period

you are eligible for benefits for 12 months regardless of hours worked. A new measurement period runs

at the same time as the stability period and will indicate if you are eligible to continue benefits for the

next 12 months.

If Im seasonal, will I be able to be on the Intrawest plan next season?

No, effective April 30, 2014 Intrawest will no longer offer any health benefits to seasonal staff. You will

still be eligible to contribute to the 401k plan.

What if I move into a regular position?

If you move into a regular position you will be able to enroll in Intrawest benefits

What if I am in a seasonal position, but work more than 30 hours a week?

Hours will be tracked on a 12 months basis for each employee and if you are not currently benefit

eligible, but you have an average of 30 hours a week for at least 9 months a year, you will become

benefit eligible for the next 12 month period.

How does the subsidy work?

The subsidy will be provided through the exchange as the individual purchases coverage through the

exchange and then trued up on the individual's federal tax return for the year.

If an employee works in CO 6 months and a different state for 6 months is their coverage portable or

will they be required to get coverage from the second state exchange? If portable, for how long?

Coverage through an exchange generally applies based on the state of residence so they would need to

get coverage in each state.

When does the subsidy start if an employee is covered under Intrawest plan for 4 months and then

loses coverage are they eligible for the subsidy once they lose coverage or is there a waiting period

or do they lose the subsidy for the year because they had employer sponsored coverage for part of the

year? The subsidy and the individual responsibility provisions are determined on a monthly basis and

will depend on when the individual purchases coverage through the exchange.


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What hours will be included in tracking my time?

All hours paid will be used to calculate the number of hours to be eligible for Intrawest benefits.

What happens if I am laid off?

If you are on Intrawest benefits they will not end unless you are terminated. Benefit coverage will

continue for the full 12 month stability period. At the end of the stability period if you do not have

enough hours to continue to be eligible, you will lose Intrawest benefits.

What if the cost of benefits exceeds 9.5% of my income in a month?

The cost is based on employee only coverage and as the Intrawest cost is less than 9.5% of the federal

poverty level, your rate for benefits will remain the same.

What happens if I am terminated and rehired?

When you are terminated benefits if you are eligible will cease and you will be offered COBRA or you

can go to the exchange. When you are rehired if the break is less than 6 months and you were benefit

eligible when you left and are still in your stability period you will be eligible to re-enroll in benefits and

benefits will continue until the end of your stability period.

What happens with my HSA?

Your HSA is yours. As you will no longer be under the Intrawest plan your account at JPMC will move to

a new account, one that is not sponsored by Intrawest. JPMC will send you information on your new

account and will move your funds to your new account.

Will I still be able to contribute to my HSA?

It will depend on the type of plan you choose to enroll in. If you choose another consumer directed

health plan, then you will be able to continue to contribute to your HSA. If you choose another type of

plan, such as traditional plan with office co-pays, then you will not be able to contribute to your HSA.

Will I be able to use the money in my HSA?

Yes. Regardless of the type of insurance plan you choose either on the exchange or through a private

plan, you can still use your HSA for eligible medical, dental, vision and Rx expenses.

What options do I have for vision and dental coverage?

There are a few options available. Some of the plans on the exchange will include some vision and/or

dental benefits. VSP (Intrawest vision provider) does offer an individual plan that you can sign up for

directly with VSP at www.vsp.com. For dental there are a few providers that offer stand-alone dental to

individuals. Delta Dental is a nationwide carrier that offers plans. In addition you can go to

www.ehealthinsurance.com to look up plans.


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If I am core or regular can I go to the exchange?

Yes. You will not be eligible for any subsidy as the Intrawest plan is considered credible coverage under

the Affordable Care Act regulations.

Can I sign up on the exchange at any time?

No, you must have a qualified event to be able to sign up for coverage at any time. If youve been on

the Intrawest plan and are losing coverage as of April 30th, (or March 31st if you dont work in April) that

is considered a qualifying event and you may sign up for the exchange effective May 1st (or April 1st if

you dont work in April).

If you are seasonal and currently do not have health insurance, you must enroll on the exchange by

March 31, 2014 to be able to have coverage in 2014. You will not be able to purchase coverage until the

next ACA open enrollment period.

Would I be able to get coverage through a private carrier if I do not go to the exchange?

You must enroll during the same open enrollment period noted above or have a qualified event to

purchase insurance through a private exchange or carrier.

Who can I contact for more information on healthcare options or the exchange?

Nicholas Hill Benefit Group, Inc.

www.HealthInsuranceMarket.org/steamboat

Seasonal Employee Health Insurance Assistance Toll Free Telephone Number: 1.866.395.1793.

Representatives from the Nicholas Hill Benefit Group will be on-site in Steamboat later this month. In

the meantime, feel free to contact their offices for assistance.

Documents

Health Insurance FAQ from Intrawest