What Large Business Employees Need to Know

If you get coverage through your employer

If you work full time at a large business with more than 50 full-time employees and get health insurance from your employer, chances are health care reform won’t affect you too much right now. The good news is there’s nothing you need to do. You can continue getting health insurance from your employer.

Health plan benefits

Health care reform doesn’t require health plans for large businesses to offer essential health benefits (EHBs). But if they do, the 10 EHBs are:

  1. Ambulance service
  2. Emergency care
  3. Hospitalization
  4. Laboratory services
  5. Maternity and newborn care
  1. Mental health and substance use services
  2. Pediatric oral and vision services
  3. Prescription drugs
  4. Rehabilitation and habilitative services
  5. Services for preventive care, wellness, and chronic disease management

Health care reform only requires EHBs in health plans for people who get insurance on their own through an individual plan or through a small business employer starting in 2014.

Wellness incentives

Health care reform rewards you for taking care of your health. And HMSA is here to help keep you on track. Your employer can offer you incentives of up to 30 percent of the cost of coverage for meeting certain health goals or for participating in wellness programs, and up to 50 percent for participating in stop-smoking programs.

For example, you could receive incentives for participating in HMSA Well-Being Connection’s Healthways Well-Being Assessment™, health education workshops, or stop-smoking programs. Check with your employer for details.

Healthways Well-Being Assessment is a trademark of Healthways, Inc. All rights reserved.

If you don’t get coverage from your employer

If you work part time (less than 20 hours a week) and don’t have insurance, you’ll need to get it. The health care reform law says almost all Americans need health insurance. If you don’t buy coverage, you may have to pay a fine to the federal government. Because of health care reform, you won’t be denied coverage, even if you were denied before because of a serious health condition.

How to get health coverage

If you don’t have coverage, don’t worry. We’ll help you choose an HMSA health plan that’s right for you.

  • Contact us directly, or
  • Buy an HMSA plan in the Hawai‘i Health Connector, an online health insurance marketplace. Depending on your income, you could get financial help from the government to pay for health insurance in the Connector. Only small businesses with up to 50 employees and people who get health insurance on their own through an individual health plan can use the Connector starting in October. The state will decide later if large businesses with more than 100 employees can use the Connector starting in 2017.

HMSA Plans for Individuals and Families

Good health care is within your reach. Discover an HMSA plan that best fits your needs and lifestyle.

This information is based on HMSA’s review of the Affordable Care Act (ACA). This overview is intended for educational purposes only and should not be used as tax, legal, or compliance advice.

Frequently Asked Questions

What is health care reform?

  • Health care reform is the Affordable Care Act, which was signed into law by President Barack Obama in 2010.
  • It is legislation that aims to:
    • Make health care more accessible for all Americans, including the uninsured
    • Make health care more affordable by eventually lowering costs
    • Improve people’s health by increasing the focus on preventive care

What does health care reform do?

  • It adds preventive benefits to health plans
  • It allows dependents up to age 26 to stay on their parents’ health plan

What is the state health marketplace or marketplace?

  • It is an online marketplace where some consumers can get a health plan. Here in Hawaii, it’s called the Hawai‘i Health Connector.
  • If you get your health plan from your employer and your company has more than 50 employees, you’re not eligible to use the marketplace.

Will I have to pay more now?

The federal government will pay for health care reform with new fees and taxes imposed on health insurers nationwide, including HMSA. This added cost may be reflected in your premiums for the upcoming year.

Who can I call if I have questions?

Call the HMSA Health Care Reform Help Line at 948-6387 on Oahu or 1 (800) 465-4672 toll-free on the Neighbor Islands from 8 a.m. to 5 p.m., Monday through Friday.