Insurance

Due to the complexity of the law that may require very fact-specific analysis, this material is not intended to be legal, accounting, or other professional advice, and is provided only as general information.
Last reviewed: March 5, 2014.

Will my plan be subject to ACA reforms?

Some of the reforms introduced by ACA are not applicable to plans sold in the large group market.   For example, the new rating factors (e.g., age, tobacco, and whether individual or family members) and the 10 essential health benefits are not required of large group health plans.

Will my plan be required to contain all 10 Essential Health Benefits?

No. Plans sold in the large group market do not need to include the 10 EHBs.

However, plans sold in the large group market are still subject to the requirements imposed by the Hawaii Prepaid Health Care Act.

How is a large employer/large business defined?

Employers must look at the definitions provided in specific provisions of federal and state law with respect to how it defines “small” and “large” employer.

• In Hawaii, under both ACA and HPCA, the Hawaii State legislature has clarified a large business is any business that employs 51 or more full-time equivalent employees.
• However, it is good for employers with 50 or more employees to consider that in some situations they may be “small employers” and in others “large employers.”
  • For purposes of W-2 reporting requirements, employers (starting first with the largest employers with over 250 W-2s and gradually to all employers) are required to provide information about health costs. An amended Form W-2c is required if an original W-2 fails to include the required information. Some “transitional” relief is provided. For more on W-2 Reporting of Employer-sponsored Health Coverage, visit the IRS website at https://www.irs.gov/uac/Employer-Provided-Health-Coverage-Informational-Reporting-Requirements:-Questions-and-Answers.

This website provides only general information, and is not intended as legal, accounting or other professional advice.

Can I purchase insurance through HealthCare.gov?

No, only Hawaii small business and individuals may purchase insurance through HealthCare.gov.

•  In Hawaii, a large business is any business that employs 51 or more full-time equivalent employees.
• The ACA definition for small employer is any employer with 1-50 full-time equivalent employees.

Do I have to offer insurance to my employees?

Yes. Under the Prepaid Health Care Act, large employers must offer affordable health insurance to their employees.

What’s the difference between a full-time employee and a full-time “equivalent” employee?

• Under the ACA, a full-time employee is anyone who works 30 or more hours a week. In Hawaii, under the Prepaid Health Care Act, a full-time employee is anyone who works 20 or more hours a week for four consecutive weeks.
• The ACA uses the term full-time employee but then expands on the definition to include both full- and part-time employees.   Note that there are complexities involved in calculating full-time employees under federal regulations.