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Health Care Reform and You

The Health Care Reform law, officially known as the Patient Protection and Affordable Care Act, was
signed by President Obama in March 2010. The law is intended to expand access to affordable quality
health care for Americans.
The law will be implemented over a 10-year period. Several major provisions, or rules of the law, take effect
in 2014. Some things may affect you and your family while others may not. Our enrollment materials
provide additional information that we hope you will find helpful.
Whats Taken Effect So Far
Health Care Reform: Whats Taken Effect So Far
Children Covered to Age 26 Your dependent children up to age 26 can be covered under your
medical plan, even if they are married, not living with you or not financially dependent on you.
Summary of Benefits and Coverage During each years enrollment, you will receive a Summary of
Benefits and Coverage in paper or electronic form with information about our plan in a standard format
so you can compare our plan to other coverage such as your spouses plan.
W-2 Reporting Each January, we will report the total value of your medical plan for the previous year
on your W-2 tax form. This is for your information only and does not affect your income or taxes.
No Lifetime Maximum There is no lifetime dollar limit on the amount your medical plan will pay for
essential health benefits. This refers to a set of benefits including the 10 general categories listed
below. All plans may not include or cover all of these categories. However, for those items that are
included, that plan cannot place lifetime dollar limits on those benefits.

Essential Health Benefits 10 General Categories:
Ambulatory patient services
Emergency services
Maternity and newborn care
Mental health and substance abuse disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
Additional Medicare Taxes Individuals earning more than $200,000 and couples earning more than
$250,000 began paying additional Medicare taxes in 2013.
Preventive Care Preventive care services like annual physicals and immunizations are covered at no
additional cost to you. Effective August 1, 2012, non-grandfathered plans were required to cover
additional womens preventive services with no coinsurance, copays or deductibles, including certain
health screenings, breast-feeding equipment and supplies, and contraceptives.
Doctor Choice If your plan requires you to choose a primary care doctor, you can select a general
practitioner, family practitioner, internal medicine specialist or pediatrician. Women can also visit an
obstetrician/gynecologist without a referral.
Emergency Care Emergency room services from any hospital are paid at the in-network level even if the
hospital isnt in our plans network.
Prescriptions for OTC Drugs You must have a prescription to pay for most over-the-counter drugs from a
Health Savings Account, Health Reimbursement Account or Flexible Spending Account.
Flexible Spending Account Annual Contributions The maximum amount you can contribute to a Health
Care Flexible Spending Account is $2,500 per year.
Health Savings Account Penalty If you use your Health Savings Account for purchases not listed as
eligible health care expenses under the federal tax code, you will pay a 20% penalty on those purchases.

Health Care Reform in 2014 and Beyond
Health Care Reform: Whats Coming Next
You may have read or heard about some of the health care reform rules coming in the future. From the new
Health Insurance Marketplaces to new requirements for having medical coverage, some significant parts of
the law are taking effect in the coming months.

The Employer Mandate
Beginning in 2015, employers with 50 or more full-time employees, working 30 hours a week on average, or
full-time equivalents may be subject to a penalty if they do not offer health coverage to full-time employees
and their dependent children up to age 26. This is referred to as the employer mandate. The coverage must
be affordable and provide minimum value.

Affordable means that the employee-only contribution for the lowest-cost plan is no more than 9.5% of
your W-2 wages.
Minimum value means that the plan pays for at least 60% of allowed charges for covered services.

The Individual Mandate
A new requirement called the individual mandate is taking effect on January 1, 2014. All U.S. citizens and
legal residents, with a few exceptions, are required to have minimum essential coverage. Coverage under
one of our medical plans will satisfy this requirement. Other types of coverage that meet the individual
mandate include plans provided by another employer, Medicare, Medicaid or individual health insurance.

The Exchange Marketplace
Health Insurance Marketplaces, or Exchanges as they are also sometimes called, are scheduled to open this
fall in all states. Marketplaces are being developed as new options where people can compare and purchase
standard health insurance plans.
Federal subsidies will be available to assist low to moderate income individuals in paying the premium for
health insurance purchased through the new Health Insurance Marketplaces. Eligibility for a subsidy is
based on income. However, individuals who are eligible for employer-sponsored coverage that is
affordable and provides minimum value are not eligible for the subsidy.
Coverage under policies purchased through the Marketplace can begin as early as January 1, 2014, and
individuals can start enrolling on October 1, 2013.

