Is premium assistance for spouse and child coverage available?

Q: I have health insurance through my employer, but coverage for my spouse and child are too expensive. Would I be eligible for premium assistance for a plan for my child?

A: Whether you or your family are eligible for premium assistance depends on whether you  have an offer of coverage that includes your spouse and dependents and (1) is affordable and (2) meets the standard for minimum coverage. The affordability of  employer-provided coverage is evaluated on these two criteria:

1. The total annual premium you pay for self-only coverage is 9.5 percent or less of your annual household income.

2. Your employer-provided plan covers at least 60 percent of health care costs for an average population. Your employer or your health insurance plan should notify you as to how much the plan covers.

If those two criteria are met, your employer’s plan is considered “affordable” under the law, and your family members would not qualify for premium assistance through Covered California.

If your employer-provided coverage does not include dependent coverage, or if your employer does not offer dependent coverage, your spouse and child may qualify for subsidies through Covered California since they would not be offered coverage. In that case, their eligibility would be based on the family’s income.

Did the health care reform legislation eliminate COBRA?

No. The new health care reform legislation, The Patient Protection and Affordable Care Act (PPACA) as amended by the Health Care and Education Reconciliation Act, did not eliminate COBRA or change the COBRA rules.

See An Employee’s Guide to Health Benefits Under COBRA, The Consolidated Omnibus Budget Reconciliation Act for more information about COBRA


Do You Qualify for a Health Insurance Coverage Exemption?

IRS Health Care Tax Tip 2014-13, Apr. 17, 2014

Find out if You Qualify for a Health Insurance Coverage Exemption

The Affordable Care Act calls for individuals to have qualifying health insurance coverage for each month of the year, have an exemption, or make a shared responsibility payment when filing his or her federal income tax return.

You may be exempt from the requirement to maintain qualifying health insurance coverage, called minimum essential coverage, and may not have to make a shared responsibility payment when you file your next federal income tax return. .

You may be exempt if you:
•Have no affordable coverage options because the minimum amount you must pay for the annual premiums is more than eight percent of your household income,
•Have a gap in coverage for less than three consecutive months, or
•Qualify for an exemption for one of several other reasons, including having a hardship that prevents you from obtaining coverage or belonging to a group explicitly exempt from the requirement.

The IRS website,, has a comprehensive list of the coverage exemptions.

How you get an exemption depends upon the type of exemption. You can obtain some exemptions only from the Marketplace in the area where you live, others only from the IRS, and yet others from either the Marketplace or the IRS.

Additional information about exemptions is available on the Individual Shared Responsibility Provision web page on The page includes a link to a chart that shows the types of exemptions available and whether they must be granted by the Marketplace, claimed on an income tax return filed with the IRS, or by either the Marketplace or the IRS. For additional information about how to get exemptions that may be granted by the Marketplace, visit

More Information

Find out more about the tax-related provisions of the health care law at

Find out more about the health care law at

Subscribe to IRS Tax Tips to get easy-to-read tips via e-mail from the IRS.


Are dental and vision governed by PPACA?


Q: Do you know if dental and vision and our STD/life policies are governed by PPACA? I’m trying to figure out if I need to change our eligibility on those to become 60 days, like our health. Do we need to make those changes with our plans or will they be an automatic change?

A: These stand-alone programs are excepted benefits under HIPAA so you shouldn’t have to revise the waiting period. Here is a reference source: proposed-guidance-issued-on-90-day-waitingperiod- limit/.



So. Cal. earthquake reminds Californians to prepare for the Big One

5.1 Southern California earthquake reminds Californians to be prepared for the Big One


Earthquake insurance can help residents repair, rebuild, or replace


LOS ANGELES, Calif. – The 5.1 La Habra earthquake was significantly more powerful than the 4.4 magnitude trembler on St. Patrick’s Day in Los Angeles. These events serve as a reminder of the importance of purchasing earthquake insurance, having an emergency plan with adequate supplies for your family, and to retrofit older homes that may not be tied down to the foundation.


“The 5.1 earthquake in La Habra is a reminder to Californians of the need for preparation before catastrophic events strike,” said Commissioner Dave Jones. “I extend my sincere concern and sympathy for those who incurred a personal injury or are dealing with damage to their homes and personal property as a result of this earthquake. The topography of California is dramatic and beautiful, but this should be a constant reminder that earthquakes can strike at any time, along any fault line, and typically when we least expect it. This reality underscores the importance for Californians to take some very simple, but very effective precautionary steps before it is too late.”


To find important information about preparing for a disaster, please visit the web site of the California Department of Insurance or call our toll-free consumer hotline at 1-800-927-HELP.


Earthquake preparedness includes, but is not limited to, the following:

″Review your insurance policies at least once each year with your agent or broker to ensure that they provide adequate coverage.

″Consider purchasing an earthquake policy if your home is in an earthquake-prone area, and is more susceptible to earthquake damage such as older or multi-story homes, or homes on soft soil or a slope.

″Take measures to retrofit your home to increase your safety during an earthquake.

″Bolting your home’s wood frame to the foundation can prevent damage resulting from the structure sliding off its foundation. And for houses on raised foundations, the bracing of “cripple walls” can also reduce damage from earthquakes.

″Brace your water heater to minimize the risks of fire and water damage caused by water heaters that topple during earthquakes.

″Mobile home owners should use earthquake-bracing systems to reduce the chance of damage from homes slipping off support jacks.

″Fasten cupboard doors with child-proof latches to prevent them from opening and spilling their contents.

″Fasten bookcases, mirrors, televisions and other tall or heavy objects to wall studs.

″Gas appliances should have flexible attachments, and family members should be familiar with gas shut-off techniques.


For more earthquake preparedness tips, go to and


Most homeowners’ and renters’ policies do not cover damage from earthquakes. Under California law all insurers selling residential property insurance are required to also offer earthquake coverage subject to minimum dwelling, personal property and additional living expense limits. Dwellings must be covered but other structures such as outbuildings, swimming pools, and masonry fences may be excluded.


Source: California Department of Insurance,

We have several employees who waive our group health plan coverage. Will waivers be permitted under the new law?

Yes. However, employers with more than 200 employees with health plans must auto-enroll new full-time employees. Adequate notice must be provided to allow these employees time to opt out. The Department of Labor has indicated that guidance on this will not be ready until after 2014.

We offer health insurance only to our executives. Will we be able to continue this plan?

Under the PPACA, employers may still offer health insurance only to their executives in grandfathered plans. For new plans, a new nondiscrimination rule applies.


We currently have a 180-day waiting period before coverage becomes effective. When will that have to be changed?

Under the Patient Protection and Affordable Care Act (PPACA, a.k.a. Obamacare), beginning in 2014 employers providing group medical coverage must provide it within 90 days of hire.


What types of coverage will allow employees to satisfy the “minimum essential coverage” under the PPACA?

Individuals are required to meet the “minimum essential coverage.”  This includes having coverage under any of the following:

  • Government sponsored programs including Medicare, Medicaid, CHIP, TRICARE for Life, and veterans benefits.
  • Eligible employer sponsored plans.
  • Health plans offered in the individual market within a State.
  • Grandfathered plans.
  • Certain other health benefits risk pools.


Health benefits coverages to report on employee W-2 forms.

Employee benefits coverages that must be reported on the W-2 include all health coverages such as:

  • Medical, Dental, and Vision coverages
  • Prescription drug coverage
  • Executive physical benefits
  • On-site clinics
  • EAPs that provide medical care
  • Wellness programs that provide medical care