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ODs have resources for exploring insurance options

September 9, 2013

As health care practitioners, optometrists may have a leg up on other small business owners when it comes to new insurance options. But as employers, there may still be many questions.

AOA surveys find many optometrists provide, or wish to provide, health insurance coverage for their employees. Yet small health care practices, like other types of small businesses, generally do not qualify for advantageous group rates insurance plans offer to larger employers.

For those with 50 or fewer employees, all health insurance marketplaces will offer the Small Business Health Options Program (SHOP), specifically developed to meet the needs of small businesses (www.healthcare.gov/small-businesses). Optometrists who do not have employees, and therefore do not qualify for SHOP programs, can still obtain coverage through the options offered by health insurance exchanges for individuals and families (www.healthcare.gov/families).

The U.S. Department of Health & Human Services (HHS) and other federal agencies offer a number of resources to help small businesses – including optometric practices – understand their rights and responsibilities as employers under the federal Affordable Care Act and assess the coverage options available through health insurance marketplaces.

Health insurance information

  • The official HHS health care reform website (www.healthcare.gov) offers a variety of reform-related topics – including how reform affects individuals, families, and businesses. Beginning in October, visitors may obtain insurance by creating an account and logging onto to the website for the appropriate state health insurance exchange website.

Tax benefits, responsibilities

  • The IRS Affordable Care Act Tax Provisions webpage (www.IRS.gov/aca) offers information on new health insurance coverage and financial assistance options, including the Premium Tax Credit, for individuals and families and new benefits and responsibilities for employers.

Small business resources

  • The U.S. Small Business Association health care webpage (www.sba.gov/healthcare) outlines, in specialized articles, aspects of the ACA pertinent to the self-employed, employers with under 25 employees, and those with up to 50 or more employees.

Legal guidance on labor provisions

  • The U.S. Employee Benefits Security Administration Affordable Care Act webpage (http://www.dol.gov/ebsa/healthreform) offers detailed information on providing coverage to employees, including guidance on the notice to employees of coverage option. (Optometrists may wish to review site document on “grandfathered” health benefits including vision benefits.)

U.S. Government Business Portal information

  • Businesses of all sizes – including optometric practices – can now visit Business.USA.gov/healthcare for information on the ACA. An interactive tool allows employers to get tailored information on how the health care law may affect them based on their business’ size, location, and plans for offering health benefits to their workers next year.

Small-employer call center

Optometric practices interested in SHOP may get answers to their health insurance questions through the new Health Insurance Marketplace Small Employer Call Center (800-706-7893).

The HHS Health Care Small Business webpage also offers an overview of the SHOP initiative and answers to the most common questions about the program, listing of SHOP options by state, and an interactive feature to help small business people determine the SHOP options available to them (www.healthcare.gov/small-businesses).

SHOP webinar

The HHS will offer a special webinar on the SHOP program Sept. 19 from 1 p.m. to 2 p.m. EST. The webinar is intended to explain how small businesses can offer employee health insurance starting in 2014. To register, log onto http://tinyurl.com/SHOPwebcast.

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