COA Fact Sheets

What doctors of optometry need to know about the ACA

This fact sheet highlights what the Patient Protection and Affordable Care Act (ACA) requires of doctors of optometry as individuals and small employers, i.e., those with 50 or fewer employees relative to health care insurance.

Who is mandated to have health insurance?

Beginning January 1, 2014, virtually all individuals are required to have health insurance that meets minimum essential coverage (see “Mandated coverage,” below).

There is no requirement for employers to provide health care coverage to their employees. However, certain financial incentives exist for some employers who choose to provide health insurance through California’s Exchange, called “Covered California” (see “Covered California,” below).

Beginning January 1, 2015, employers of more than 50 full-time equivalent employees (FTEs) that do not offer affordable health insurance that provides minimum value to their FTEs (and dependents if covered) may be required to pay an assessment, called an “Employer Shared Responsibility Payment,” if at least one of their full-time employees is certified to receive a premium tax credit through the Covered California insurance marketplace. A full-time employee is defined as one who is employed an average of at least 30 hours per week (see “Employers with 50 or More Employees”).

If your health insurance coverage is currently provided by your employer, meets federal minimal coverage levels and is affordable, you do not need to change anything. If you are covered by a plan that existed on March 23, 2010, your plan may be "grandfathered" (see “Grandfathered plans,” below); however, you may not get some rights and protections that other plans offer.

Mandated coverage

All health care policies offered through Covered California and those policies in the private marketplace not grandfathered (See “Grandfathered plans,” below) must offer the below 10 essential health benefits:

1. Ambulatory patient services2. Emergency services3. Hospitalization4. Maternity and newborn care5. Mental health and substance use disorder services, including behavioral health

treatment6. Prescription drugs7. Rehabilitative and habilitative services and devices8. Laboratory services9. Preventive and wellness services and chronic disease management10. Pediatric services, including oral and vision care.

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COA Fact Sheets

Pediatric vision benefits definedMost health plans in the exchange will contract with a vision plan to provide the pediatric vision essential benefit required under the law. The benefit includes an eye exam and glasses for children up to 19 years of age. Low vision will also be covered.

Will adult eye exams be covered in Covered California plans?

No. Based on federal regulations released in February that prohibit adult eye exams to be covered as essential benefits, the state Department of Managed Care and Covered California have determined that qualified health plans (QHPs) in the exchange can’t cover adult eye exams at all. Additionally, supplemental adult vision coverage is currently not available under Covered California. Covered California is having problems figuring out how to provide that coverage within federal guidelines. COA continues to advocate that Covered California should ensure that adult coverage is made available in a timely way.

In addition to the mandated essential health benefits, above, unless indicated otherwise, all insurance policies must feature the following:

Guarantee issue: Covered California, non-grandfathered, employer-sponsored grandfathered, and government plans must sell coverage to everyone interested, regardless of pre-existing conditions, and cannot charge more based on health status or gender (see “Grandfathered plans,” below).

No lifetime and annual limits: All insurance plans are prohibited from imposing financial lifetime limits on coverage of the 10 essential health benefits, and Covered California, non-grandfathered, employer-sponsored grandfathered and government plans may not place annual limits on these benefits (see “Grandfathered plans,” below).

Coverage cancellation prohibitions: No coverage may be cancelled by any plan because of an honest mistake, left out information that has little bearing on one’s health or the policyholder gets sick. However, a carrier may cancel coverage if a person’s insurance application contains false or incomplete information on purpose and if premiums are not paid on time.

Free preventive care: Covered California, non-grandfathered and government plans must cover certain adult, women and children preventive services delivered by a network provider without charging a copayment or coinsurance and without having met the yearly deductible (see “Resources,” below, for links to those preventive services). Grandfathered plans do not have to meet this requirement (see “Grandfathered plans,” below).

Out-of-pocket expense limits: Limits annual co-pays, co-insurance, deductibles, etc., to $6,350 per individual and $12,700 per family.

Children’s coverage: All plans that cover children must allow them to be added or kept on the health insurance policy until they turn 26 years old, even if they are married, not living with their parents, attending school, not financially dependent on their parents, and eligible to enroll in their (the child’s) employer’s plan.

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COA Fact Sheets Doctor choice and emergency room access: Covered California, non-grandfathered

and government plans must provide the opportunity to choose a doctor from your health plan’s provider network, not require you to obtain a primary care doctor referral to see an OB-GYN provider, and allow you to use an out-of-network emergency room without penalty or prior approval (see “Grandfathered plans,” below).

