Get Employer Coverage Tool 2022-2024

Employer mandate overview. Generally, employers must offer health insurance that is affordable and provides minimum value to 95% of their full-time employees and their children up to the end of the month in which they turn age 26, or be subject to penalties.

Employer-sponsored coverage, also known as employer-sponsored insurance or employer-provided health insurance, is health insurance offered to you and your dependents through your job. Your employer may offer a choice of group health plans to eligible workers and cover part of the premium (monthly cost).

An employer-sponsored plan provides minimum value if it covers at least 60 percent of the total allowed cost of benefits that are expected to be incurred under the plan.

Small business owners with fewer than 50 full-time employees are not required to offer health care coverage to their employees. However, you should know that if a small business with fewer than 50 full-time employees does offer coverage, then that coverage must comply with the requirements of the ACA.

HDHPs and Minimum Value The ACA provides that large employers who do not offer essential health benefits that are affordable and provide minimum value may be subject to a shared responsibility penalty. It is possible that an HDHP, on its own, will not satisfy the minimum value requirement.

MINIMUM PREMIUM PLAN (MPP) - A plan where the employer and the insurer agree that the employer will be responsible for paying all claims up to an agreed-upon aggregate level, with the insurer responsible for the excess. The insurer usually is also responsible for processing claims and administrative services.

A health plan meets the minimum value standard if both of these apply: It's designed to pay at least 60% of the total cost of medical services for a standard population. Its benefits include substantial coverage of physician and inpatient hospital services.

Minimum Essential Coverage (MEC) and Minimum Value (MV): Minimum Essential Coverage is a lower threshold than Minimum Value (MV). MV is the 60% Actuarial Value and is met when a plan pays on average at least 60% of the actuarial value of allowed benefits under the plan.