SHOP – Small Business Health Options Program

The Marketplace Health
Insurance Open Enrollment and
How it Impacts Libraries, Plus tips
on how to assist patrons.
CHIP – Children’s Health Insurance Program
FTEs – Full-time Equivalent Employees
HIX – Health Insurance Exchange
SHOP – Small Business Health Options Program
QHP – Qualified Health Plan
CHIP – Children’s Health Insurance
Provides health coverage to more than 43
million children, including half of all low-income
children in the United States.
The ACA extends eligibility for this health
coverage and Medicaid and is expected to
provide numerous improvements to these
FTEs – Full-time Equivalent Employees
What is a FTE?
Monthly hours of all part-time employees (up to 120 hours) are
totaled and divided by 120 (month)
Full-time employees working 30 hours per week (or more) are
totaled and divided by 130 hours (month)
Example: 30 Part-time employees working 25 hours/week
(3000 hours (month)/120 (hours) = 25 FTEs
Plus, 20 Full-time employees = 45 FTEs (small employer)
HIX – Health Insurance Exchange
Effective January 1, 2014 Each State may set up a HIX.
Michigan does not have its own HIX so the Federal
Government will administer the exchange.
All Employers must provide written notice to each current
employee, and new hire, of the existence of the HIX.
– Give to current employees prior to October 1, 2013
– Give to new employees on hire date after October 1, 2013
HIX (continued)
• Model Notice to Employees:
Many provisions of the Affordable Care Act become effective on January 1,
2014. This letter is to serve as notification to you that the Health Insurance
Marketplace will be open on October 1, 2013.
This Marketplace will allow individuals access to information regarding
affordable health insurance coverage. You can visit the Marketplace at
For the first year of this program, Open Enrollment will be October 1, 2013 –
March 31, 2014. Annual Open Enroll periods after that will start on October
15 and end on December 7.
Please see the attached notice for further information. (Workshop
attendees, the notice is attached in the back of the packet)
SHOP – Small Business Health Options Program
Simplifies the process of buying health insurance for your
small business
SHOP Marketplace is open to employers with 50 or fewer
full-time-equivalent employees (FTEs)
Some employers may be eligible for a small business
health care tax credit.
To qualify for tax credit:
- Must purchase coverage through SHOP
-Fewer than 25 FTEs
-FTEs making less than $50,000./yr.
Small group tax credits are only allowed for two years.
Only apply to the smallest, lowest income employers
SHOP (continued)
• If you are a small business, you do not have to
purchase health insurance from the SHOP, you
can continue purchasing your insurance
through your Broker, or other provider.
• The incentive of purchasing through SHOP is
the possible tax credits.
• You can continue to use your current licensed
agent or broker to buy health insurance in the
QHP - Qualified Health Plan
• Under the Affordable Care Act. Starting in 2014,
to be considered a Qualified Health Plan an
insurance plan must provide:
• Provide essential health benefits
• Follow established limits on cost-sharing (such as
deductibles, copayments, and out-of-pocket
maximum amounts) and meet other
A qualified health plan will have a certification by
each Marketplace in which it is sold.
The Marketplace
Insurance Marketplace website
If you reside in Michigan this is the website you use to
apply for coverage, compare plans, and enroll.
Effective October 1, 2013 this website will be launched.
For the first year of this program Open Enrollment will
be October 1, 2013 – March 31, 2014.
Subsequent years Open Enrollment will be October 15,
through December 7.
Special enrollment periods available in certain
circumstances during the year.
Insurance Benefit Levels
• Four levels of health insurance coverage
• Each level of coverage covers a cores set of benefits called Core Benefits.
They include:
-Outpatient Care
-Emergency Room
-Inpatient care in a hospital
-Care before and after your baby is born
-Mental Health and substance use disorder services: Includes behavioral health treatment, counseling, psychotherapy
-Prescription drugs
-Services and devices that help in recovery if you are injured, or have a disability or chronic condition
-Lab tests
-Preventive services including counseling, screening, and vaccines to keep you healthy and care for chronic conditions
-Pediatric services : This includes dental care and vision care for kids
Application Process
• There are four (4) ways individuals may apply:
1. By mail, using a paper form
2. Online at
3. By toll-free telephone at 1-800-318-2596 or
4. In person using the services of a certified Navigator
• Enrollment begins October 1, 2013
• One Application, one time, and applicants will
see all the programs they qualify for.
• New Healthcare law offers some added
protection to individuals and their families
Can not be turn down for insurance due to a chronic condition or due to
a previous condition.