Premiums: Health insurance premiums can only vary based upon location of insured, family composition and age (three levels).

Individual mandate

With certain very limited exceptions, beginning in 2014, individuals must have and maintain health insurance that provides for the minimum essential coverage (see “Mandated coverage,” above) obtained through:

The private insurance market (Note: COA members are encouraged to contact COA-sponsored insurance broker Marsh for more information on their health care options. Marsh insurance experts are certified by Covered California to sell individual and small group insurance in the Covered California marketplace. In addition, they can discuss alternative networks in the private marketplace that might have broader options and coverages to meet member’s needs. Contact Marsh at 800-775-2020.)

An employer plan that meets affordability and minimum value requirements (see Covered California,” below)

A state or federal health insurance Exchange; the Exchange in California is “Covered California” (see “Covered California,” below)

A government program, e.g., Medicare, Medi-Cal, CHIP, TRICARE, etc. Grandfathered plans Those health insurance policies that were in existence on March

23, 2010, and have stayed basically the same are considered “grandfathered” even if a person joined the plan after that date. Grandfathered plans do not have to provide free preventive care or protect the right to choose a doctor or access emergency care outside the plan network. Additionally, grandfathered individual health insurance plans (the kind you buy yourself, not the kind you get from an employer) can place annual financial limits on covered benefits not part of the essential health benefits and do not have to cover pre-existing conditions. Plans lose their grandfathered status when changes are made to eliminate a diagnosis or condition treatment benefit, increase cost-sharing for the policyholder, increase the deductible or out-of-pocket maximum more than 15 percent plus inflation, increase a co-pay by more than $5 plus inflation, decrease the employer contribution by more than 5 percent, impose dollar value limits below specified amounts, etc.

Fines (taxes)

Persons who do not obtain health insurance are subject to the below fines (taxes):

In 2014, the fine is 1 percent of annual income or $95 per person for the year, whichever is higher. The fine increases every year. In 2016 it is 2.5% of income or $695 per person, whichever is higher.

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COA Fact Sheets In 2014, the fine for uninsured children is $47.50 per child up to $285.

It's important to remember that someone who pays the fine won't get any health insurance coverage. They still will be responsible for 100 percent of the cost of their medical care.

Covered California

Beginning on October 1, 2103, individuals and small businesses have been able to enroll in the newly created state health insurance exchange, Covered California. Coverage for services will begin on January 1, 2014. Covered California is an online marketplace where California residents and small businesses will be able to shop online, over the phone or in person to find health care insurance options and compare different health insurance plans. Individuals will learn if they qualify for federal financial assistance (subsidies) or are eligible for public health programs like Medi-Cal. Employers with fewer than 25 full-time workers will be able to find out if they qualify for a small business tax credit that can help cover the cost of providing employee health care. It is estimated that 2-5 million Californians will be newly enrolled in a health plan through Covered California by 2017.

All plans available through Covered California meet state and federal requirements for affordability and minimum essential coverage. It is the only place in which qualified individuals and businesses can obtain federally authorized financial premium assistance, cost-sharing assistance and tax credits to reduce their health care costs.

Plan types

Individuals and small businesses have the choice of several health plan types within Covered California:

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COA Fact Sheets Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations

(EPOs): Some of these plans may limit coverage to providers inside their networks. If a policyholder uses a doctor or facility that isn't in the HMO’s network, he or she may have to pay the full cost of the services provided. HMO members usually have a primary care doctor and must get referrals to see specialists. This is generally not true for EPOs.

Preferred Provider Organizations (PPOs) and Point-of-Service plans (POS): These insurance plans give a choice of getting care within or outside of a provider network. With PPO or POS plans, a policyholder may use out-of-network providers and facilities, but will have to pay more than using in-network ones.

High Deductible Health Plan (HDHP): These plans typically feature lower premiums and higher deductibles than traditional insurance plans. As of 2013, HDHPs are plans with a minimum deductible of $1,250 per year for individual coverage and $2,500 for family coverage. With an HDHP, the policyholder can use a health savings account or a health reimbursement arrangement to pay for qualified out-of-pocket medical costs. This can lower the amount of federal tax owed.

