Medical Plan

Health Care Reform
The 2010 health care reform law, the Affordable Care Act (ACA), is 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 a group plan offers benefits, as well as the way insurance carriers manage the plans. In 2013, the hot topics were the new Marketplaces, the employer requirement to notify employees about the Marketplaces, and the delay in large employer penalties to 2015.

TLC is helping its clients comply with the ACA law in many ways, including distributing the Marketplace notices, reporting the value of healthcare on W2’s as needed, and assisting with headcount calculation. TLC also offers group health plan options that clients may offer to their worksite employees—not only complying with ACA affordable coverage rules, but also outsourcing the burden of benefits administration to TLC.

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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. 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 be facing penalties starting in 2015 if you don’t offer an affordable group health plan. The TLC plans meet all ACA coverage requirements, helping you stay in compliance while you outsource your administrative burden at the same time.

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, and possibly qualify for a government subsidy toward the premium, based on income. Their options include the public Marketplace (the government-run online health insurance shopping site), private Exchanges (like the Marketplace but run by private companies), and going direct to the carriers for an individual quote (such as Blue Cross, Aetna, United Health Care, Humana, and regional carriers). Employees who purchase individual coverage may qualify for a government subsidy toward the premium (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; in addition, individual insurance premiums are not pre-tax or tax-deductible. An employer-sponsored plan is usually more economical for the employee because of employer contributions toward premiums and pre-tax deductions of the employee share of premiums.

The public Marketplace is available at and the site provides links to each state’s Marketplace (some states are running 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).