What Employees of Small Businesses Need to Know

Almost everyone will need health coverage

Starting in 2014, almost all Americans must have health insurance or risk paying a federal fine. If you work part-time and need coverage, you can buy health insurance in the marketplace or directly from HMSA. Everyone can get health insurance even if you were denied in the past because of a serious health condition.

Options for buying a health plan

If you work for a company with up to 50 full-time employees, your employer has two options to buy employee health plans. Companies can continue to work directly with HMSA or use the state health marketplace, called the Hawai‘i Health Connector.

Premiums are changing

Starting in 2014, health plan premiums for Affordable Care Act Plans will be based on your age. Health plans for older employees may cost more than plans for younger employees.

Also, the federal government will pay for health care reform with new fees and taxes for health insurers nationwide, including HMSA. This will increase health plan premiums.

Benefits are changing

Starting in 2014, Affordable Care Act Plans will include:

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

I work part-time and don’t have employer coverage

If you work part time (less than 20 hours a week) and don’t have health insurance, you’ll need to get coverage or pay a fine to the Internal Revenue Service. Health insurance will help keep you healthy and protect you from the high cost of health care. Because of health care reform, you won’t be denied health insurance, even if you couldn’t get coverage in the past because of a serious health condition.

Your employer isn’t required to offer you coverage. You can buy an HMSA individual plan directly from us or in the Hawai‘i Health Connector, the state’s online health insurance marketplace. Depending on your income, you could be eligible for financial help to pay for health insurance if you buy it in the Connector.

HMSA Plans for Individuals and Families

Don't wait for a health emergency to invest in an HMSA health plan.

Dependent coverage

Do your spouse and children have health insurance? If not, they’ll need coverage starting in 2014 or will have to pay a fine to the Internal Revenue Service. Health insurance will help keep them healthy and protect them from the high cost of medical care. Check if your employer offers dependent coverage. Young adults could be covered under a family plan until age 26.

If your employer doesn’t offer dependent coverage, your dependents can get an HMSA plan directly from us or in the Hawai‘i Health Connector, the state’s online health insurance marketplace. Depending on their income, they could be eligible for financial help to pay for health insurance if they buy it in the Connector. And because of health care reform, they won’t be denied coverage even if they were turned down for insurance in the past because of a serious health condition.

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

How can I stay updated on health care reform?

Sign up for our health care reform e-newsletter. If you have questions, call our health care reform helpline at 808-948-6387 on Oahu or 1-800-465-4672 toll-free on the Neighbor Islands, Monday through Friday, 8 a.m. to 5 p.m.

What’s the state marketplace?

The state marketplace is an online marketplace to help people buy health insurance. Hawaii’s marketplace is called the Hawai‘i Health Connector.

Will I have to use the marketplace?

Check with your employer. Employers will decide if they’ll use the marketplace or continue to get employee health plans directly from HMSA.

Why is the state creating the marketplace?

The health care reform law requires states to have an marketplace. Starting January 1, 2014, almost every American must have health insurance or risk paying a fine to the federal government.

What if I don't purchase health insurance?

The Internal Revenue Service will fine people who don’t have insurance:

  • 2014: $95 or 1 percent of income, whichever is greater
  • 2015: $325 or 2 percent of income, whichever is greater
  • 2016: $695 or 2.5 percent of income, whichever is greater

Is anyone excluded from paying a fine?

There are a few exceptions to the penalty, including:

  • Religious reasons
  • Not present in the United States
  • In prison
  • Not able to pay for coverage that is more than 8 percent of the household income
  • An income that is below 100 percent of the poverty level
  • Having a hardship waiver
  • Not covered for less than three months during the year

Learn more at healthcare.gov.

Will HMSA health plans be in the marketplace?

Yes. HMSA health plans will be in the marketplace.

Who can use the marketplace?

Small businesses with up to 50 full-time employees can allow their employees to use the marketplace. People who buy individual health plans on their own can also use the marketplace.

Will health plan premiums go up?

The federal government will pay for health care reform with new fees and taxes for health insurers nationwide, including HMSA. This will increase health plan premiums.