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I am a bit confused with the Affordable care act and employer insurance. If the employer mandate starts in 2015 and the individual mandate starts in 2014, how would an employee know if their employer provided insurance was acceptable in terms of the individual mandate?

  • I'm not sure what you're asking. If you're covered by your employer, I don't think you have to worry about the individual mandate. – Avi Nov 9 '13 at 4:56
  • My question: How do I know if health insurance from an employer sponsored plan is sufficient enough to cover the mandate? (We asked my spouse's benefits department if the plans offered are grandfathered and they literally had no idea.) – Michael WS Nov 9 '13 at 5:06
  • I think they automatically are, I have to check. – Avi Nov 9 '13 at 5:33
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If your employer is providing you with insurance, the individual mandate does not apply. Your employer provided insurance exempts you from an individual mandate, and as such, minimum standards of care are not your concern. They wouldn't be your concern either way: you just have to have insurance. It's up to insurance companies to ensure that that insurance meets minimum standards of care. In fact, insurance companies will be cancelling such policies before the employer mandate comes into effect.

From Kaiser Health News:

The Congressional Budget Office estimates that in 2014 nearly three out of five Americans will have coverage through an employer-provided plan and 12 percent through Medicaid and the Children's Health Insurance Program, federal-state programs that provide insurance to lower income Americans. If you have insurance in either of those ways, you are not affected.

(Emphasis mine).

Because you receive insurance from your employer, you do not have to worry about the individual mandate.

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It seems like its up to your benefits provider to know if your employer sponsored health plan is actually compliant or not. The answer seems to be that cannot find out right now.

from healthcare.gov

How to find out if your plan is grandfathered?

Check your plan’s materials: Health plans must disclose if they are grandfathered in all materials describing plan benefits. They must offer contact information.

Check with your employer or your health plan's benefits administrator.

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I am in this exact situation, as our company is in the benefits selection phase for Medical and Dental plans for our employees to rollover in January 2014. As such, we have company-wide web meetings with benefits providers, who START the webcast by stating that our company plan is in compliance with the Affordable Care Act.

Having said this, we are not required to, BUT CAN, seek medical insurance through the ACA, if we believe we can achieve a better, more comfortable or affordable plan for our money, in the medical marketplace. They also make a point of saying that our company plan provides an employer match, making our plan more fiscally advantageous than anything else we could find, since the match does not carry over to plans found in the marketplace.

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  • That's really interesting that every web cast starts the same way. I wonder who is liable if they say it is compliant and it is not actually compliant. – Michael WS Nov 10 '13 at 0:44

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