Essential Health Benefits
Starting in 2014, group health plans sponsored by small employers with no more than 50 full-time
employees are required to cover a set of essential health benefits.Here are the 10 general categories:

Ambulatory patient services
Emergency services
Maternity and newborn care
Mental health and substance abuse disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care

Group health plans sponsored by larger employers with more than 50 full-time employees are not required
to cover essential health benefits. However, anything on the list thats included in the plan must be covered
without annual or lifetime dollar limits.

Taxes and Fees
There are a number of new taxes and fees imposed by the health care reform law. Some have already been
implemented and more will take effect over the next year. From medical devices to brand-name drugs to
insurance fees, you may be impacted directly or indirectly.
Summary Health Information
As an employee, the health benefits available to you represent a significant component of your
compensation package. They also provide important protection for you and your family in the case of
illness or injury.
Your plan offers a series of health coverage options. Choosing a health coverage option is an important
decision. To help you make an informed choice, your plan makes available a Summary of Benefits and
Coverage (SBC), which summarizes important information about any health coverage option in a standard
format, to help you compare across options.
Should you need to review an SBC, they are located in the Human Resources Department.

Health Care Reform: Health Insurance
Marketplace (aka Exchange) FAQs
What is the new health insurance exchange, or Marketplace, and when will it be available?
The health insurance exchange is an online marketplace that was established with the intent of making it
easier andmore affordable to buy health coverage. Whether or not this goal is achieved is yet to be
determined. Effective for 2014, the Marketplace will allow individuals and small businesses to compare
health plans and find out if they are eligible for tax credits for private insurance or other health programs
like the Childrens Health Insurance Program (CHIP) and enroll in a health plan that meets their needs.
Is the Marketplace relevant for people that have coverage through their employer?
Probably not. Although employers can purchase their coverage through the Marketplace, most employers
are expected to maintain their plans outside of the Marketplace, based upon the projected pricing and plan
options. If your employer does not purchase coverage through the Marketplace, it is unlikely the
Marketplace will be a viable option for you, because you would be forfeiting your employers contribution
towards your benefit premiums if you waive coverage from your employers plan and enroll in the
Marketplace plan.
When will I be able to enroll in a health plan through the new Marketplace?
The initial enrollment period for the Marketplace will begin on Oct. 1, 2013. Starting in October 2013, you
will be able to get information from the Marketplace about the plans in your state. You will be able to enroll
directly through the website or by calling a toll-free phone hotline. If you are having difficulty finding a plan
that meets your needs and budget, there will be people available to help. Your coverage through the
Marketplace could begin as early as Jan. 1, 2014.
What type of health plans will be available through the Marketplace?
The health plans will be similar to the plan(s) you receive from your employer. All health plans offered
through the Marketplace will have limits on cost-sharing and cover a comprehensive package of items and
services, which is known as the essential health benefits package. In general, the Marketplace will offer
four levels of coverage for consumers.
How much will a health plan cost through the Marketplace?
The premiums for health plans offered in the Marketplace will vary by type of plan and location, but the
total premiums will be very similar to the total premiums under your current employer plan. The big
difference, however, is that you are receiving a company contribution under your current company
sponsored plan, but you will lose that contribution if you drop your employer coverage to join the
Marketplace. Different financial assistance programs will be linked to the Marketplace when enrollment
begins, such as Medicaid and the Childrens Health Insurance Program. Also, when enrollment through the
Marketplace starts in October 2013, some individuals will be eligible for a new kind of premium tax credit
they can use right away to lower their monthly health plan premiums.

Who will be eligible for the Marketplaces premium tax credit?
Eligibility for the tax credit depends on your income and family size and your eligibility for minimum
essential coverage through your employers plan. To be eligible for the tax credit, you must enroll in a
health plan through the Marketplace and you:

Must have household income for the year between 100 percent and 400 percent of the federal poverty line
for your family size
May not be claimed as a tax dependent of another taxpayer
Must file a joint return, if married
Cannot be eligible for minimum essential coverage under an employer health plan

If you are eligible to enroll in an employers health plan that meets certain standards, you are eligible for
minimum essential coverage. This would make you ineligible for the premium tax credit. An employers plan
does not provide minimum essential coverage if the cost for employee-only coverage is more than 9.5
percent of your income for the year.
How can I access information about the Marketplace in my state and possibly get a price and
coverage quote?
The federal government has established a tool to walk you through a process to direct to you to the correct
Marketplace based upon what state you are in. To use this tool visit:

