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Anthem's Health Insurance Marketplace User Fee

Sep 10, 2013

The Affordable Care Act (ACA or health care reform law) has a rule that establishes a marketplace user fee that insurance companies that have plans in a federally-facilitated marketplace, including partnership models, must pay. Federally-facilitated and state-based marketplaces are charging an on-exchange fee for individual and small group participation.  

The Department of Health and Human Services (HHS) requires insurance companies to pool all user fee costs across their applicable market in a state to help avoid adverse selection on the marketplace. This means that, while the fee will be calculated based only on marketplace enrollment, the cost is applied to non-grandfathered individual and small group plans on and off the marketplace.  

For more information about the fee, view the fact sheet and Frequently Asked Questions.

Reminder:  Employers must issue exchange notices to workers by October 1

Notices about the health insurance exchanges have to be given to current workers no later than October 1, 2013. Starting October 1, the notices have to be given to new workers on the day they are hired.

The notices must:

1. tell workers about exchanges, including a description of the services provided and how they can contact exchanges;

2. let workers know they may be eligible for a premium tax credit if the employer plan's does not cover at least 60% of the total allowed cost of benefits, and the worker buys a qualified health plan through an exchange;

3. explain that if the worker buys a qualified health plan through an exchange, he or she may lose the employer contribution (if any) to any health benefit plan the employer offers, and that all or part of the contribution may be excluded from income for federal tax purposes.  

Here is the model notice employers can use. See this fact sheet for more information.

Contact your b&p Sales Representative for any questions regarding Anthem plans or quotes - 888.722.3373.

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