Medical Plan

TLC Medical Insurance

Outsourcing the burden of benefits administration to TLC makes sense. If you need to offer benefits anyway, why not let us do all the work? TLC offers a range of Aetna PPO-style plans, including an HSA-compatible option, and HMO options. Aetna is a top-rated national carrier with a strong provider network and best-in-class customer service and online tools. And TLC handles all the benefits administration, from employee communications and payroll deductions to vendor payments and COBRA administration. So you can spend time focusing on your business rather than benefits communications and administrative tasks.

If you have 5 or more total employees, you can apply for a no-obligation rate quote to see if offering the TLC Aetna plans is right for your business. If you have 50 or more total employees, you may confront IRS ACA penalties if you don’t offer a group health plan that meets affordability and minimum coverage requirements. The TLC plans meet all ACA coverage requirements, helping you stay in compliance while you outsource your administrative burden at the same time.
 

Affordable Care Act (ACA)

For the past decade, the Affordable Care Act (ACA) has been changing the way we think about health insurance and the employer’s involvement in it. The law has brought about many changes in the way an employer offers benefits, as well as the way insurance carriers manage the plans. The ACA was intended to make coverage more affordable for everyone, ensure coverage of pre-existing conditions, extend dependent child eligibility, and regulate how certain medical services are covered such as mental health and women’s health. The law brought about new Marketplaces, where an individual can shop for a medical plan and apply for premium tax assistance. Individual and employer coverage requirements and penalties have been a much-debated element of the ACA. In 2019, the individual uninsured penalty dropped to $0 but the requirement to have health insurance technically still exists. Employer coverage, notification and filing requirements are still in place—Applicable Large Employers (ALEs) face stiff penalties for noncompliance (an ALE is generally an employer or group of commonly owned employers with 50 or more employees).

TLC is helping its clients comply with the ACA law in many ways, including distributing basic Marketplace notices, and reporting the value of healthcare on W2’s as needed. TLC also offers an ACA filing preparation service (Forms 1094-C/1095-C), which includes distribution of forms to employees and preparation of the IRS filing, and assistance with response to IRS and Marketplace inquiries and demands. Data sharing and fees apply. Contact TLC for details about the ACA Service.

TLC also offers group health plan options that clients may offer to their worksite employees—helping the employer comply with ACA affordable minimum coverage rules, as well as outsourcing the burden of benefits administration to TLC. Minimum participation and contribution requirements and group underwriting applies. Contact TLC for details.

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Medical Insurance via Marketplaces and Exchanges

Whether or not you offer a group health plan to your employees, they can now also shop online for individual coverage through a state or federal Marketplace, private exchanges or directly with insurance companies. Employees who purchase individual coverage via the Marketplace may qualify for premium tax assistance if their income is less than 4x Federal Poverty Level, but they will not qualify if they’re eligible for an employer-sponsored group plan that meets ACA requirements. An employer-sponsored plan is usually more economical for the employee because of employer contributions toward premiums and pre-tax deduction of the employee share of premiums (individual insurance premiums are not pre-tax or tax-deductible).

The public Marketplace is available at www.healthcare.gov and the site provides links to each state’s Marketplace (some states run their own but most are federal or a combination of state and federal). Small businesses (50 or fewer full-time-equivalent employees) can also request small group quotes at this site through the Small Business Health Options Program (SHOP).


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