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Benefits of NMHIX SHOP

What are the benefits of NMHIX SHOP?

NMHIX provides an online marketplace where small businesses can shop for group health insurance plans:

  • A single point of entry for small businesses and their employees to apply for coverage.
  • Small businesses with 25 or fewer full-time equivalent employees and an average salary less than $50,000 per year may qualify for the Small Business Health Care Tax Credit worth up to 50% of the employer's premium contribution.

Small businesses select a level of plan benefits that they would like to offer their employees. Benefits levels are bronze, silver, gold, or platinum and are referred to as “metal levels”. Employers will select a metal level of coverage and employees will select from a variety of plans within that level.

What are the 10 essential health benefits covered by all health plans available through SHOP?

All the health plans available through SHOP include the following benefits:

  • Maternity and newborn care
  • Pediatric services
  • Preventive services for adults
  • Emergency services
  • Hospitalization
  • Ambulatory patient services (Outpatient care)
  • Prescription medications
  • Mental and behavioral health
  • Rehabilitative services and devices
  • Laboratory services

About cost basis plansBack to Top

What is a cost basis plan and why do I need to choose one?

A "cost basis plan" is a plan you select within the metal level you have chosen for your employees. The cost basis plan serves as a benchmark for determining your total monthly cost for premiums. It might be the lowest cost plan, an average plan, or the highest cost plan within your metal level.

Choosing a cost basis plan allows you, as an employer, to accurately forecast your monthly health insurance costs, as long as new employees and/or dependents are not added to your roster. After you select your cost basis plan, each employee can determine their monthly cost for any plan within the metal level you’ve selected.

How does the cost basis plan work?

First, multiply each employee's premium for the cost basis plan by your contribution percentage. This determines the amount of your contribution toward that employee's monthly premium. Based on each employee's age, their premiums for the cost basis plan may be different. So the dollar amount of your contribution will not be the same for each employee.

By selecting a cost basis plan, your contribution to each employee is set. This is true regardless of which plan the employee selects. If they choose a plan that costs more than the cost basis plan, they will have to pay a higher percentage of the premium.

For example, Acme Widget has 3 employees, as shown below. The employer chooses Silver Plan A as the cost basis plan and 50% as the employer contribution.

Employee Premium for Silver Plan A Employer Cost
Judy, age 20 $150 $75 = (150 × 50%)
Bob, age 30 $200 $100 = (200 × 50%)
Carl, age 40 $250 $125 = (250 × 50%)

If Judy picks Silver Plan B, and her premium for that plan is $200, she still only gets a $75 contribution from her employer. She pays the $125 difference.

As you can see from the example above, while the percentage you contribute towards individual employees' coverage may be the same, because the cost of plans may differ based on age, the actual dollar amount may differ.

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How do I choose insurance plans to offer my employees?

Once you register as an Employer and you have uploaded your employee information, you will be asked to select one of the four metal levels.

Plans within each metal level have approximately the same “actuarial value.” This means that any plan in that level will cover about the same percentage of the average consumer’s covered health care costs. For example, Bronze plans are designed to cover about 60% of those costs. The corresponding values are 70% for Silver plans, 80% for Gold plans and 90% for Platinum plans.

Can I get extra help selecting plans to offer my employees?

Yes, just click Get Assistance at the top of the page to find a local, licensed insurance agent to help you at no charge to you.

Can my employees select any plan they want?

Your employees have the option to select any available plan within the metal level you selected.

What do I do if some of my employees have affordability issues?

You can:

  • Increase the employer contribution percentage toward employee and/or dependent coverage.
  • Choose a lower metal level from among the Bronze, Silver, Gold, and Platinum levels.
  • Ignore the affordability issues. There are no tax penalties under the Affordable Care Act if you have fewer than 100 employees.

How do I activate employee open enrollment?

The open enrollment process is activated automatically when you set up health coverage for your employees and select a coverage start date. Once you finish setting up coverage, Open Enrollment dates are automatically determined, and the system will start the Open Enrollment Period based on the coverage start date you selected.

  • Start by selecting "Set Up Coverage" from the "Coverage" menu.
  • As you are setting up health coverage for your employees, one of the steps is to select the coverage effective date, which in turn will determine the open enrollment period for your employees.
  • After you complete the health coverage setup – and where available, dental coverage setup – you will review and confirm your selections. After this, you are done. Just don’t forget to pay the binder invoice on time.
  • When Open enrollment starts, your employees will receive an email from us, informing them where to go and what they need to do to sign-up for health coverage.

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What is considered affordable employer sponsored health insurance?

If an employee's share of the premium for the least expensive plan available to them is less than 9.5% of their gross income, the plan is considered affordable.

What happens if an employer doesn't offer affordable coverage to a full-time employee?

If the health insurance offered by an employer is not considered affordable to a particular employee, that employee may be eligible for tax credits or other subsidies to lower the costs of an individual or family plan purchased through a health insurance marketplace. This eligibility is dependent on several factors, including the employee’s household size and income.

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How do I qualify for the Small Business Health Care Tax Credit?

You should consult your tax advisor to discuss the specifics of your company’s situation. In general, qualifying for the Small Business Health Care Tax Credit requires that:

  • Your business has fewer than 25 full-time equivalent employees.
  • The average annual salary of these employees is less than $50,000.
  • Your business offers health insurance to all full-time employees who work an average of 30 or more hours per week.

How do I apply for Small Business Health Care Tax Credit?

Complete the Internal Revenue Service form 8941 and include it with the tax return for your business. This form is available at http://www.irs.gov/pub/irs-pdf/f8941.pdf

How can my business avoid tax penalties?

The tax penalty for not providing healthcare coverage applies only to employers with more than 50 employees. Consult your tax advisor for more information.