Catastrophic Health Insurance Plan: Available only to people under 30 and to some low-income people who are exempt from paying the fee because other insurance is considered unaffordable or because they have received "hardship exemptions," these plans cover essential health benefits at a generally lower premium than traditional coverage but have a very high deductible. Generally, this means they provide "safety net" coverage in case of an accident or serious illness. Catastrophic plans usually do not provide coverage for services like prescription drugs or shots. Covered California-offered catastrophic plans cover three annual primary care visits and preventive services at no cost. After the deductible is met, they cover the mandated essential health benefits. People with catastrophic plans are not eligible for lower costs on their monthly premiums or out-of-pocket costs.

Medi-Cal: Working in partnership with the state Department of Health Care Services, eligible individuals can obtain Medi-Cal coverage through Covered California.

Plan categories

The plans in Covered California are offered in four categories. Called "The Medal Plans," these plans pay a designated percentage of health care costs, including deductibles, co-pays, co-insurance, etc., and premiums will differ based on the plan selection. Those plans are:

1. Platinum: Plan pays 90 percent of the costs, policyholder pays 10 percent2. Gold: Plan pays 80 percent of the costs, policyholder pays 20 percent3. Silver: Plan pays 70 percent of the costs, policyholder pays 30 percent4. Bronze: Plan pays 60 percent of the costs, policyholder pays 40 percent

Coverage for individuals

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COA Fact SheetsIndividuals can apply for coverage anytime during the initial open enrollment period beginning October 1, 2013, through the end of March 31, 2014. After open enrollment ends on March 31, 2014, health coverage through Covered California is not available until the next annual enrollment period (October 2014-December 2014) unless there is a qualifying life event , for example, move to a new state, certain changes in income, or change in family size from marriage, divorce or a baby.

Covered California has established 11 health plans in 19 pricing regions throughout the state from which individuals can purchase health care insurance. Those plans are:

1. Anthem Blue Cross of California2. Blue Shield of California3. Chinese Community Health Plan4. Contra Costa Health Plan5. Health Net6. Kaiser Permanente7. L.A. Care Health Plan8. Molina Healthcare9. Sharp Health Plan10. Valley Health Plan11. Western Health Advantage.

Each region has an average of four insurers. The pricing regions consist of individual counties or a regional group of counties. To find what plans are in your county, click here and scroll down to page 11.

How can doctors of optometry participate as a provider in Covered California?Doctors of optometry will not necessarily “sign up” to participate in the exchange. In fact, Covered California is not responsible for contracting with any type of providers. Instead, providers will be able to participate in the exchange through contractual relationships with the QHPs that have been selected. Doctors of optometry should contact all of the plans chosen to participate in their county to determine how they will cover the pediatric vision essential benefit. The plan should be able to inform you whether they are contracting directly with doctors of optometry, and how you can sign up to become a provider on their panel, or whether they have contracted with a vision plan for the coverage. If they have contracted with a vision plan, you should then contact that vision plan to become a network provider if you currently are not a participating provider in the plan. Once you are contracted with the QHP or the vision plan, you will then be able to see individuals in the exchange receiving coverage by those plans in your region.

Premium and cost-sharing assistance

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COA Fact SheetsIndividuals who purchase insurance through Covered California and are not currently receiving affordable health insurance through an employer or public program that meets minimum coverage requirements, are eligible for subsidies for health insurance premiums and cost-sharing if their income meets certain eligibility requirements. Those subsidies include:

Premium assistance : Premium assistance is available from the federal government to help lower the cost of health coverage for individuals and families who make less than 400 percent of the federal poverty level (FPL) – up to $45,960 for individuals and $94,200 for a family of four. If purchasing coverage through Covered California, premium assistance can be immediately applied which reduces the amount paid by the policyholder each month (see Covered California “Shop and Compare Tool”).

Cost-sharing subsidies : These subsidies, available with Silver plans only (see “Plan categories,” above), reduce the out-of-pocket amount of health care expenses an individual or family has to pay. These expenses might include copayments for health care services or other costs you pay when you get services. Those with incomes that are less than about $28,725 for a single person and less than about $58,875 for a family of four in 2013 may be eligible for those subsidies.

Medi-Cal assistance: Starting in 2014, Medi-Cal will expand to cover people under age 65, including people with disabilities, with income of less than $15,856 for an individual and $32,499 for a family of four. The coverage is free for those who qualify.

An online calculator at the Covered California website helps estimate how much it will cost to purchase health insurance in 2014 and the amount of financial assistance available to qualified individuals. In addition, by completing a Covered California application, an individual will learn whether he or she qualifies for free coverage through Medi-Cal.

Marsh or Covered California coverage application process

The purchasing process is easy and you can choose the method that works best for you:

Marsh:

Call Marsh client services to explore all your options, both within Covered California and in the private marketplace, at 800-775-2020

Online

Covered California

Online .

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COA Fact Sheets Call the Covered California Customer Call Center at (888) 975-1142. Covered California Certified Insurance Agents and Certified Enrollment Counselors are

available in your community to provide expert advice and support. Find one by calling (888) 975-1142, or online.

Send application forms to:Covered California Service CenterP.O. Box 3530

Rancho Cordova, CA 95670-5667

Small Business Coverage – 50 Employees or Less

Small businesses with 50 or fewer employees can also obtain health insurance for their employees through Covered California’s Small Business Health Options Program (SHOP). (Note: If self-employed with no employees, you can get coverage through the individual market, but not through SHOP.) SHOP has six health plans similar to those usually available only to larger employers in 19 pricing regions throughout the state from which businesses can purchase health care insurance that feature the same plan types and categories as individual plans. Those carriers are:

1. Blue Shield of California2. Chinese Community Health Plan3. Health Net4. Kaiser Permanente5. Sharp Health Plan6. Western Health Advantage

No region of the state has fewer than three health insurance plans available, and most will have four or more, with dozens of products to choose from. The plans, a mix of health maintenance organizations (HMOs) and preferred provider organizations (PPOs), are be sold through licensed agents who are trained and certified by Covered California, including COA-sponsored broker Marsh. All plans offered through SHOP must be offered outside Covered California by the specified carriers at the same cost and network. However, the premium assistance and employer tax credits are available only on plans purchased through SHOP. To find what plans are in your county, click here and scroll down to page 10.

Whether purchased through Covered California or on the private insurance market, small group plans must feature the following:

Participation: Must offer coverage to all full-time employees – generally those working 30 or more hours per week on average.

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COA Fact Sheets Plan enrollment: Employers can enroll in SHOP or the private marketplace throughout

the year. Premium assistance and cost-sharing: Employees are not eligible for premium

assistance and cost-sharing subsidies if the employer offers a health insurance plan that pays at least 60 percent of the essential coverage and the employee contribution to the plan for employee-only coverage is no greater than 9.5 percent of the employee’s household income.

Deductibles: Limit deductibles to no more than $2,000 per individual and $4,000 per family in a policy year. Note: Carriers can exceed these limits if their plans cannot reasonably reach the coverage actuarial value the law sets.

Waiting periods: Coverage waiting periods for new FTEs cannot exceed 60 days.

Employer SHOP tax credits available only through Covered California

Available only to small employers who purchase health care insurance through SHOP, ACA extends the small business Health Care Tax Credit to provide employers with a tax credit if the business 1) has fewer than 25 FTEs for the tax year, 2) pays employees an average of less than $50,000 per year and 3) contributes at least 50 percent toward employees’ premium cost (35 percent for nonprofits). Employers with 10 or fewer full-time-equivalent employees with wages averaging $25,000 or less are eligible for the maximum amount of tax credits. For purposes of calculating employee count, the number of employees does not include business owners or family members.

Advance payments of the tax credit can be used right away to lower monthly premium costs. If qualified, an employer may choose how much advance credit payments to apply to premiums each month, up to a maximum amount. If the amount of advance credit payments received for the year is less than the tax credit due, the employer will get the difference as a refundable credit when through the business’ federal income tax return. If the advance payments for the year are more than the amount of the credit, the employer must repay the excess advance payments with the tax return.

To calculate your FTEs and average annual wages for the purposes of this credit, refer to this Q&A from IRS. Or, use this Small Business Health Care Credit Estimator to help find out whether the business is eligible for the credit and how much might be received.

Get applications for coverage through SHOP below:

For employers For employees

Or you can sign up online at the Covered California website by clicking here.

