Q: What is the Marketplace?
A: Florida’s Health Insurance Marketplace is a web-based shopping experience that allows easy access to and side-by-side comparison of health care options for small businesses.
Q: What products will be offered?
A: Initially vendors will offer insurance and limited benefit policies. In late phases provider organizations may participate with prepaid service contracts offered by health clinics, health providers, pharmacies, service networks, group practices, and professional associations. Other groups may offer health services for a specified amount and type of service or treatment. Payroll services, medical savings accounts and other insurance options that are helpful to employers can also be offered.
Q: Which businesses can participate?
A: Initially, eligible employers include Florida’s small businesses with 4 to 50 participating employees at the time of enrollment. Other eligible groups and individuals can join the Marketplace in 2013.
Q: After a business joins, who in the business is eligible to participate?
A: Employers determine which employees are eligible for benefits and the amount of any employer contribution. Eligible employees are identified as employees actively engaged in the conduct of the business of an enrolled employer who works at least 25 hours per week. This includes a self‐employed individual, a sole proprietor, a partner of a partnership, or an independent contractor if included as an employee under a health benefit plan of a small employer.
Q: How do employees sign up?
A: Enrolled employers will inform employees of the opportunity to shop for coverage and services by providing a web link allowing access to the employer’s customized Marketplace home page. Employees will have up to 60 days to shop and compare their options.
Q: Usually my employer picks my plan and benefits for me. How does it work in the Marketplace?
A: Here, the employer will recommend 4 plans within one insurance vendor. Benefit information is standardized for easy comparison. You can compare and contrast the plans to determine the best fit for your needs.
Q: How do I pay for the coverage and services I choose?
A: Your employer will collect your share of the premium through payroll deduction. Each pay period your employer will forward any employer contribution along with your payroll-deducted amount. Your contribution may also be considered pre-tax, depending on your employer’s benefit plan and the options you pick. Your employer’s contribution toward the premium must be at least 50 percent of the lowest price plan offered by the selected vendor.
Q: Do I have to leave the Marketplace if I lose my job or change employers?
A: During the small group pilot program you must be associated with an employer. You may be eligible for COBRA through your employer which would lead to continued coverage through Florida Health Choices upon leaving your employment. Check with your employer about your COBRA options.
Q: Is this the same as the “health exchanges” being mandated by the federal government?
A: The Marketplace is not the same as a “health exchange.” There are no mandates as to the products and plans that an insurer is allowed to offer, and there are no requirements for a small business to participate. This marketplace is completely voluntary.