AFFORABLE CARE ACT (OBAMACARE)
The Affordable Care Act (ACA) Large Employer Mandate requires employers to offer full time employees a compliant
health care plan effective January 1, 2015. LONE STAR Staffing is offering three plans for coverage to eligible full time
employees. The plans are: the ACA-Compliant Minimum Value Plan (MVP), the ACA-Compliant Minimum Essential
Coverage (MEC) Plan, and non-ACA Compliant Limited Medical Plan. Both the MVP and MEC plans are compliant with
the ACA Individual Mandate and the Employer Mandate. The Limited Medical Plan is not compliant with the ACA
Employer and Individual Mandates.
We are offering you a health plan option called MVP. This plan does not provide hospitalization. Federal Law requires a
specific disclosure to the effect that this offer of coverage under MVP does not preclude you from obtaining a premium
tax credit, if otherwise eligible. Please consider this a correction per federal requirements of any prior disclosures that
stated or implied that the offer of the MVP would preclude an otherwise tax-credit- eligible employee from obtaining a
premium tax credit.
MEDICAL INSURANCE PLANS OFFERED IN 2015
1) MVP
Monthly Premium Cost (before Employer Contribution, if applicable):
Employee-Only
$218.13
Employee + Child(ren) $348.77
Under the MVP, the employee contributes up to 9.5% of their income toward the health care plan premium for
Employee-only Plans. LONE STAR Staffing will pay the remainder toward the premium of Employee-Only plans, if EE
contribution of 9.5% income does not satisfy monthly premium. Employees who elect to participate in an Employee +
Child(ren) plan, are required to pay the full amount of the premium difference between the Employee-Only and
Employee + Child(ren) plans.
Listed below are examples of what an employee’s contribution toward the MVP would be based upon the employee’s
hourly pay rate. These examples assume the employee works a 40-hour workweek each week.
In the first example highlighted below, an employee who earns $13/ hour would pay $214.07/ month (approximately
$49.40/ week) for Employee-Only coverage on the MVP plan. LONE STAR Staffing would pay the remaining premium of
$4.06/ month.
In the second example highlighted below, an employee who earns $13/ hour would pay $344.71/ month (approximately
$79.55/ week) for Employee + Child(ren) coverage on the MVP plan. LONE STAR Staffing would pay the remaining
premium of $4.06/ month.
MVP Employee-Only coverage at $218.13/ month
Hourly Pay Rate
$9.00
$10.00
$11.00
$13.00
$15.00
$16.00
Monthly Gross at
40 hours/ week
$1,560.00
$1,733.33
$1,906.67
$2,253.33
$2,600.00
$2,773.33
9.5% of
Income
$148.20
$164.67
$181.13
$214.07
$247.00
$263.47
Employee monthly
contribution
$148.20
$164.67
$181.13
$214.07
$218.13
$218.13
Employee Weekly Premium
Deduction Amount
$34.20
$38.00
$41.80
$49.40
$50.34
$50.34
Employer monthly
contribution
$69.93
$53.46
$37.00
$4.06
$0.00
$0.00
MVP Employee+ Child(ren) coverage at $348.77/ month
Hourly Pay
Rate
Monthly Gross at
40 hours/ week
$9.00
$10.00
$11.00
$13.00
$15.00
$16.00
$1,560.00
$1,733.33
$1,906.67
$2,253.33
$2,600.00
$2,773.33
9.5% of
Income
$148.20
$164.67
$181.13
$214.07
$247.00
$263.47
Employee monthly contribution (Employee
pays difference for child coverage at 100%)
Employee Weekly Premium
Deduction Amount
Employer monthly
contribution
$278.84
$295.31
$311.77
$344.71
$348.77
$348.77
$64.35
$68.15
$71.95
$79.55
$80.49
$80.49
$69.93
$53.46
$37.00
$4.06
$0.00
$0.00
2) MEC
Monthly Premium Cost:
Employee-Only
$70.58
Employee + Child(ren) $202.89
Under the MEC Plan, the employee is responsible for 100% of the health care plan premium. Regardless of the
employee’s pay rate or number of hours worked, an employee who elects to participate in the MEC Employee-Only plan
would pay $70.58/ month (approximately $16.29/ week). An employee who elects to participate in the MEC Employee +
Child(ren) plan would pay $202.89/ month (approximately $46.82/ week). The services that are covered under the MEC
Plan do not have a Co-Pay.
