My family is eligible for job-based coverage but I’m not sure how to answer the questions about my employer’s health coverage in the Employee Coverage Detail section of the application.

When you get to the Employee Coverage Detail section of the application, it is important to answer these questions correctly, so you are receiving the proper amount of financial savings for which you qualify.

Referring to this question in the application: “What is the amount that (family member) would have to pay for the lowest-cost family plan available through (family member)’s company that provides coverage for (family member)?”

When adding the cost of family coverage to determine the lowest cost premium that meets minimum value standards, be sure to use the premium amount necessary to cover the employee and ALL of their tax dependent family members.

See below for more details:

• Include the premium amount that would cover all family members regardless of whether they are seeking coverage through Pennie or not.
• Make sure that “Family” includes the employee, the employee’s spouse (filing a joint tax return), and employee’s tax dependents
• Do NOT include non-tax dependents offered employee sponsored coverage (e.g. adult children up to 26 who are independent tax filers)
  • Financial savings for an employee’s non-tax dependents is based on ENROLLING in employee sponsored coverage, not just an offer of employee sponsored coverage.
• Financial savings for an employee’s tax dependents is based on an OFFER of employee sponsored coverage, regardless of whether they enroll in employee sponsored coverage

If the family members are offered employer-sponsored coverage that meets standards for affordability and minimum value but are unable to enroll because the employee did not enroll, the family members would still be ineligible for financial savings.

If the employer-sponsored coverage includes multiple plan options, then use the cost for the lowest-cost plan option that meets minimum value standards.

Note: Do not calculate “cost of family coverage” as the cost to enroll family members minus the cost to enroll only the employee, or the cost of individual family members or combinations of family members that do not include the entire tax household with an offer of family coverage.

Example:

Evan has an offer of job-based coverage that would cover Evan and Evan’s family members.  Evan has a spouse and two children.  Evan’s employer offers three health plans, only two of which are minimum value (see table below).  They will use the cost of the lowest cost minimum value plan (Plan #A2) to determine if the job-based coverage is affordable.  When completing the application, they will enter the “employee only” cost ($200 per month for Plan #A2) to determine if the job-based coverage is affordable for Evan.  For Evan’s family members, they will enter the “family” cost ($600 per month for Plan #A2) to determine if the job-based coverage is affordable for Evan’s spouse and children.  The reason they use “family” cost is that is the level of coverage that would cover Evan and all of Evan’s eligible tax dependents. 

If Evan’s annual household income is $60,000, the job-based coverage would be affordable for Evan but unaffordable for Evan’s spouse and children.  Evan would be ineligible for financial assistance for coverage through Pennie, whereas Evan’s spouse and children could be eligible for financial assistance for coverage through Pennie.

Other Resources:

I have an offer of job-based insurance coverage for my family, but it’s unaffordable. Can I get financial assistance to enroll my family in coverage through Pennie instead? – pennie help