Employee-Health Care
Our best asset is our employees and there health,  we can insure them individually or as a group.
4 TIERS OF COVERAGE
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To access the official Covered California website, click here now.

  1. The Affordable Care Act was placed in to Federal Law on March 2010, to become effective October1st, 2013 for Open Enrollment until March 31st, 2014.
  2. Everyone is required by law to apply, you can do this on an Individual bases, or through your EMPLOYER SMALL BUSINESS HEALTH OPTION PROGRAM also referred to as (S.H.O.P).
  3. Penalties for not applying for the Affordable Care Act within each open enrollment period are as follows:
1st YR. 2014, $95.00 per Adult $47.50 per Child.
2nd YR. 2015, $325.00 per Adult and $162.50 per Child.
3rd YR. 2016 $695.00 per Adult and $ $347.50 per Child.
4 TIERS OF COVERAGE
  1. There are Four (4) Tiers of Coverage with Percentage of Coverage Benefits:
1 Bronze 60% Least Expensive with basic coverage’s
2 Silver 70% Middle Ground Expense with more Coverage’s
3 Gold 80% Higher Expense with Richer benefit’s
4 Platinum 90% Highest Expense with Very Rich Benefits
EMPLOYERS HEALTH OPTION PROGRAMS
  1. If your Employer is offering the a Health Care Program Called S.H.O.P. Item (B) above you are may be able to join once the employer has set up their account with CoveredCA.com, you may chose any one of Four (4) Tiered plans indicated above.
  2. The Employer will be responsible to pay only 50 % of the total cost of that plan for each employee who enrolls, in the plan that the Employer pre-selected for His /Her employee. You as the employee can select the same Tier Plan as the your Employer has selected and pay 50% of the total cost or you may be eligible to pay less if you qualify for premium and deductible assistance. If you prefer to have a richer benefit plan you may buy up in coverage plans to one of a the other more expensive and richer benefits plan options, however you the employee will be responsible to pay the additional cost difference for that plan, SEE THE EXAMPLE BELOW.

Example: If the Employer Selected the Silver Plan LEAST EXPENSIVE and will contribute 50% of the total employee cost for that plan and you prefer to have the Gold Plan, you will be responsible for the cost difference. Again unless you may qualify for premium and deductible financial assistance paid by the Federal Government for up to Five years if you check that box or less, if you feel your future income will increases.

SMALL EMPLOYERS: Small Businesses Health Option Program: (SHOP) beginning with 50 or less employees are required to set up an account with CoveredCa.com and provide a spread sheet of all employees full or part time or enter each employee separately, Your Certified Covered CA Agent can help you with this entire process.

LARGE EMPLOYERS: Employers with 50 or more employees Tax & Penalties are waived until 2015. At which time all large Employers are required to set up an account with CoveredCA.com, failure to offer any coverage to full-time employees and their dependents or, that does not meet the law`s affordable standard (employee`s cost for self-only coverage must not exceed 9.5% of household income or 9.5% of employee`s W-2) or that does not meet minimum value standard, and At least one full-time employee receives a premium tax credit in the exchange.

EXCISE TAX/PENALTIES: Penalty for not offering coverage is equal to the number of full-time employees employed during that year minus 30, multiplied by $2,000.
Penalty for providing coverage that is not affordable or does not comply with minimum value (MV) coverage under ACA guidelines is equal to the lesser of $3000 per employee who qualifies for a subsidy in the Exchange, or $2000 per full time-time employee.

INDIVIDUALS APPLYING FOR AFFORDABLE CARE
  1. Beginning January 1, 2014 all US Citizens with a few exceptions, are required to have health insurance and their dependents or be subject to a Tax Penalty in 2014, and each subsequent year thereafter. The initial Open Enrollment began October 1st 2013 till March 2014. Subsequent years for Open Enrollment will be on October 1st till December7th each year.
Tax Penalties

1st YR. 2014, $95.00 per Adult $47.50 per Child.
2nd YR. 2015, $325.00 per Adult and $162.50 per Child.
3rd YR. 2016 $695.00 per Adult and $ $347.50 per Child.
  1. All enrollments are guaranteed coverage in one of the 4 Metal Tiers BRONZE, SILVER, GOLD, PLATINUM Coverage plans regardless of pre-existing conditions. It all comes down to what you can afford monthly.

There are Four (4) Tiers of Coverage with Percentage of Coverage Benefits:

1 Bronze 60% Least Expensive with basic coverage’s
2 Silver 70% Middle Ground Expense with more Coverage’s
3 Gold 80% Higher Expense with Richer benefit’s
4 Platinum 90% Highest Expense with Very Rich Benefits
  1. Individuals and or Total Family income that meet the thresholds may qualify for either for Medi-Care and or possibly premium and deductible federal financial assistance based on your individual and or Family gross taxable income. These are question you will need to answer on the application.
AFFORDABILITY
  1. Affordability Standard is that your cost of this coverage must not exceed 9.5% of the household income. Or 9.5% of the Federal Poverty Line (FPL) Safe Harbor.
  2. Once you complete the Individual Application and submit to your designated ACA Covered California Certified Agent, he or she will help you by reviewing the completed the application, show you all the plan options and associated cost. Including Medicare if you qualify, or Premium and deductible financial assistance.
  3. Please note, when completing the on-line Individual Application, there are several Confirmation Agencies associated with Affordable Care Act, (ACA) that will verify the information you put on the application. Example, IRS, Social Security, State & Federal Immigration, State Welfare, Unemployment, and a few other agencies.

For Assistance in completing the Coveredca applications, please contact:

William R. Sizemore, a Coveredca Certified Agent.

Phone (818) 341-2107

Email: capi@sbcglobal.net