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Transcript of Fidelis Care
Who Is Fidelis Care?
insurance company, formed in 1993
More than 1 million members, 60,000 providers
New York State’s largest provider of government-based insurance products:
Why Fidelis Care?
Health insurance has changed. Individuals are expected to make their own health care decisions. Employers are left wondering, "What Should I do?"
We can help.
Our mission is to provide quality, affordable health care coverage to people of all ages and at all stages of life.
Affordable Health Care Is What We Do.
Whether you need help signing your employees up for insurance or navigating the system, Fidelis Care can help.
We're not in this business to make money or drive up profits.
Quality health coverage.
It's Our Mission.
NY State of Health
Medicaid Managed Care
Child Health Plus
Managed Long Term Care
Do I have to provide insurance
No employer has to offer coverage, but larger employers (50 or more FTEs) may be subject to the Employer Shared Responsibility Payment in 2016
Only applies if one of your employees can save money on monthly premiums in the Marketplace
If you don’t offer insurance, the annual payment is
$2,000 per full-time employee
(excluding the first 30 employees)
If you do offer insurance, but it doesn’t meet minimum requirements*, the annual payment is
$3,000 per full-time employee
who qualifies for savings in the Marketplace
*Plan’s share of costs is at least 60% and employee’s share of premium costs is not more than 9.5% of yearly household income
What Are My Options?
If you have less than 50 FTEs:
1) Employees can purchase coverage through the individual section of the Marketplace
2) You can select a plan through SHOP and offer it to your employees (you may qualify for a tax credit)
In 2015, you can pick a benefit level and let your employees pick their plan (originally planned for 2014, but delayed 1 year)
If choosing #1, Fidelis Care has a wide offering of new insurance products, with low premiums
If you have 50 or more FTEs:
1) …but less than 100 FTEs, you can purchase insurance for your employees through SHOP in 2016
2) You can purchase insurance for your employees through a commercial health plan, avoiding any penalties
Plan’s share of costs must be 60%+ and employee’s share of premium not more than 9.5% of yearly household income
3) You can pay the penalty for not providing insurance, but educate your employees about options in the Marketplace
No penalties for 2014
If choosing #3, Fidelis Care can help educate your employees about available insurance products
Why Is Fidelis Care the Solution?
NY State of Health
, all insurance products are standardized
Same Levels (Platinum, Gold, Silver, Bronze)
Fidelis Care maximizes the differences:
We offer low premiums because it's our mission
We have a large provider network
We have people in the community, ready and willing to help
We've been doing this for more
than 20 years.
We work with the NYS Government to make sure everyone has access to quality, affordable health coverage.
The solution to your problem is Fidelis Care.
How Do My Employees Benefit?
Products offered through the NY State of Health have low deductibles, annual "out-of-pocket" limits, and selections are varied to address an individual employee's unique needs.
All plans cover "Essential Health Benefits" like Emergency Room Visits, Hospitalization, Maternity and Newborn Care, and Laboratory Services.
In order to make coverage even more affordable, the Marketplace offers two types of financial assistance:
Tax Credits (lowers monthly premiums)
Cost-sharing Reductions (reduces out-of-pocket)
The application process will determine any financial assistance for which an employee may qualify.
What Should I Do Next?
Employees who are U.S. Citizens (or who are lawfully present in the U.S. for the period of enrollment), residents of New York State, and not incarcerated can apply during the open enrollment period* (typically October 1 through December 7; 2014: November 15 through February 15)
An employee may have changes in circumstance at any time during the normal plan year.
Certain changes are considered to be “qualifying events” and allow an employee to enroll during a special enrollment period. The special enrollment period continues for 60 days from the date of the event.
Loss of minimum essential coverage
Gaining or becoming a dependent
Gaining lawful presence
Enrollment errors of the Marketplace
Material contract violations by Qualified Health Plans
Gaining or losing eligibility for premium tax credits or cost sharing reductions
Relocation resulting in new or different Qualified Health Plan selection
Why Fidelis Care?
Fidelis Care can help your employees enroll in coverage.
We will make sure that coverage meets "minimum essential" value so that you can avoid any penalties.
We will meet with your employees in person to help them enroll. Or we can be at your store, helping your customers get coverage-- and you'll be giving back to the community.
Low premiums, large provider network, in-person assistance.
That's the Fidelis Care
We're in this business to help people: