The Large Business
Guide to Health Care Law
How the new changes in health care law
will affect you and your employees
Table of contents
Introduction
Introduction
3
Part I: A general overview of the health care law
5
Responsibilities of employers, employees and individuals
Part II: Knowing your group size is the first step
The health care law affects employers differently. In fact, most employers have
already felt some of the law’s effects. The impacts on your business depend on
the size of your company, how much your employees are paid, the type of
coverage you currently provide, and whether your plan qualifies for
“grandfathered” status.
8
Group size is a key factor
How do I determine group size
Part III: Will I have to pay penalties?
In general, many small businesses will need to make changes to their current
plans to comply with the law. Larger businesses will see less impact to products
and rates. But larger businesses will see new penalties for not offering the
right level of coverage, or if the coverage offered isn’t affordable based on an
employee’s pay scale (effective in 2015).
11
Large groups may incur penalties
Part IV: Grandfathered status
14
Part V: Other important provisions
15
Part VI: Additional taxes and fees
17
Part VII: Take action now – Checklist for large employers
19
Part VIII: What Independence Blue Cross is doing to help
20
As an employer or benefits manager, health insurance is one of the most
important things you can provide for your employees and their families. That fact
isn’t changing. But many things about health insurance are changing as part of
the new health care law – officially called the Patient Protection and Affordable
Care Act.
Independence Blue Cross (IBC) created The Large Business Guide to Health Care
Law to help you understand how the health care law affects the way you provide
health care benefits to your employees. This guide highlights some of the critical
impact areas facing businesses, including what your legal requirements are under
the health care law, the penalties you may incur for non-compliance, and key
decisions you will need to make. It also contains information and tools that will
help you and your business prepare for the changes ahead as more key provisions
of the law are implemented.
Complying with the law
Finding solutions
Part IX: Glossary of common health care terms
23
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Part I: A general overview
of the health care law
Here’s a brief outline of what you’ll find in this guide:
• A quick overview of the health care law
• Information about the penalties you may incur as a large business
The health care law affects virtually everyone – individuals, families, and
businesses of all sizes. The law’s provisions are being implemented in phases over
a 10-year period from 2010 to 2020. Some provisions of the law are already in
effect. They include the following:
• Step-by-step instructions for determining eligible employees
• A description of key provisions of the health care law that affect
large businesses
• A checklist to help you comply with the law and make important decisions
• All group health plans that offer dependent coverage must cover dependents
until they reach the age of 26.
about the health care benefits your company offers
• Plans must cover certain preventive health care services at 100 percent
• A description of what Independence Blue Cross is doing to help
• A glossary that explains common health care terms
IBC is your partner in providing quality, cost-effective health care coverage.
We’re here to help you navigate the changing health care environment, comply
with the law, and make the best health care coverage choices for your business
and employees.
for in-network providers, and an individual will have no financial
responsibility for those preventive services. (Grandfathered plans are
exempt from this requirement.)
• Plans cannot deny coverage to people under the age of 19 who have
pre-existing health conditions.
• Plans cannot impose lifetime maximum dollar limits on essential health
benefits and annual limits of these benefits are restricted; there will be no
annual dollar limits beginning on January 1, 2014.
• Plans must have internal and external appeals processes that members
can use to appeal coverage decisions. (Grandfathered plans are exempt from
this requirement.)
• Members can designate any participating primary care physician or
pediatrician (for a child) as their primary care physician. In addition, women
can see OB/GYN physicians without a referral. (Grandfathered plans are
exempt from this requirement.)
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Other major changes are scheduled for implementation in 2014. Although some
of these provisions do not apply to large employers directly, they may affect
decisions you make about the health care benefits you offer your employees.
Some of the changes scheduled to take effect in 2014 include:
The employer reporting provision requires you to submit annual reports to the
U.S. Department of Health and Human Services on the terms and conditions of
health care coverage provided to your full-time employees. The employer mandate
penalties and reporting requirements, which were scheduled for implementation
in January 2014, will now go into effect on January 1, 2015.
• Everyone is required to have health insurance.
Responsibilities of employers, employees, and individuals
• No one can be denied coverage because of his or her health status.
• Annual dollar limits on essential benefits are eliminated.
• Employees who work at least 30 hours per week are to be considered full-time
and should be offered health coverage if the employer has 50 or more FTEs.
• Coverage waiting periods of greater than 90 days are eliminated for group
health plans.
• Many single people and working families who purchase coverage on their own
may get tax credits/subsides from the government to help pay their health
care coverage costs. This includes many people who the government does not
currently help.
• Individuals and small businesses will have a new way to buy health insurance.
They can compare and evaluate health plans through an online portal called
the Health Insurance Marketplace.
The law encourages states to expand eligibility for their Medical Assistance
programs, also known as Medicaid, to those under age 65 whose incomes are
below 133% of the federal poverty level. Many states are expanding their
Medical Assistance programs and offering health plans to more people who are
uninsured. Some states began phasing in coverage of these individuals in 2010.
To find out more about Medicaid eligibility in each state, visit:
www.healthcare.gov/do-i-qualify-for-medicaid
The federal government made some important decisions about some of the key
provisions that affect large businesses. The employer mandate, or employer
shared responsibilities provision, goes into effect in January 2104. However
the government has delayed implementation of the penalties that apply to
employers who do not comply and the employer reporting requirements.
Under the employer mandate, you could incur penalties if you do not provide your
employees with health care coverage, the right level of coverage, or coverage
that is considered affordable.
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As of January 1, 2014, most individuals will need to enroll in a health care plan
or face government penalties. This provision is known as the individual mandate.
One of the ways an individual can obtain health coverage is through a group
health plan provided by an employer. However, the individual mandate applies to
individuals even if their employer does not offer health insurance.
Effective January 1, 2014, groups with fewer than 50 full-time employees do not
have to offer health care coverage, and there is no penalty if they do not offer
coverage. Small businesses that offer coverage may be eligible for tax credits if
they offer health insurance. If a small business offers health care coverage, it
must provide certain benefits and cost-sharing levels.
Large groups of more than 50 full-time or full-time-equivalent employees must
offer health care coverage to all full-time employees or incur a penalty starting in
2015. (See explanation of group size on page 8.)
2014 sample penalty for
individuals without a health plan
$600
$300
$150
$15,000
$30,000
$60,000
Taxable Income
7
Part II: Knowing your group size
is the first step
How do I determine group size?
Group size is a key factor
Determine your full-time employees by identifying all employees who work 30
or more hours per week. To that amount, add the number of your full-timeequivalent employees.
To determine your group size, you first need to calculate the number of hours
worked by your full-time and full-time-equivalent employees (see page 10).
The size of your business determines how your benefits or rates are constructed,
and whether or not you will be penalized for not offering coverage. The health
care law includes precise guidelines about calculating group size.
In 2014, the federal government will define full-time workers as those who work
30 hours per week or more. Part-time employees will be counted as part of the
total employee count.
The health care law defines small groups as those with a total of 2-100 full-time
and full-time-equivalent (FTE) employees. But the law allows states to modify the
FTE number for small businesses for 2014 and 2015. Most states are choosing
that option and will classify small business as those with up to 50 FTEs. Groups
with 51 or more total employees are classified as large groups.
Starting in 2016, businesses in every state with 2-100 employees will be classified
as small businesses.
You must also account for part-time workers, by calculating full-time-equivalents
as follows:
1
Add the total hours worked by part-time employees per month and divide
that number by 120.
2
Add this number to your total number of full-time employees. This will
give you your group size.
Seasonal workers may also contribute
to your overall group size.
For more details on how to determine your group’s size, please refer to the
Internal Revenue Service website and/or consult your legal or accounting
professional for assistance.
Definition of hours of service
An employee’s hours of service include each hour for which she or he is paid, or
entitled to payment, during the tax year. You must also add each hour of paid
leave, but no more than 160 hours of paid leave service per year are required to
be counted for an employee.
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Ways to determine hours of service per employee:
1
Determine actual hours of service from records of hours worked and
hours for which payment of wages is made or due, including hours for
paid leave; or
2
Use a days-worked equivalency which credits the employee with 8 hours of service for each day payment of wages is made or due, including days of paid leave; or
3
Use a weeks-worked equivalency which credits the employee with
40 hours of service for each week payment of wages is made or due, including weeks of paid leave.
How to calculate your group size
Once you have determined each employee’s accurate hours of service, add the
total hours of service you pay wages to your employees during the year (but not
more than 2,080 hours for any employee). Divide by 2,080. If the result is not a
whole number, round it to the next lowest whole number. If the result is less than
one, round up to one.
Seasonal workers are generally not covered unless they work more than 120 days
per year. However, premiums you pay on behalf of seasonal employees may be
counted to determine the amount of your credit.
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Part III: Will I have to pay penalties?
Large groups may incur penalties
As a large employer with 50 or more employees, you are required to offer health
insurance coverage in 2014. Starting in 2015, you may incur penalties under the
employer mandate or employer shared responsibilities provision if you do not provide
your employees with health insurance coverage, or the minimum level of health
insurance coverage, or if the health insurance coverage you offer is considered
unaffordable to some of your employees. You also must submit annual reports to
the government about the coverage you provide to your full-time employees.
This provision is scheduled for implementation in January 2014. But the federal
government delayed implementation of the penalties and reporting requirements
for a year. They will now go into effect in 2015. Penalties incurred in 2015 will be
payable in 2016.
Although implementation of the employer penalties and reporting requirements
has been delayed, the Internal Revenue Service encourages large employers to
voluntarily maintain or expand health coverage and to comply with information
reporting requirements in 2014.
You can avoid penalties that the federal government will start imposing in 2015
by providing your employees with a health plan that meets the coverage and
affordability requirements established by the new health care law.
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As a large group, your plan must meet
certain coverage requirements:
How do I pay?
• The minimum value of your health plan must be
60 percent or greater of the total cost. This means
that the cost-sharing associated with the plan must
on average result in the plan paying 60 percent of
associated costs and the member paying no more
than 40 percent. The federal government has issued
a calculator that you can use to test the cost-sharing
of your plan to determine whether or not it meets
minimum value requirements.
60%
40%
Your business could incur two types of penalties – one for not providing health
insurance coverage, and one for not providing the minimal level of health
insurance coverage or affordable health insurance coverage. The amount
of the penalties will increase over time. For 2015, the penalties that will be
assessed are:
• A $2,000 penalty if you do not offer group health insurance coverage. This
Employer must pay at
least 60% of plan value
• You are not required to offer essential health benefits. But if you do offer
any of the 10 essential health benefits identified by the health care law, you
cannot impose any lifetime or annual dollar maximums on those services.
• The annual out-of-pocket maximum (OPM) for essential health benefits
cannot exceed the OPM for health savings account compatible high
deductible health plans. These amounts will be indexed annually. For 2014,
the OPM is $6,350 for individual coverage and $12,700 for family coverage,
and only needs to include major medical. In 2015, the OPM must include
major medical and ancillaries.
penalty is based on the total number of full-time employees your business
employs (the first 30 employees are not included in this calculation). At
least one employee has to purchase subsidized coverage on the new Health
Insurance Marketplace for this penalty to apply. If you choose not to offer
any coverage, and one employee goes to the individual Marketplace and
receives a subsidy, you will be penalized $2,000 per full-time employee after
the first 30.
• A $3,000 qualification penalty if you fail to offer a qualifying plan (minimum
and/or affordable) to any employee. The penalty applies if any of those
employees purchase subsidized coverage through the Marketplace. This
penalty is assessed based on the number of employees who are not offered
qualifying coverage and subsequently purchase subsidized coverage through
the Marketplace.
• Starting in 2015, you may incur penalties if you do not offer health coverage
to all full-time employees who work 30 hours a week and if you have 50 or
more FTEs, and you must begin reporting to the government. You also must
offer coverage to their dependent children (not spouses), although you are
not required to pay for those dependents.
$2,000 penalty
$3,000 qualification penalty
if you do not offer group
health insurance
if you fail to offer a qualifying plan
(minimum and/or affordable)
to any employee
Your health plan also must be affordable:
• Affordability is determined by the single employee contribution amount for
the lowest-cost plan offered.
• If the contribution towards a single premium exceeds 9.5 percent of an
employee’s W2 wages, the plan is unaffordable for that employee. There are
other safe-harbor measures available to groups to determine affordability of
health plans they offer.
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Part IV: Grandfathered status
Part V: Other important provisions
If your plan has been granted grandfathered status, your health plan has to
comply with some – but not all – provisions of the health care law. Grandfathered
status applies only to plans that were in effect on March 23, 2010 and that
continue to meet specific guidelines to maintain that status.
As a large employer, other provisions in the health care law will affect your
business and your health plan in the months and years ahead, including:
Some requirements your grandfathered plan may not have to meet, include:
You are required to notify all employees in writing by early fall of 2013 and all
new hires who start working for your company after that time. The Marketplace
is an online shopping tool administered by the federal government.
• Covering 100 percent of certain preventive services if the services were
received from an in-network provider.
• Allowing female employees to see OB/GYN physicians without a referral.
• Allowing members to designate any participating primary care physician or
pediatrician (for children) as their primary doctor.
• Implementing an internal and external appeals process.
Notification requirements – 2013
Beginning no later than October 1, 2013, employers must provide the
Marketplace notice to each new employee at the time of hiring. For 2014, the
government will consider a notice to have been timely delivered if it is provided
within 14 days of an employee’s start date.
With respect to current workers, employers are required to provide the notice by
October 1. The notice must be provided automatically, free of charge, and written
in language that the average employee can understand.
• Eliminating prior authorization for hospital emergency services for
participating and out-of-network providers.
• Prohibiting discrimination that favors highly compensated individuals (fully
insured plans only).
Specifically, you must:
• Provide a description of the services the Marketplace offers,
Even if your plan has grandfathered status, you must comply
with many provisions of the health care law including the following:
• Provide instructions about how to contact the Marketplace and request
• You must provide coverage to children under age 19 with pre-existing health
conditions. Starting in 2014, you cannot deny coverage to anyone because of
existing health conditions.
assistance,
• Let employees know that they may be eligible for premium tax credits if the
plan you offer pays less than 60 percent of the costs of covered services,
• Explain that if employees purchase a qualified health plan through the
• You cannot impose lifetime dollar limits on essential health benefits.
• The health care law limits annual dollar limits on essential health benefits
through 2013, and eliminates them in 2014.
Marketplace, they may lose any employer contribution to any health plan
offered by the employer and all or a portion of the contribution may be
excluded from income for federal income tax purposes.
• If your plan covers dependent children, you must extend coverage to dependent
children until age 26.
Keep in mind that you can lose grandfathered status if you make significant
changes to the health plan, such as the benefits it includes or the amounts
employees pay in cost-sharing fees (deductibles, premiums, and copayments).
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Guaranteed issue and renewability – 2014
New reporting requirements – 2015
In 2014, the health care law requires insurers to offer all insurance products
in the individual and group market to everyone in the state. This means that
employees are guaranteed coverage regardless of their health status or other
factors. In addition, all group health insurance plans must have guaranteed
renewability. That means insurers cannot refuse to renew coverage when
people are sick.
Large employers will have to submit annual reports to the
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AR T
H C POR
E
ALT
U.S. Department of Health and Human Services on the
HE UAL R
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terms and conditions of health care coverage provided to
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full-time employees. The report should include: duration of
waiting period, the monthly premium for the lowest-cost
option offered to employees, employer’s premium share, and a list of employees.
This provision was scheduled for implementation in 2014. Although the federal
government delayed implementation until January 2015, the Internal Revenue
Service encourages large employers to voluntarily submit these reports in 2014.
Wellness provisions – 2014
The Department of Health and Human Services has issued rules to increase
the incentives you can offer employees who participate in wellness programs.
Here’s how the rules would affect the two types of wellness programs offered
to employees.
• Participatory wellness programs
These programs are generally available to everyone, regardless of their
health status. Examples of participatory wellness programs include:
reimbursement for gym memberships, rewards for attending no-cost
health education seminars, or completing a health risk assessment without
requiring any further action. The proposed rules do not alter the incentives
available for these programs.
• Health-contingent wellness programs
These programs generally require individuals to meet specific standards
to obtain rewards. For example, employees may receive rewards if they do
not use tobacco or if they decrease the use of tobacco products; or, they
may receive awards if they achieve a specified cholesterol level or weight.
The final rules would allow you to increase the rewards you offer for these
programs from 20 to 30 percent of the cost of health coverage (total
premium). The maximum reward could increase to as much as 50 percent
for programs that prevent or reduce tobacco use. The final rules would
require health-contingent wellness programs to meet certain requirements.
To qualify, you must offer rewards for programs designed to promote health
or prevent diseases, offer rewards to all similarly situated individuals (the
program should have provisions for those whose medical conditions make
it inadvisable or difficult to participate), and notify employees about their
opportunity to qualify for the rewards.
