Page 22 - Optima Tax EE Guide 01-20 CA w Kaiser
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Annual                                                           ACA




                     Notices


                                                                         Even though the Affordable Care Act (ACA)’s
                                                                         penalty for not having health coverage
                                                                         (known as the individual mandate) has been
         Optima Tax Relief plans are partially arranged by Optima
         Tax Relief and governed by it’s plan rules and documents.       reduced to zero, if you are a taxpayer
                                                                         in  California, you will still be required to have
         ERISA and various other state and federal laws require that     health coverage (unless you qualify for an
         employers provide disclosure and annual notices to their        exemption) or pay a penalty for the 2020 tax
         plan participants. Optima Tax Relief distributes annual
         notices to new-hires, and each year during open enrollment.     year. In addition, several other states,
         You may also request a copy by contacting the Human             including Massachusetts, New Jersey, and
                                                                         Vermont, as well as the District of Columbia,
         Resources Department, or download a copy from ADP.              have reinstated an individual mandate
                                                                         requirement, and others are considering
         The following are a list of Annual Notices:                     doing so.
         •   Medicare Part D Notice of Creditable Coverage: Plans
            are required to provide each covered participant and         You may consider these options below to
            dependent a Certificate of Creditable Coverage to qualify    satisfy this requirement:
            for enrollment in Medicare Part D prescription drug          •   Enroll in a medical plan offered
            coverage when qualified without a penalty.                       by  Optima Tax Relief or another group
         •   HIPAA Notice of Privacy Practices: This notice is               medical plan meeting the requirements
            intended to inform employees of the privacy practices            for minimum essential coverage;
            followed by Optima Tax Relief’s group health plan. It also   •   Purchase coverage through a health
            explains the federal privacy rights afforded to you and          insurance marketplace;
            the members of your family as plan participants covered
            under a group plan.                                          •   Enroll in coverage through a government
         •   Women's Health and Cancer Rights Act (WHCRA): This              -sponsored program if eligible.
            act contains important protections for breast cancer
            patients who choose breast reconstruction with a             However, if you choose to purchase coverage
            mastectomy.                                                  through the marketplace, because Optima
                                                                         Tax Relief’s medical plans are considered
         •   Newborns’ and Mothers’ Health Protection Act: This          affordable and meet minimum value under
            act affects the amount of time a mother and her              the Affordable Care Act, you may not be
            newborn child are covered for a hospital stay following      eligible for a subsidy, and you may not see
            childbirth.                                                  lower premiums or out-of-pocket costs
         •   Special Enrollment Rights: Plan participants are            through the marketplace. In addition,
            entitled to certain special enrollment rights outside of     employer contributions to your medical
            Optima Tax Relief’s open enrollment period. This notice      benefits will be lost and your portion of
            provides information on special enrollment periods for       medical premiums will no longer be paid via
            loss of prior coverage or the addition of a new              payroll deductions on a pre-tax basis.
            dependent.
         •   Medicaid & Children’s Health Insurance Program:
            Some states offer premium assistance programs for
            those who are eligible for health coverage from their
            employers, but are unable to afford the premiums. This                     For More Information
            notice provides information on how to determine if your                     Go to www.healthcare.gov.
            state offers a premium assistance program.
         •   Summary of Benefits and Coverage (SBC): Health
            insurance issuers and group health plans are required to
            provide you with an easy-to-understand summary about
            your health plan’s benefits and coverage.









    22  Employee Benefits
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