Calculate your group size to help determine whether your company qualifies for a small business or large business health plan. Group size is determined by the number of full-time equivalent employees (FTEs) as defined in the Affordable Care Act. Companies with a common owner or are otherwise related are generally combined and treated as a single group, and their employees are combined for purpose of determining group size.
The Hawaii Insurance Commissioner has confirmed the State of Hawaii definitions are as follows:
- Small Group: 1 to 50 FTEs
- Large Group: 51 or more FTEs
These fees and taxes are being imposed on all health plans, including HMAA, by the federal government to pay for the Affordable Care Act (ACA). Groups will see these fees and taxes added to their monthly premium invoices. While we are bound by law to comply with these taxes and fees, HMAA always strives to ensure you and your employees are getting the most value for your hard-earned premium dollars. Thus we remain focused on continuously bringing new health and wellness initiatives and other value-added services to our members.
HMAA is currently required to collect and remit the following taxes and fees created by the Affordable Care Act, which may or may not have an impact on your premium rates at this time, depending upon your group’s circumstances. Please contact your HMAA Account Manager or email AccountManager@hmaa.com for more information on the specific amount or collection period applicable to your group.
Employees are generally eligible for coverage on the first day of the month following at least 20 hours per week of employment for four consecutive weeks, and earning at least 86.67 times the minimum hourly wage per month. Please refer to your Company’s policy on enrollment and the Hawaii Prepaid Health Care Act for more information about employee eligibility.
The “Pay or Play” provision applies to Applicable Large Employers (ALEs) with an average of at least 50 full-time employees, including full-time equivalents (FTEs), working at least 30 hours per week on business days during the preceding calendar year. Essentially, ALEs may “Pay” a penalty if they do not “Play” by the rules of offering minimum essential coverage (MEC). With all of HMAA’s medical plans meeting or exceeding the MEC standard and Hawaii’s Prepaid Healthcare Act in effect, the Pay or Play provision has minimal impact on Hawaii employer health coverage, but it includes certain reporting requirements. Beginning with the 2015 plan year, ALEs must report health coverage offered on an informational return to the IRS, as well as furnish coverage statements to applicable individuals. A tax penalty will be assessed to ALEs that fail to provide minimum essential coverage to 70% of their full-time employees and eligible dependents up to age 26. For the 2016 coverage year and beyond, the requirement increases to 95%.
View the following fact sheets for additional information:
Your open enrollment period is each anniversary of your group’s HMAA coverage, at which time employees may make changes to their coverage including enrolling dependents, and employers can make changes to their health benefits package. Please note that any changes must be requested prior to your group’s coverage anniversary date.
Under a transitional policy outlined by former President Obama and approved by the Hawaii Division of Insurance in 2013, health insurers are able to continue coverage that would otherwise be terminated, cancelled or modified as a result of the Affordable Care Act (ACA) compliant policy and rate structure. Since then, CMS announced a number of extensions to this transitional policy, and HMAA has chosen to provide this additional flexibility to our clients.
- On March 5, 2014: Extended to policies renewed on or before October 1, 2016.
- On February 29, 2016: Extended provided that all policies end by December 31, 2017.
- On February 23, 2017: Extended provided that all policies end by December 31, 2018.
- On April 9, 2018: Extended provided that all policies end by December 31, 2019.
- On April 30, 2019: Extended provided that all policies end by December 31, 2020.
HMAA small businesses whose health plans are affected by the transitional policy (also called “grandmothered” health plans) have been notified about their ability to maintain their current coverage.
This does not impact all HMAA clients. You are a grandmothered group affected by this transitional policy if your business:
- Has 50 or fewer full-time equivalent employees;
- Is not currently enrolled in a grandfathered health plan; and
- Obtained HMAA coverage before October 1, 2013.
If you are an HMAA group that is not affected by this transitional policy, you do not have to do anything at this time, and we will contact you prior to your next scheduled renewal.
Eligible employees and/or their dependents may be enrolled outside of open enrollment only if a qualifying event occurs. Members must enroll within 30 days of the qualifying event. Qualifying events may include the following:
- Employee increased hours worked to 20 per week, for four consecutive weeks
- Involuntary loss of coverage from another health plan
- Employee is entitled to additional benefits or coverage due to a change in employment status or meeting other eligibility requirements established by the employer
- Newborn child or newly adopted dependent
- Marriage or civil union
Please refer to your Company’s policy on enrollment.
- Grandfathered status applies to health plans that were in effect on March 23, 2010 and did not conduct any action that would cause the plan to lose grandfathered status in accordance with Health Care Reform and Department of Labor regulations. You may also view our frequently asked questions regarding grandfathered health plans for more information.
- Grandmothered status applies to transitional health plans that were in effect as of October 1, 2013 and renewed prior to December 31, 2020 in accordance with the Transitional Policy.
Although these plans are not required to fully comply with the ACA’s essential health benefits mandate, HMAA has enhanced its coverage for preventive and wellness services for these plans. If at any time you determine that your health plan no longer qualifies for grandfathered or grandmothered status, please contact your HMAA Account Manager or email AccountManager@hmaa.com so we can update our records with the correct classification. Penalties may be imposed on employers and health plans that fail to adhere to grandfathering and grandmothering provisions.