The MEC Health Care plan covers the absolute minimum requirements under the ACA/ Obamacare. MEC does not
include coverage for Doctor visits or prescriptions. For example, if an employee covered under MEC were to go to their
Primary Care Physician to be treated for the flu, the employee would have to pay the full cost of the doctor visit and the
full cost of any prescriptions prescribed as those are not services/ benefits covered under the MEC Plan.
3) LIMITED MEDICAL PLAN
The Limited Medical Plan is the same benefits program that LONE STAR Staffing has offered through Essential Staff Care
in 2014. This program is NOT COMPLIANT under the ACA Employer or Individual Mandates. Employees who enroll for
coverage under this plan (with no coverage under any other compliant plan) may be subject to penalties when filing
Income Tax Returns at the end of the year for not participating in an ACA-Compliant Plan.
Benefits such as Dental, Vision, Short Term Disability and/ or Term Life Insurance cannot be purchased without also
enrolling in the Limited Medical Plan. For example, an employee who enrolled for Employee-Only MEC coverage but
also wanted Dental Insurance would also have to enroll in the Limited Medical Plan in order to sign up for the Dental. In
that scenario, the employee would be enrolled in a complaint plan (MEC) so s/he would not be subject to penalties at
the end of the year and would be able to enroll in Dental coverage because s/he would also be enrolled in the Limited
Medical Plan. In that scenario, the employee’s approximate monthly cost for all 3 benefits would be $201.05 ($70.58 for
Employee-Only MEC Plan, $107.81 Limited Medical Plan Employee-Only, and $22.66 Dental benefits Employee-Only).
The Limited Medical Plan is the only Medical Insurance Plan offered by Full Steam Staffing that includes hospital services
in the cost of the monthly premium.
The Limited Medical Plan is the only medical insurance plan offered by Full Steam Staffing that allows an employee to
add his/ her Spouse on the insurance. This is because the Limited Medical Plan is not an ACA-Compliant Plan and is paid
at 100% by the employee.
Pricing for the Plan is listed below.
EMPLOYEE-ONLY
WEEKLY RATE
APPROXIMATE MONTHLY RATE
MEDICAL
$24.88
$107.81
DENTAL
$5.23
$22.66
VISION
$2.35
$10.18
TERM LIFE INSURANCE
$0.60
$2.60
SHORT-TERM DISABILITY
$4.20
$18.20
WEEKLY RATE
APPROXIMATE MONTHLY RATE
MEDICAL
$50.49
$218.79
DENTAL
$10.46
$45.33
VISION
$4.00
$17.33
TERM LIFE INSURANCE
$0.90
$3.90
EMPLOYEE + 1
*SHORT-TERM DISABILITY
N/A
N/A
EMPLOYEE + FAMILY
WEEKLY RATE
APPROXIMATE MONTHLY RATE
MEDICAL
$67.42
$292.15
DENTAL
$17.26
$74.79
VISION
$5.64
$24.44
TERM LIFE INSURANCE
$1.80
$7.80
*SHORT-TERM DISABILITY
N/A
*ONLY AVAILABLE AS EMPLOYEE- ONLY
N/A
*ONLY AVAILABLE AS EMPLOYEE- ONLY
**OPTIONAL HOSPITAL INDEMNITY COVERAGE
The MVP and MEC Plans do not offer coverage for hospital services. Optional Hospital Indemnity Coverage can be
added to the MVP Plan at an additional cost.