Other employer obligations under ACAAll California employers must comply with the below regardless if health benefits are provided to employees:

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COA Fact Sheets Health Insurance Marketplace Coverage Options: Written notice is required to be

provided to all current employees describing the existence of, and options available, under Covered California, as well as the employee’s potential eligibility for tax credits. Additionally, this notice must be provided to new employees within 14 days of a new hire's start date. The federal Department of Labor has created two model notification forms which are available to download in English and Spanish. One form is for employers who do not offer coverage and one for employers who do offer coverage. (Note: As of this writing, there are no penalties for not providing the notice, however, the U.S. Department of Labor has announced it will establish penalties.) Below are links to the model notification forms:→ Model Notice for employers that offer a health plan to some or all employees

- MS Word Format - en español Printer Friendly Version - MS Word Format→ Model Notice for employers that do not offer a health plan - MS Word Format

en español Printer Friendly Format - MS Word Format• Additional Medicare withholding: Beginning January 1, 2013, ACA increases the

employee portion of the Medicare Part A Hospital Insurance (HI) withholdings by .9 percent (from 1.45% to 2.35%) on employees with incomes of over $200,000 for single filers and $250,000 for married joint filers. It is the employer’s obligation to withhold this additional tax, which applies only to wages in excess of these thresholds. The employer portion of the tax remains unchanged at 1.45%.

Limits on Flexible Spending Account contributions: For plan years beginning on or after January 2013, the maximum amount an employee may elect to contribute to health care flexible spending arrangements (FSAs), aka Section 125 plans or “cafeteria” plans, for any year is capped at $2,500, subject to cost-of-living adjustments. The limit only applies to employee contributions and does not extend to employer contributions. Learn more about FSA contributions, as well as what is excluded from the cap, from this IRS-provided document.

Employer-provided health care coverage considerations

As stated above, ACA does not require employers to provide employees with health care coverage. This is an employer choice. In considering whether to continue or newly offer employees health insurance, you might take into account the following:

• The offering of employer-provided health insurance can be helpful to attract and retain quality workers.

• Coverage can improve the health of workers; employees with health insurance could result in reduced costly absenteeism and turnover, and make for happier and productive workers.

• People who are insured are protected against uncertain and high medical expenses and are therefore more likely to receive needed, timely and appropriate health care and thus reduce lost productivity due to work absences.

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COA Fact Sheets• Employer involvement in the selection and provision of health care benefits creates a

work environment concerned about employee health and productivity, including prevention and wellness.

• Because most large employers provide employer-sponsored health insurance, small business-provided health care coverage can assist in competing for talent and provides a valued benefit to promote employee loyalty and morale.

• Individuals strive to improve their own marketability through education, experience, and skill development so they can work for the companies with the best compensation and benefits.

• An employer-provided health insurance plan can also be an attractive option because of the favorable tax treatment for employees as premiums may be payroll deducted before taxes.

Communicating to your employees

Whether an optometric practice decides to provide health care benefits to its employees, most of the practice’s employees will nonetheless be required to obtain health insurance. In promoting mutually beneficial employer-employee relations, educating employees on the basics of their options may well be a worthwhile investment. This also provides an opportunity for practice owners to educate and engage their employees on the scope of the practice’s employee benefits.

Below are some thoughts for using health care reform as an opportunity to engage, educate and empower your staff:

Don’t overwhelm with too much content. As this fact sheet conveys, health care reform is multifaceted. However, short summaries of information are much more digestible and should focus on basics, e.g., requirement for coverage, options to obtain coverage, premium assistance and cost-sharing availability (if applicable), etc.

Build a strong foundation. Crafting a powerful message around the ACA as it relates to your practice will outline for employees what information they actually need to know.

Don’t leave it to government-driven communication. Your employees are likely reading and hearing about health care reform from many sources. Mandated communications dictated by the government may cause more confusion if the practice does not carefully deliver a message that is tailored to your business. Make sure your employees are not in the dark by providing supplementary materials to mandated notices (there are a number of fact sheets on the Covered California website that can be tailored to your practice).

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COA Fact Sheets

Toss the textbooks. Don’t talk academically or politically about health care reform. Instead, use your practice’s voice, language and tone, and communicate in a style that your employees already know. Deliver high-level information on how the law will affect them in a format that will work for their job and lifestyle.

Reach employees where they are. We live in a digital world where people are plugged into smartphones, tablets and computers all day long. Communicate with workers through the medium they are used to: information on a screen, with a variety of action, and a narrative. Consider making information easily accessible through an Internet or intranet connection, which works for people whether they are tuning in at the office or home.

Communicating with your patients

We know you are getting lots of questions from patients. COA has developed a list of the most common questions our doctors are getting and some quick answers you can provide your patients. Q: Will I qualify for help with my costs? A: Starting in 2014, there will be several government programs that offer financial

assistance to reduce the cost of health insurance.1. Premium assistance — Federal help will be available to reduce the cost of an

individual’s or family’s monthly health insurance payments. Individuals who make up to $45,960 and families of four that make up to $94,200 may qualify for premium assistance.