Before submitting enrollment applications to HMAA, please ensure they are complete and accurate, including the following:
- When an employee enrolls a dependent, ensure that the dependent’s Social Security number (SSN) is submitted in the “Dependent Enrollment Information” section of the application. Due to federal requirements, SSNs are required for all persons enrolling. For newborns, HMAA will allow up to one year for submission of the SSN.
- The enrollment application must be signed and dated by the employee, verifying that the information is correct, within 60 days of the coverage effective date.
- For all qualifying events, applications must be submitted within 30 days of the event, even if the subscriber already has family coverage. Proof of eligibility may also be required (e.g., birth certificate, state-issued marriage or civil union certificate, court order, adoption records, HIPAA certificate).
The impact to your health insurance costs and benefits, including out-of-pocket expenses and deductibles, will depend on your group’s business size and grandfathered status. For small businesses, it also depends on your employee demographics, including their ages. With the additional benefits and new federal fees and taxes mandated by the Affordable Care Act, your cost may increase, perhaps a great deal.
- New mandated fees and taxes may increase your cost.
- Plans with lower monthly costs may have increasingly high deductibles that can still make health care unaffordable for those who need it most.
For further information about the impact of ACA on your health plan benefits, please refer to the current version of your HMAA plan documents by obtaining them from your health plan administrator or through your Online for Members account.
All of HMAA’s health plans meet the minimum actuarial value and essential coverage requirements under ACA.
According to the State of Hawaii Department of Labor and Industrial Relations (DLIR), the following categories of employees can claim an exemption from coverage:
- Those covered by a Federally established health insurance or prepaid health care plan, such as Medicare, Medicaid or medical care benefits provided for military dependents and military retirees and their dependents;
- Those covered as dependents under a qualified health care plan;
- Those who are recipients of public assistance or covered by a State-legislated health care plan governing medical assistance; and
- Those who are followers of religious groups who depend upon prayer or other spiritual means for healing.
To claim an exemption or individual waiver, an employee must complete and submit “Employee Notification to Employer” (Form HC-5) to the employer. The employer retains the original and gives a copy to the employee. The employer sends a copy to the DLIR in certain circumstances. The waiver is binding for one year and must be renewed every December 31. For further information, please visit the DLIR website.
Yes, employers still need to comply with the Hawaii Prepaid Health Care Act, which requires employers to provide health coverage for employees who work 20 hours or more a week for four consecutive weeks. Employees cannot contribute more than 1.5% of their wages.
Employers are not responsible for providing coverage for employees who do not meet Prepaid’s minimum eligibility requirements.
All terminations must be submitted in writing on or before the last day of the month in which eligibility ends. Please use the Member Change or Termination Form for terminations. A group health plan cannot rescind coverage with respect to an individual unless he/she performs an act, practice, or omission that constitutes fraud or intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage, or due to non-payment of premium. For more information, please consult with your legal counsel or visit www.healthcare.gov.
Your full premium payment must be received no later than the first day of the month for which coverage is expected. If we do not receive payment in full, your company will receive a notice of intent to cancel your policy. Scheduling or acceptance of a late payment does not guarantee coverage. Because your health plan is a prepaid plan, any claims incurred during months with unpaid premiums will be denied. Plan termination notices are also sent to the State of Hawaii Department of Labor.
Please make checks payable to HMAA. Mail your payment, along with the stub from your premium bill, to:
P.O. Box 29790
Honolulu, Hawaii 96820-2190
To avoid claims payment delays and other issues, we advise against adjusting your statement balance. Please inform us of any enrollment changes and HMAA will make all billing adjustments, which will appear on the following month’s statement.
COBRA coverage is available for employers that have at least 20 employees for at least 6 months in the previous calendar year. Both full-time and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of a full-time employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full-time. For more information about COBRA, visit the U.S. Department of Labor’s website at www.dol.gov/ebsa.
Subscribers (covered employees) and dependents aged 18+ may access their coverage information by logging into their Online for Members account. Once logged in, select the desired member to view, print or download an image of the Coverage Information page, which reflects the member’s name, ID number, and coverage period, and can be used as evidence of coverage. You may also contact our Customer Service Center for assistance.
HMAA provides certain groups free 24/7 online access to benefits, eligibility maintenance, and other administrative functions. Click on the following link to access Online for Group Administration. Certain requirements apply.
HMAA respects the privacy and confidentiality of protected and individually-identifiable health information (PHI and IIHI). Once a dependent turns 18 years old, his/her parent or guardian will no longer have the right to access the dependent’s health or insurance records without authorization from the dependent. This policy is in accordance with Federal and State confidentiality laws regarding health care and minors’ rights. Certain exceptions may apply.
Members may complete and submit a written authorization to authorize the disclosure of their personal health information to another person or entity.
We are pleased to offer our employer groups special offers and discounts through our Member Plus Discount Program. HMAA groups are also welcome to become participating merchants and enjoy free promotion of their business through the program.
We invite you to explore our Health & Wellness Programs. Helping your employees take care of their health is important, not only to help them feel their best, but for the health of your business. Our health and productivity solutions give your employees the empowerment and support they need to take better care of themselves which can help reduce employee stress, job burnout, absenteeism, and health-related costs by creating a healthier workplace.
For information about the Affordable Care Act (ACA), please visit our Health Care Reform FAQs section or healthcare.gov. Please consult with your attorney regarding any legal questions.
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