Can my monthly costs go up?

Once you have selected the metal tier of plans available to your employees, your cost basis plan and the amount of your employer contribution, the cost of health insurance for each employee is locked in for the current coverage year. However, if your roster of employees and dependents changes, your company’s total monthly costs for health insurance can vary during the course of the year.

How do I see which of my employees have signed up for coverage?

During Open Enrollment, you can view a list of employees and the enrollment status of each person, as well as the participation rate for the whole group by going to the "Reports" menu, and clicking on Participation Report or Detail View.

Outside the Open enrollment period, you can view which of your employees are currently covered in a health insurance plan by going to the "Employees" menu, and clicking on Manage List. The "Enrollment Status" column will display "Enrolled" for each employee who is currently enrolled in a health insurance plan through your business.

What happens if my group doesn't meet the minimum participation rate?

You may need to select a different metal level of plans or a higher employer contribution percentage to encourage a greater number of your employees to participate. If your group does not meet the minimum participation rate set by NMHIX, you may start the coverage setup process again, with a potential new future start date.

Understanding the employee Manage List pageBack to Top

What do the status columns mean?

There are two status columns – one shows whether your employee is covered by a health plan ("Enrollment Status"), and the other shows whether your employee is currently employed by your company and eligible for coverage ("Employment Status").

What do the words below the Enrollment Status column mean?

The "Enrollment Status" column displays the health insurance enrollment status for each individual employee listed. The four options that you may see are: Not Enrolled, Enrolled, Waived, or Canceled.

  • "Enrolled" means that the employee has health insurance for the current coverage term.
  • "Not Enrolled" means that the employee has not enrolled in a health insurance plan through your company for the current coverage term.
  • "Waived" means that the employee waived coverage for the current coverage term during Open Enrollment.
  • "Canceled" is used in two circumstances: 1) the employee had coverage and then canceled it, or 2) you, the employer, terminated the employee’s coverage.

What do the words below the Employment Status column mean?

The "Employment Status" column displays the employment status for each individual employee listed. The four options that you may see are: Eligible, Not Eligible, Terminated, or Deleted.

  • "Eligible" means that the employee is currently employed by your business and is eligible for health insurance coverage.
  • "Not Eligible" means that the employee is currently employed, but you, the employer, have determined that the employee is not eligible for health insurance sponsored by your business.
  • "Terminated" or "Deleted" means that the person is not currently employed.

Renew coverage for the upcoming yearBack to Top

What is the process for getting coverage for next year?

Health and dental coverage are generally purchased for a year at a time - the exception being for the addition of a new hire midway through an existing coverage year. About two and a half months before the end of the current coverage year, you will be notified that it is time to renew coverage for the upcoming year. Your dashboard will also prompt you to renew coverage for the upcoming coverage year. The process will be similar to how you previously set up coverage for your employees - they go through an open enrollment period, and you receive and pay for a binder invoice and subsequent monthly invoices.

Are my coverage selections automatically applied toward the next year?

No. Employers must actively select coverage again in order to enable employees to renew coverage. If you do not visit the exchange to pro-actively set up coverage for the upcoming year, your employees will not be able to select plans, and consequently will not have health or dental insurance for the upcoming year.

Is there a time limit for me to set up coverage for an upcoming year?

Yes. Employers must set up coverage for an upcoming year prior to employees being able to participate in open enrollment. Specific deadlines for employers vary from month to month. Please pay attention to the notification that informs you it is time to renew coverage for the upcoming year. That notification will outline the deadlines that apply to your specific re-enrollment.

What if I miss the deadline to set up coverage for an upcoming year?

If you miss the deadline to set up coverage for an upcoming year, return to your Employer Dashboard. Under the Coverage menu item, select the Set Up Coverage option and follow the on screen instructions from there. This will allow you to set up coverage for the next available coverage start date available to your employees. Please be aware that missing the deadline to renew coverage for an upcoming year may result in a gap in coverage for your employees.

Understanding paymentsBack to Top

When is my first payment due?

After open enrollment ends, if your company has met the minimum participation rate, you will need to pay the binder invoice by the deadline to ensure that your employees will be covered. You will be notified that the binder invoice is available on the 11th day of the month prior to the coverage start date. The binder payment must be made by the 15th day of the month prior to the coverage start date. If payment is not received by the 15th, enrollment for employees at your company will be canceled. There is no grace period for the binder payment.

What is the billing schedule for the coverage year?

After your coverage start date, you will begin receiving monthly invoices on the 5th day of every month. These monthly invoices are sent in advance of the coverage month. Monthly payments are due on the first day of the month of coverage. If you miss the deadline for a regular monthly payment, you will enter a 30-day grace period during which time you may still make payment and retain coverage for your employees. If the monthly payment is not received by the end of the grace period, your company’s enrollments will be terminated retroactive to the last paid-through date.

Example: An employer has been making regular monthly payments on time. On July 5th, the employer receives the invoice for coverage during the month of August. The due date for this payment is August 1st.

If the employer does not pay by August 1st, a grace period begins, which ends on August 30th. During this grace period, the employer can still pay the invoice sent on July 5th. If the employer pays before August 30th, the account is considered current and there is no negative impact on the coverage for employees.

If the employer does not pay by the end of the grace period, August 30th, then coverage will be terminated for all employees at the company. The termination will be retroactive to the last paid-through date – i.e., July 31.

How do I submit my employer group’s premium and how does it get to the insurance carriers?

Employer groups are required to enter their banking information into the beWellnm for Small Business module upon enrollment. The premium will be automatically deducted from the bank account on a monthly basis when it is due. Shortly thereafter, beWellnm for Small Business sends the premiums to the appropriate carriers along with a supporting electronic remittance with the detail of each transaction.

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