Insurers can not charge more for coverage of women than men.
Bans lifetime limits on coverage.
Navigator Program
Each State is assigned Navigators to provide people
with clear directions and information to help them get
where they need to go.
Navigators are groups of people who are specially
trained to provide assistance to individuals and families
with the information necessary to determine which
health insurance option best fits their needs, and then
help them enroll in the plan of their choice.
Navigators (continued)
• Navigators must be certified
Take the initial web-based training
Take required on-going training
Recertified annually
Not accept direct or indirect compensation from
issuers related to enrollment of a Quality Health Plan,
or non Quality Health Plans or receive any financial
benefit, direct or indirect, from enrolling consumers in
health plans.
Navigators are funded through grants provided by
Government Exchange funds.
Navigators (continued)
• A Navigators Responsibilities include:
– Conducting public education on available health plans
– Distributing fair and impartial information on
enrollment and premium tax credits
– Facilitating the enrollment process
– Referring all grievances, complaints or questions
regarding health plans and coverage to an office of
the health insurance consumer assistance or
ombudsman, or any other appropriate state agency
– Provide culturally and linguistically appropriate
information to meet the needs of the population
Navigators (continued)
Navigators in Michigan are:
• Community Bridges Management Inc.
Linden (586) 741-8360
• Arab Community Center for Economic & Social
Services (ACCESS)
Dearborn (313) 945-8367
• American Indian Health & Family Services of SE
Michigan, INC.
Detroit (313) 846-3718
• Michigan Consumers for Healthcare
How to Protect Yourself From Fraud
Be informed
• Visit (, the
official Marketplace website.
• Compare insurance plans carefully before making your
• Look for official government seals, logos or web addresses
• Know the Marketplace Open Enrollment Dates
– October 1 , 2013 – March 31, 2014
– No one can enroll you in a health plan in the Marketplace until Open
Enrollment begins or after it ends unless you have a special
Examples: moving to a new state, certain changes in your income, changes in
your family size ( if you marry, divorce, have a baby, adopt).
Protect from Fraud (continued)
• Protect your private health care and financial information
– No one should be asking you for your personal health
information. Don’t give it to anyone.
– Keep personal and account numbers private. Don’t give
your social security number or credit card or banking
information to companies you did not contact or in
response to unsolicited advertisements.
– Never give your personal health or financial information to
someone who calls or who comes to your home uninvited,
even if they say they are from the Marketplace.
Protect from Fraud (continued)
• Ask questions and verify the answers
– The Marketplace has trained assisters in every
state to help you at no cost. You should never be
asked to pay for services or help.
– Ask questions if any information is unclear
– Double check information that is confusing or
sounds fishy. Visit or call
them at 1-800-318-2596
– Don’t sign anything you don’t understand
Protection from Fraud (continued)
• If you suspect fraud, report it
– Call the Health Insurance Marketplace consumer
call center at 1-800-318-2596
Or contact your local, state, or federal law
enforcement agencies or your state department of
How the Marketplace Impacts
Approximately 7 Million people are expected to
sign up for coverage in the new Marketplace.
-It is predicted that libraries will be especially
impacted in states where little effort has been
done to promote the ACA.
Take a Breath
FIVE Keys to Avoid Conflict
Policy & Practice
• Review library policy for patron privacy and
• Past Practice – How did and/or does your
library assist patrons requesting help:
A. Completing applications for unemployment
B. Filing income taxes online
C. Frozen on a page containing personal
Basic Information Required to Complete Application
Required for Individual Applicant
• Social Security Number (Document number if legal immigrant)
• Employer and Income information (W-2 or paystub)
• A completed Employer Coverage Tool
Required for Family Applicant
Social Security Numbers (Document numbers for legal immigrants)
Employer and Income Information for each family member
Policy Numbers for any current health insurance
Information about job-related health insurance available to the family
A completed Employer Coverage Tool for each eligible family member
Useful Websites - Government
KEY THREE (cont.)
Useful Websites – Association, Foundation and Provider
Identify the NAVIGATORS
Michigan ACA Navigators
Community Bridges Management Inc.
(586) 741-8360
Arab Community Center for Economic & Social Services
(313) 945-8367
American Indian Health & Family Services of SE MI, Inc.
(313) 846-3718
Michigan Consumers for Healthcare
Prepare a ACA Glossary – A Sampling
The following links are not endorsed by The Library
Network. They are examples of provider prepared
common ACA terms which may be useful to public
library patrons.

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