General
Arizona Health Insurance
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General
| Bronze Essential Care 1 | Bronze Essental Care 2 H S A | Silver Balanced Care 4 | Silver Balanced Care 9 | Gold Secure Care 4 | |
| Deductible | $ 6,800.00 | $ 6,550.00 | $ 7,050.00 | $ 4,200.00 | $ 1,400.00 |
| Coinsurance | 0 | 0 | 0 | 20% | 10% |
| Out of Pocket Max | $ 6,800.00 | $ 6,800.00 | $ 7,050.00 | $ 7,150.00 | $ 5,705.00 |
| Doctor Visit PCP | Subject to Deductible | Subject to Deductible | $ 30.00 | $ 30.00 | $ 10.00 |
| Doctor Visit Specialist | Subject to Deductible | Subject to Deductible | $ 60.00 | $ 50.00 | $ 30.00 |
| Preventative Care | No Charge | No Charge | No Charge | No Charge | No Charge |
| Prescriptions | |||||
| Generic Drugs | $ 20.00 | Subject to Deductible | $ 15.00 | $ 20.00 | $ 15.00 |
| Brand Drugs | Subject to Deductible | Subject to Deductible | $ 50.00 | Deductible then $40 | $ 50.00 |
| Brand (Non-Preferred) | Subject to Deductible | Subject to Deductible | Subject to Deductible | Deductible then $70 | Deductible then $70 |
| Specialty | Subject to Deductible | Subject to Deductible | Subject to Deductible | Deductible then 50% | Deductible then 50% |
| Emergency Room | Subject to Deductible | Subject to Deductible | Subject to Deductible | $ 400.00 | Deductible then $150 |
| Hosptial In Patient | Subject to Deductible | Subject to Deductible | Subject to Deductible | Deductible then 20% | Deductible then $375/Day |
| X-Rays | Subject to Deductible | Subject to Deductible | Subject to Deductible | $ 50.00 | Deductible then $60 |
| CT Scans, Pet Scansm MRI | Subject to Deductible | Subject to Deductible | Subject to Deductible | $ 250.00 | Deductible then $250 |
| Lab Tests | Subject to Deductible | Subject to Deductible | Subject to Deductible | $ 20.00 | No Charge after deductible |
Special Enrollment Periods and Qualifying Life Events
Did you recently have a Qualifying Life Event such as a marriage, a loss of employer coverage or permanent move to a different zip code in Arizona?
You might qualify for a Special Enrollment Period. View some of the possible qualifications by following the link below. If you qualify, then contact an expert to learn how to get you and your family covered today.
What is an ACA-compliant Health Plan and do I need one?
As an Arizona employer, from 2015 onward, you have a responsibility according to the Affordable Care Act to provide affordable insurance to your full-time employees. Even if your Arizona employees choose to pursue their own health insurance outside of work, you are still required to offer a company plan. This "Employer Mandate" has set a new standard for businesses and puts hefty penalties on businesses that don't meet the minimum requirements.
According to the Affordable Care Act's "Employer Shared Responsibility Provision" an Employer Mandate was set out in the following criteria:
All businesses with 50 or more full-time equivalent employees (FTE) must provide health insurance to at least 95% of their full-time employees and dependents up to age 26, or pay a fee.
This mandate isn't to be taken lightly, especially considering that the fee is up to $2,000 per full-time employee who goes without coverage because of the company. This fee excludes the first 30 employees but adds up quickly considering it is a monthly fee per employee.
Here's a quick summary of the facts:
- The fee only applies to companies with 50+ full-time employees
- The fee is $2,000 per month per full-time employee (excluding the first 30)
- Companies with 100+ employees must provide coverage for at least 95% to avoid any fees
- If you do provide coverage it must offer minimum value and be affordable to avoid a fee
- Coverage must extend to employees dependents up to 26 years of age
For more stipulations and explanations of the criteria set out for employee coverage, visit the ObamaCare Facts website.
Is my plan compliant?
For your convenience, we have attached a checklist that outlines compliance regulations that you may need to abide by according to your business size and situation. This document is by no means all-encompassing or binding in any way. These are general guidelines intended to help you know the basics of an ERISA (Employee Retirement Income Security Act) compliant plan.
View the ERISA Compliance Checklist here.
Additional guidelines can be found through this Group Health Plan Notices worksheet.
Is my plan Grandfathered In?
Some Arizona health insurance plans can be "grandfathered" in. These plans must have existed prior to March 23, 2010, and also must still abide by some of the ACA's quality regulations.
"Grandmothered" plans are ones that exist after March 23, 2010, but still qualify for some exemptions from ACA regulations. While some of these plans do exist for the 2016-2017 year, most if not all will be terminated by September 2017.
More Details: What Is the Difference Between a Grandfathered and a Grandmothered Health Plan? (opens in new window)
Need additional answers?
Navigating the ACA and its many stipulations can feel like treading through a minefield. If you need additional assistance with choosing the right insurance plan for your Phoenix or Scottsdale employees then feel free to contact us. We are happy to help you with your Arizona group and Medicare insurance questions.
In a hurry, click here to contact us via email to schedule a time for your free consultation.
Related Topics
Group Health Insurance for Small Business
Health Insurance Tax Deductions for the Self Employed
Health Insurance and Your Taxes: 3 Things You Need to Know
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