New Health Insurance Marketplace Coverage
Options and Your Health Coverage

PART A: General Information
When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance:
the Health Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice
provides some basic information about the new Marketplace and employment-based health coverage offered
by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget.
The Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may
be eligible for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for
health insurance coverage through the Marketplace begins in October 2013 for coverage starting as early as
January 1, 2014.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer
coverage, or offers coverage that doesn't meet certain standards. The savings on your premium that you're
eligible for depends on your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be
eligible for a tax credit through the Marketplace and may wish to enroll in your employer's health plan.
However, you may be eligible for a tax credit that lowers your monthly premium, or a reduction in certain
cost-sharing if your employer does not offer coverage to you at all or does not offer coverage that meets
certain standards. If the cost of a plan from your employer that would cover you (and not any other members
of your family) is more than 9.5% of your household income for the year, or if the coverage your employer
provides does not meet the "minimum value" standard set by the Affordable Care Act, you may be eligible for
a tax credit
Note: If you purchase a health plan through the Marketplace instead of accepting health coverage
offered by your employer, then you may lose the employer contribution (if any) to the employer-offered
coverage. Also, this employer contribution -as well as your employee contribution to employer-offered
coverageis often excluded from income for Federal and State income tax purposes. Your payments for
coverage through the Marketplace are made on an after-tax basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan
description or contact Melita Group Benefits Help Desk at or 1.800.986.6660.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through
the Marketplace and its cost. Please visit for more information, including an online
application for health insurance coverage and contact information for a Health Insurance Marketplace in
your area.

Form Approved
OMB No. (expires 11-30-
An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs.

PART B: Information About Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your employer. If you decide to
complete an application for coverage in the Marketplace, you will be asked to provide this information. This
information is numbered to correspond to the Marketplace application.

3. Employer Name
4. Employer Identification Number (EIN)
5. Employer address
60 East 3
Avenue, Suite 270
6. Employer phone number
7. City
San Mateo
8. State
9. Zip Code
10. Who can we contact about employee health coverage at this job?
Reena Rai
11. Phone number (if different from above) 12. Email address
Here is some basic information about health coverage offered by this employer:
As your employer, we offer a health plan to:
All employees.
Some employees. Eligible employees are:
Regular employees working at least 30 hours a week.

With respect to dependents:
We do offer coverage. Eligible dependents are:
Spouse, domestic partner, and children up to age 26.

We do not offer coverage.
If checked, this coverage meets the minimum value standard, and the cost of this coverage to you is
intended to be affordable, based on employee wages.
** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount through
the Marketplace. The Marketplace will use your household income, along with other factors, to determine whether you
may be eligible for a premium discount. If, for example, your wages vary from week to week (perhaps you are an hourly
employee or you work on a commission basis), if you are newly employed mid-year, or if you have other income losses,
you may still qualify for a premium discount.

If you decide to shop for coverage in the Marketplace, will guide you through the process.
Here's the employer information you'll enter when you visit to find out if you can get a tax
credit to lower your monthly premiums.
The information below corresponds to the Marketplace Employer Coverage Tool. Completing this section is
optional for employers, but will help ensure employees understand their coverage choices.

13. Is the employee currently eligible for coverage offered by this employer, or will the employee be eligible
in the next 3 months?
Yes (Continue)
13a. If the employee is not eligible today, including as a result of a waiting or probationary period, when is
the employee eligible for coverage? (mm/dd/yyyy) (Continue)
No (STOP and return this form to employee)

14. Does the employer offer a health plan that meets the minimum value standard*?
Yes (Go to question 15)
No (STOP and return form to employee)

15. For the lowest-cost plan that meets the minimum value standard* offered only to the employee (don't
include family plans): If the employer has wellness programs, provide the premium that the employee
would pay if he/ she received the maximum discount for any tobacco cessation programs, and didn't receive
any other discounts based on wellness programs.
a. How much would the employee have to pay in premiums for this plan? $
b. How often?
Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly
If the plan year will end soon and you know that the health plans offered will change, go to question 16. If you
don't know, STOP and return form to employee.
16. What change will the employer make for the new plan year?
Employer won't offer health coverage
Employer will start offering health coverage to employees or change the premium for the lowest-cost plan
available only to the employee that meets the minimum value standard.* (Premium should reflect the
discount for wellness programs. See question 15.)
a. How much will the employee have to pay in premiums for that plan? $
b. How often?
Weekly Every 2 weeks Twice a month Monthly Quarterly Yearly
Date of change (mm/dd/yyyy):
*An employer-sponsored health plan meets the "minimum value standard" if the plan's share of the total allowed benefit costs covered by the plan is no less than 60 percent of such costs (Section
36B(c)(2)(C)(ii) of the Internal Revenue Code of 1986