2. Cost-sharing assistance — Cost-sharing subsidies reduce the amount of health care expenses an individual or family has to pay at the time of medical care. Those with incomes that are less than about $28,725 for a single person and less than about $58,875 for a family of four in 2013 may be eligible for those subsidies.

3. Medi-Cal - Free or low-cost health coverage for those who qualify, including people with disabilities, and those with incomes of less than $15,000 for a single individual and $31,180 for a family of four.

This online calculator will help you estimate how much it will cost to purchase health insurance in 2014 and the amount of financial assistance available.

Q: What kind of coverage is available? A: Covered California will offer many of the same health plans available on the private

market today. Individual consumers will have a choice of up to 12 health insurance

companies through Covered California, depending on location. Anthem Blue Cross, Blue Shield and Kaiser are available in all counties.

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COA Fact Sheets

Businesses with 50 or fewer full-time equivalent employees (FTEs) will be able to choose from six carriers through the Small Business Health Options Program (SHOP). The plans, similar to those usually only available to larger employers, will be available from Blue Shield of California, Chinese Community Health Plan, Health Net, Kaiser Permanente, Sharp Health Plan and Western Health Advantage. Tax credits are available to eligible employers with 25 or fewer FTEs.

Q: What is the eye care benefit under Covered California?A: Most health plans in the exchange will contract with a vision plan to provide the

pediatric vision essential benefit required under the law. The benefit includes an eye exam and glasses or contact lenses for children up to 19 years of age. Unfortunately, there is no vision coverage for adults at this time.

Q: What is the penalty if I don’t get insurance?A: In 2014, people who can afford to but do not purchase health insurance or have

coverage through their employer or Medicare will pay a tax penalty. For an individual, the tax starts at $95 a year or up to 1 percent of income, whichever is greater, and by 2016 rises to $695 per individual or 2.5 percent of income. For a family, the tax is capped at $285 in 2014 and rises to $2,085 or 2.5 percent of income in 2016. The Internal Revenue Service will collect the penalty via tax returns.

Q: How do I sign up?A: Enrollment process is easy and you can choose the method that works best for you:

Online at https://www.coveredca.com/. The website provides information about each health insurance plan, explained in clear and simple terms. Individuals and small business employers will know exactly what they pay and what they get before they buy.

By phone. Call the Covered California Customer Call Center at (888) 975-1142. In person. Covered California Certified Insurance Agents and Certified Enrollment

Counselors are available in your community to provide expert advice and support. Find one by calling (888) 975-1142, or through https://www.coveredca.com/.

By mail. Send application forms available at https://www.coveredca.com/PDFs/English/paper_application/CA-SingleStreamApp_66MAX_092713.pdf to:

Covered California Service Center P.O. Box 3530 Rancho Cordova, CA 95670-5667

When you are ready to enroll, have the following: Number of people being enrolled (whole or partial family), including the birth date of

each person Social security number(s) for each family member Home ZIP code

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COA Fact Sheets Most recent income tax filings, including dependent tax information and head of

household status (if any) Legal immigration information, such as your immigration number Information about your status as a member of a federally recognized tribe

Q: When is the deadline to sign up? A: For individuals, you have until December 14, 2013, to enroll for coverage that

starts on January 1, 2014. Open enrollment for Covered California-offered policies effective in 2014 ends March 31, 2014.Small employers can enroll for coverage through Covered California throughout

the year.

Q: Where can I get more information?A: For more information, visit the Covered California website.

Resources

Covered California, e-Health Insurance Companies for 2014: Making the Individual Marketing in California Affordable

Covered California e-Small Business Health Options Program (SHOP) Covered California “Getting Financial Help” fact sheet on premium assistance Covered California “Getting Yourself and Your Family Covered” fact sheet on cost

sharing and premium assistance for individuals and families Covered California income guidelines for health care premium subsidies : Covered California “Shop and Compare Tool” to find out more about premium

assistance and how the sliding scale works based income Preventive health services required to be provided at no charge to adults Preventive health services required to be provided at no charge to women Preventive health services required to be provided at no charge to children (18-years-of-

age and under, depending on the service) Covered California “Small Business Fact Sheet” Covered California “Small Business Tax Credit” fact sheet on premium credits available

to certain small businesses Covered California Frequently Asked Questions

Questions – more information

Questions on this topic are welcomed at the COA Member Resource Center staffed by Jason Gabhart, COA external relations manager, or at 916-266-5043.

© 2013 California Optometric Association. All rights reserved.

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