The Hospital Indemnity Coverage cannot be purchased as a standalone product. It can only be added to the MVP Plan.
It cannot be added to the MEC Plan.
Monthly Rates
Medical
Employee
Employee + 1
Employee + Family
$24.60
$46.49
$63.43
FREQUENTLY ASKED QUESTIONS
1.
Why did my employer choose these plans?
The MVP and MEC plans were selected because they are the most affordable options for employees. The MVP and MEC
plans have no deductibles. This means there is no minimum dollar amount that must first be paid by the employee
before the insurance begins to contribute. For example, plans on State Healthcare Exchanges and with other National
Carriers (like Aetna or Blue Shield) have deductibles that average approximately $6,000. Those plans with deductibles
require the employee to pay 100% of the cost for all services (labs, imaging, etc.) up to the first $6,000 in services before
the insurance will contribute toward the cost of services. This requires the employee to essentially pay for their first
$6,000 in medical benefits utilized regardless of their income level or number of hours worked.
The MVP and MEC plans cover at 100% In-Network Breast Cancer Mammography screening, Cholesterol and Diabetes
screenings, Diet Counseling and many other vital services. The MVP and MEC plans are PPO, not HMO.
2.
What if I don’t want to participate in the health insurance plan?
Employees who choose not to participate in the health insurance plans need to complete the application and select that
they are “declining” coverage. Because the ACA requires individuals to carry ACA-compliant health care insurance,
employees who do not participate in the health insurance plans offered by LONE STAR Staffing may be subject to
penalties at the end of the year when filing taxes. 2014 was the first year that the Individual Mandate of the ACA went
into effect so penalties for individuals not having coverage under a compliant plan will be enforced when 2014 tax
returns are filed.
The penalties are:



2014 - $95 per adult, $47.50 per child up to $285 per family or 1% of adjusted income, whichever is greater.
2015- $325 per adult, $162.50 per child up to $975 per family or 2% of adjusted income, whichever is greater.
2016- $695 per adult, $347.50 per child up to $2,085 per family or 2.5% of adjusted income, whichever is
greater.
3.
If I am on my Spouse’s health insurance, will I still be subject to penalties at the end of the year?
It depends. If your Spouse’s health insurance plan is ACA compliant, and you are listed on the plan, you may not be
subject to penalties for non-compliance under the Individual Mandate. You still need to complete the Declination Form
during the LONE STAR Staffing Health Insurance Open Enrollment.
4.
Why is LONE STAR Staffing offering a plan that includes coverage for my child(ren) but not for my Spouse?
The ACA requires employers to offer plans for employees and their children. There is no requirement to offer plans with
Spouse Coverage. Because LONE STAR Staffing does not offer plans with Spouse Coverage, Spouses may be able to
qualify for a subsidy through their State Health Exchange. Had Spouse Coverage been included on the LONE STAR
Staffing health insurance plans, the employee would be required to pay the full cost of the Spouse Coverage. LONE
STAR Staffing does not offer Spouse Coverage in order to allow employees’ Spouses the opportunity to purchase less
expensive coverage through their State Health Exchange and possibly qualify for a subsidy.
5.
Are the deductions for health insurance taken out before or after taxes?
Health insurance premiums are deducted after taxes (Post-Tax). This allows employees to drop coverage at any time
without requiring a “qualifying event” (loss of job, divorce, etc.) in order to make changes to coverage.
6.
What would my annual cost for coverage look like in 2015 compared to declining coverage and just paying the
penalty?
