Bảo hiểm sức khỏe do nhà tuyển dụng cung cấp, thường được gọi là bảo hiểm sức khỏe do nhà tuyển dụng cung cấp, là một loại kế hoạch bảo hiểm sức khỏe được doanh nghiệp cung cấp cho nhân viên của họ. Dưới đây là các điểm quan trọng về bảo hiểm sức khỏe do nhà tuyển dụng cung cấp:
Bảo hiểm do nhà tuyển dụng tài trợ là gì?
Bảo hiểm do nhà tuyển dụng tài trợ, còn được gọi là bảo hiểm do nhà tuyển dụng tài trợ hoặc bảo hiểm y tế do nhà tuyển dụng cung cấp, là bảo hiểm y tế được cung cấp cho bạn và những người phụ thuộc của bạn thông qua công việc của bạn. Chủ lao động của bạn có thể đưa ra các lựa chọn về chương trình sức khỏe nhóm cho những người lao động đủ điều kiện và chi trả một phần phí bảo hiểm (chi phí hàng tháng). Người sử dụng lao động thường trả phần lớn phí bảo hiểm và người lao động trả phần còn lại. Bạn có thể được bảo hiểm với tư cách là một công nhân hiện tại hoặc người đã nghỉ hưu.
Bạn có thể mua bảo hiểm y tế thông qua Covered California, nhưng bạn sẽ không đủ điều kiện nhận trợ giúp tài chính dưới hình thức tín dụng thuế phí bảo hiểm nếu chủ lao động của bạn cung cấp chương trình sức khỏe đáp ứng các tiêu chuẩn giá trị tối thiểu và được coi là hợp túi tiền. Một chương trình sức khỏe được coi là có giá trị tối thiểu nếu nó chi trả ít nhất 60% tổng chi phí dịch vụ y tế và cung cấp đủ bảo hiểm cho các dịch vụ bệnh viện và bác sĩ. Vào năm 2023, một chương trình bảo hiểm sức khỏe được coi là “giá cả phải chăng” nếu phí bảo hiểm của chương trình không quá 9,12% thu nhập hộ gia đình của nhân viên
What happens if I lose my employer-sponsored coverage?
Even if you quit or get fired, you can buy a plan through Covered California or sign up for COBRA if you lose your employer-sponsored coverage.
What happens if I have a Covered California plan and then get an offer of health coverage through my job?
If the offer of health coverage meets the minimum value standard and is considered affordable, you will no longer qualify for financial help to lower the cost of a Covered California health plan. To find out if your employer-sponsored plan is considered affordable, use the Affordability Tool, or print or download the Employer Coverage Worksheet.
What if I missed my employer’s open-enrollment period?
You can still sign up for a health plan through Covered California. You will have to pay full price unless your employer-sponsored coverage is considered not affordable and does not meet minimum value standards. Use the Affordability Tool to estimate if your employer-sponsored coverage is affordable.
How does having employer-sponsored health coverage affect my taxes?
Employers deduct premium payments from your paycheck before taxes, which lowers your taxable income.
Contact Covered California for help getting enrolled or if you have other questions.
Employer Coverage for Family Members
Affordability for Family Coverage
For purposes of employer-sponsored coverage, family means the employee, spouse (if filing a joint tax return) and any dependents claimed on the tax return. Non-dependents who could enroll as members of the coverage unit through the “under-26 rule” are not considered to be part of the tax family.
Beginning Dec. 12, 2022, affordability for family members will be determined based on the cost an employee has to pay for family coverage.
Until now, if family coverage were available from an employer and just one family member had an affordable offer of coverage, all family members were ineligible for financial help (in the form of tax credits) to buy a health plan through Covered California. This was even when the cost of coverage for the whole family was greater than 9.61 percent of family income. This definition of “affordable” employer coverage was known as the “family glitch.”
Now the glitch is fixed. If the employee must pay more than 9.12 percent of household income toward the premium for a family plan, the plan is considered unaffordable. And the employee’s family members may qualify for financial help (both tax credits and cost-sharing reductions).
In fact, family members may qualify for tax credits even when the employee does not. If the employee has an offer of employee-only coverage that is considered affordable (9.12 percent of household income) and provides minimum value, the employee will not qualify for financial help, but their family members may still qualify for financial help.
The rules for how to calculate affordability of employer-sponsored coverage have changed. The Affordability Tool can help you estimate if you or your family members qualify for financial help.
For help with questions about employer-sponsored coverage or getting enrolled, contact an agent or certified enroller, visit our Support page, or use Help on Demand.
See the examples below (all employer-sponsored plans in these examples are assumed to meet the minimum value requirements):
Example 1
Employee’s monthly household income = $3,500 (about $42,000 per year)
9.12 percent of the employee’s monthly household income = $319
Monthly cost to the employee for the lowest-priced plan the employer offers for self-only coverage = $270
Is the plan affordable?
YES, the employee’s share of the lowest cost self-only plan ($270) is less than 9.12 percent of the employee’s household income ($319). The employee does not qualify for financial help to lower the cost of a Covered California health plan.
Example 2
Employee’s monthly household income = $2,500 (about $30,000 per year)
9.12 percent of the employee’s monthly household income = $228
Monthly cost to the employee for the lowest-priced plan the employer offers for self-only coverage = $285
Is the plan affordable?
NO, the employee’s share of the lowest-cost self-only plan ($285) is more than 9.12 percent of the employee’s household income ($228). The employee may qualify for financial help to lower the cost of a Covered California health plan.
Example 3
Employee’s monthly household income = $2,500 (about $30,000 per year).
9.12 percent of the employee’s monthly household income = $228.
Monthly cost to the employee for the lowest-priced plan the employer offers for self-only coverage = $285.
Is the plan affordable?
NO, the employee’s share of the lowest-cost self-only plan ($285) is more than 9.12 percent of the employee’s household income ($228). The employee may qualify for financial help to lower the cost of a Covered California health plan.
Monthly cost to the employee for the lowest-priced plan the employer offers for family coverage = $500.
Is the plan affordable?
NO, the employee’s share of the lowest-cost family plan ($500) is more than 9.12 percent of the employee’s household income ($228). The employee’s family members who are part of the tax household may qualify for financial help to lower the cost of a Covered California health plan.
For help with questions about employer-sponsored coverage or getting enrolled, contact an agent or certified enroller, visit our Support page, or use Help on Demand.
https://www.coveredca.com/learning-center/employer-sponsored-coverage/
Employer-Sponsored Coverage
Employers offer many types of health coverage options, such as group insurance, Health Reimbursement Accounts (HRAs), supplemental plans, flex spending accounts to use with a health plan, and COBRA.
With so many choices, you might wonder if you should enroll in your employer plan or shop with Covered California instead. In most cases, your employer offer is your best bet. In fact, if your employer offer meets the federal affordability and minimum value standards, you will not qualify for financial help to lower the cost of a Covered California health plan.
