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Essential Benefits Package
<br />- HHS Secretary will recommend an essential health care
<br />benefits package that indudes a comprehensive set of
<br />SerVICeS: (Sec. 1302)
<br />• Hospital services; prQesslonal services; pre,aiption drugs;
<br />rehabilitation and habilitative services; mental health and sut)stance
<br />use disorders; and maternity pre
<br />• Well=baby, well-chtld care, oral health and vision services for
<br />chifdreirvnder age 21 rs.c w•s, uozl
<br />• Recomihended preventive services with no cost-sharing and
<br />all recommended immunizations (s.~ Ion, lows)
<br />Mental health parity law applies to qualified health plans ts« vrlrp>
<br />Subsidies to Individuals
<br />- Refundable, advanceable premium credits
<br />will be available to individuals with incomes
<br />up to 400% FPL on a sliding scale basis
<br />(#43,320/yr. for one person, 558,280 fior two,;73,240 for three,
<br />#88,200 for a family of four in 2010).* (sec Iwl, as antatdetl M Se[3001 of
<br />RecatdGatlon)
<br />• individuals not eligible for subsidies if they have
<br />,, em~l0yer-based coverage, TRICARE, VA, Medicaid,
<br />or Medicare (sa. I,o>c~xzxBx~, rso=)
<br />• No)#h;Carolina's median household income in 2008
<br />" was $46,574 (avg. household = z.s people).
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<br />Employer Responsibilities
<br />- Employers with 50 or more full-time
<br />employees required to offer insurance or
<br />pay penalty (s«.1201, 3513, amended s«. IOORec«duznoB)
<br />- Employers with less than 50 full-time
<br />.:employees exempt from penalties. (Sec. 1533(dx2>)
<br />• Employers with 25 or fewer emplo ees and average
<br />anntjal wages of less than $50,000 can receive a
<br />-tax credit. (sK. r,n, sew lu lus7
<br />Orange County has approximate)y 2,991
<br />employees with less than 50 employees.
<br />Individual Mandate
<br />- Citizens and legal immigrants will be required to
<br />pay penalty if they do not have qualified health
<br />insurance, unless exempt. (Sec 1312(Q, 3501, xnatded Stx 1002 M
<br />RecancilWbon)
<br /> Sliding Scale Subsidies
<br /> <333% FPL 2% of 6% #1,983 (Ind)/#3,967 (tarn)
<br /> Income (1/3'• HSA limit)
<br />
<br />:• 133-150% 3-4% 6% #1,983 /;3,967
<br /> FPL
<br />-'~ 150-200% 46.3% 13% #1,983/ X3,967
<br /> FPL
<br /> 200-250% 6.3-8.05% 27% #2,975/ #5,950 (I/1 x5A
<br /> FPL limn)
<br /> 250-300% 8.05-9.5% 30% ;2,975/;5,950
<br />
<br />~
<br />~ FPL u<br~.r wr rwq tidua. a,a, w.n•mcs, copsy..
<br />` 300-400% :,ei~w~ .nos .mb' r ~ ' t
<br />'
<br /> FPL ,oz, m •ma,a.e sae. toot rn i
<br />Health Benefits Exchange
<br />- States will create a Health Benefits Exchange
<br />for individuals and small businesses. (srr.1311, Isz1)
<br />• Limited to citizens and lawful residents who do not
<br />have access to employer-sponsored or govemmental-
<br />sup„ported health insurance and to small businesses
<br />f with~1Q0 or fewer employees. (sx 1313(m
<br />- Exchanges will:
<br />• Provide standardized information (including quality
<br />and costs) to help consumers choose between plans
<br />• Determine eligibility for the subsidy
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