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Large groups may be allowed on the marketplace – 2017
States will have the option of allowing large companies with more than 100
employees to buy health insurance through state-based health insurance
marketplaces. Initially, only individuals who buy their own insurance and small
businesses will be able to use these online portals when they open in the fall of
2013. The marketplaces will make it easier for those purchasing health insurance
to compare products and prices.
Part VI: Additional taxes and fees
Cadillac tax – 2018
The health care law imposes a 40-percent tax on high-value health plans starting
in 2018. The tax applies to an amount above established dollar thresholds and is
levied on insurers for fully-insured plans, employers for health savings account
(HSA) contributions, and plan sponsors for self-insured plans. Taxes are imposed
when employee health plan costs exceed $10,200 for single person plans and
$27,500 for other plans, such as family plans. This limit is subject to annual
adjustments. Higher benefit limits are allowed for retirees age 55 and older who
are not eligible for Medicare and for people in high-risk jobs.
The health plan costs are defined by the total cost of premiums, including
employer and worker contributions to flexible spending accounts or HSAs.
Stand-alone vision, dental, accident, disability, and long-term care benefits are
not included in the limits under the cadillac tax rule.
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New taxes and fees
The health care law includes mandated taxes and fees from nearly all health
insurers to build a pool of funds for several initiatives. These funds will be used
to help stabilize premiums for people who are newly insured, and develop best
practices to improve the quality of medical outcomes.
After basic medical rates are calculated, health insurers will add the following
fees to employer plans:
Part VII: Take action now —
Checklist for large groups
Here are some of the things that are already required, or that you may need to do
in the future to comply with the new health care law:
Determine your group size
†† Determine whether your health plan continues to qualify for grandfathered status.
• Patient-centered outcomes research trust fund fee
This fee funds research to help patients and health care providers make more
informed decisions. The fee started in 2011 at $1 per enrollee and doubled
to $2 per enrollee in 2012. This fee will continue through 2019. Health
insurance companies collect this fee for fully-insured employers. The plan
sponsor is responsible for paying the fee for self-funded groups.
• Reinsurance program contribution
This fee will be used to fund state-based transitional reinsurance programs.
The fee, which will be collected from 2014 to 2016, will be based on
the number of enrollees. The contributions will be set each year by the
Department of Health and Human Services. It is estimated that the amount
assessed in 2014 will be from $61-105 per enrollee.
Address new administrative duties
Implementation Date
†† Perform discrimination testing
(new for non-grandfathered, fully insured groups)
Delayed
(New date not set yet)
†† Implement higher Medicare Part A payroll taxes for
2013
high-wage earners
†† Issue notice of Marketplace to employees
2013
†† Implement health flexible spending account maximum
2013
†† Include the aggregate value of health coverage on
2013
employees’ W2 forms
†† Create and submit health care coverage annual report
2015
to the Department of Health & Human Services
• Health insurance provider tax/fee
This tax helps fund the health care law. Health insurers must pay an annual
non-deductible tax/fee to the Internal Revenue Service. The amount
assessed is calculated by market share based on premiums written.
Manage new taxes and fees
†† Discontinue any tax deduction for Medicare Part D
Implementation Date
2013
subsidy amounts
†† Calculate and pay patient-centered outcomes fee
2013
(self-funded plans only)
†† Calculate and pay reinsurance contribution
2014
(self-funded plans only)
Assess your current offerings
Implementation Date
†† Does your business meet new waiting period requirements?
2014
†† Does it meet the health care law’s actuarial value and
2015
affordability requirements?
†† Identify changes you need to make and implement
Ongoing
remedies as needed.
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Part VIII: What Independence
Blue Cross is doing to help
We’ll also incorporate other key provisions of the health care law into many of our
plans. For 2014, we will:
• Eliminate pre-existing condition exclusions for adults
• Add new maximum out-of-pocket limits for non-grandfathered plans
Complying with the law
At IBC, we’re following implementation of the health care law closely. We have
made major changes to our health plans, and will be making additional changes
to make sure your plans comply with the law. We have met many requirements of
the health care law, and adopted other provisions prior to when they took effect.