EMPLOYEE EARNS $10/ HOUR
AND WORKS 40 HOURS/ WEEK
EMPLOYEE EARNS $13/ HOUR
AND WORKS 40 HOURS/ WEEK
EMPLOYEE EARNS $21.64/
HOUR AND WORKS 40 HOURS/
WEEK
EMPLOYEE
ONLY
FAMILY OF 4 ON
EMPLOYEE +
CHILD(REN PLAN)
EMPLOYEE
ONLY
FAMILY OF 4 ON
EMPLOYEE +
CHILD(REN PLAN)
EMPLOYEE
ONLY
FAMILY OF 4 ON
EMPLOYEE +
CHILD(REN PLAN)
MEC
$727.80
$2,043.00
$727.80
$2,043.00
$727.80
$2,043.00
MVP
$1,976.04
$3,543.72
$2,568.84
$4,136.52
$2,617.56
$4,185.24
LIMITED MEDICAL PLAN
+ PENALTY FOR NONCOMPLIANCE (UNDER
OPTION 1 LEVEL OF
MED. COVERAGE)
$1,618.76
$4,480.84
$1,834.56
$4,480.84
$2,193.98
$4,480.84
$416.00
$975.00
$540.80
$975.00
$900.22
$975.00
PLAN YEAR 2015
PENALTY (NONCOMPLIANCE)
7.
If I am currently enrolled in Medicare/ Medi-Cal, will I be penalized if I do not sign up for an ACA-Compliant
Health Care plan with my employer?
If you are qualified to participate in Medicare (or Medi-Cal in California) for 2015, you do not need to enroll in ACAcompatible medical insurance through your employer. You will need to decline coverage during the LONE STAR Staffing
November 1-15th Open Enrollment. You will not be penalized at the end of the year when filing your 2015 taxes because
Medicare is considered a compliant plan under the ACA.
8.
Under the MVP Plan, what payments contribute toward my annual Out-of-Pocket maximum?
All copays for covered services that are paid by the employee are applied to the annual Out-of-Pocket maximum.
Payment for any covered prescription copays are also applied to the annual Out-of-Pocket maximum. However,
payment for any services out of network or any services not covered under the MVP are not applied toward the annual
Out-of-Pocket maximum.
9.
How can I find out if my Primary Care Physician is In-Network for these health care plans?
The Provider Network for the MVP Plan is called Multi Plan. For a list of providers, go to www.multiplan.com . Go to
Provider Lookup Online. Put in zip code or state. Plan participants can also call 888-342-7427.
The Provider Network for MEC and the Limited Medical Plan are First Health. For a list of providers, go to
myfirsthealth.com . Go to Provider Lookup Online. Put in zip code or state.
10.
Up until what age can I keep my child(ren) on my insurance?
An employee can include their children (up to age 26) on their plan. Children up to age 26 can stay on their parent's
employer plan even if they have another offer of coverage through an employer. Both married and unmarried children
qualify for this coverage.
11.
Will I be charged an additional fee for having more than one child on my health insurance?
When electing the Limited Medical plan only will there be a difference in the rate for having EE+1 and for the Family
Tier.
12.
How do I know if am considered a seasonal employee who is not eligible for medical insurance?
A seasonal employee means an employee in a position where the customary annual employment is six months
or less. By the nature of the position, a seasonal employee typically works for a period of six months or less, and that
period begins in approximately the same part of each calendar year, such as summer or winter. In certain unusual
instances, the employee can still be considered a seasonal employee even if the seasonal employment is extended in a
particular year beyond its customary duration. Separate jobs staffed during the year can be seasonal, and you will
remain a seasonal employee if you move between seasonal positions. Your hours may fluctuate from time to time
depending on business needs and how your hours are scheduled. Simply because your hours may increase from timeto-time does not mean you cease to be a seasonal employee; it does not mean you are full-time for benefits or other
purposes. Nor does it mean you will be retained past the season for your work. Variation in hours is part of your job
position and may be such that you work well over 30 hours per week for an extended time. Again, that possible hours
variation is a normal part of your job which we anticipated when we set our seasonal status determination for this
position. All changes to full-time positions will be documented with a formal notice to you (similar to this Notice); in the
absence of that designation by us, a change has not occurred.