For example, no changes needed to be made to your coverage in the following
areas because IBC already included these provisions in its health plans:
• Coverage for in-network emergency room visits
(these limits in 2014 will be $6,350 for individual plans and $12,700 for
family coverage)
Finding solutions
IBC is working on your behalf to find innovative solutions that address cost and
quality issues for employers. Some steps we’re taking include:
• Joining a national effort to improve service at lower costs for multi-state
customers;
• The ability to select a pediatrician as a primary care physician
• Offering innovative workplace wellness programs to employers;
• Direct access to OB/GYN physicians
• Using technology to more effectively serve our customers and help them to
improve their health.
• No preexisting-condition exclusions for children
Here are some of the changes we’ve made to comply with the health care law.
All IBC plans now include these benefits:
• Coverage of employees’ dependents to age 26
• 100 percent coverage for designated preventive care services
• No lifetime dollar maximums on essential health benefits (this eliminates
limits, such as $1 million lifetime maximums for out-of-network care)
We also think it’s our responsibility to be part of the solutions that will help make
our community healthier, and to provide access to quality health care coverage
in a way that’s efficient and cost effective. The health insurers that will thrive in
this fast-paced and rapidly changing environment will be those with a clear plan
and powerful focus on finding fresh and innovative ways to deliver real value to
consumers. So we’ve set a bold vision to lead the way regionally and nationally in
transforming the delivery of health care by lowering costs and helping to raise the
quality of health care.
• No annual dollar maximums on essential benefits (this eliminates limits, such
as the $2,500 annual limit for durable medical equipment)
• No rescission (cancellation) of coverage except in cases of fraud, intentional
misrepresentation of material facts, or nonpayment of premiums
• No preexisting condition exclusions for children under 19
• Enhanced internal appeals and external review processes
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Here are some of the specific things we’re doing to help
improve the health care system for us all:
• Strengthening partnerships
We believe that collaboration and partnership are the answers to most
problems that face our health care system. We are, and have been, working
closely with other Blue Cross and Blue Shield plans, affiliates, physicians,
and hospitals, and with more than a dozen health care systems to find
solutions that work. IBC is helping create groundbreaking new models
of cost-effective care that use new and different methods and practices,
experimenting with options, launching new pilots, and finding the best ways
to keep people healthy. For example, we’re funding a large pilot program
in the United States for a relatively new health-care model – called the
patient-centered medical home – that is revolutionizing primary care.
• Developing incentive programs
We started talking several years ago with doctors and hospitals about new
ways to work together to manage costs and improve quality of care. And we
developed incentive programs that reward high-quality, cost-effective care.
• Planning for the future
We’re helping create a new center for health care innovation where
innovators can incubate and develop ideas, harness technology, and create
new products, services, and marketing approaches.
IBC is committed to delivering the health
care coverage we believe Americans truly need
Part IX: Glossary of
common health care terms
Here are simple definitions of some of the health insurance terms in this guide.
• Employer shared responsibility
A provision of health care law that requires groups with 50 or more fulltime or full-time-equivalent employees to provide affordable and minimum
value health coverage to their employees. If this level of health care coverage
is not provided and a group member obtains a subsidy from the individual
Marketplace, the group will be subject to a government penalty.
• Group size
The number of full-time and full-time-equivalent employees employed by a
company. In 2014, the definition of a full-time employee is someone who
works at least 30 hours per week.
• Health care law
A short way to refer to the Patient Protection and Affordable Care Act.
President Obama signed this bill into law in 2010. Many key parts of the law
go into effect in 2014. This law is sometimes referred to as Obamacare.
• Health insurance marketplace
A new online state marketplace where consumers and small businesses can
shop for health insurance, comparing products and prices. It also is known as
an “Exchange” and the “Small Business Health Options Program (SHOP).”
States will have the option of allowing large companies with more than 100
employees to buy health insurance through these marketplaces starting in 2017.
• Individual mandate
Encouragement
to stay well
Superb care
when they are ill
A coordinated health care
system that rewards those
who provide the safest,
most effective care
A provision of health care law that requires individuals to have health care
coverage by 2014 or the individual may be subject to government penalties.
• Minimum value
Minimum value is the average share of total health spending on essential
health benefits paid for by the plan.
• Tax credits/subsidies
Subsidies that will lower the costs of health care for many people based on
their income level. Some people may be eligible for health plans with $0 or
low-cost premiums. Others will be eligible for tax credits that help lower
their monthly premiums and also give them a break on their out-of-pocket
health care costs (a deductible, copayments, and co-insurance amounts).
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Independence Blue Cross is an independent licensee of
the Blue Cross and Blue Shield Association.