In 2005, the state of Utah recognized the need for reforms in the health care industry, and proceeded to make massive reforms in the system. Such initiative eventually led to the passing of the important legislation HB 133, also known as the Utah Health Exchange, in 2008.
So what is the Exchange? It’s a web-based marketplace where consumers can choose from among many different health care options based on what they need. Originally rolled out in January 2010 on a pilot program, January 2011 launched the very first enrollment opportunity for most small employers. Based on information released from the State of Utah as of March 7th, the Exchange has successfully enrolled 83 employer groups and 2,534 covered lives.
The Exchange is, essentially, a defined contribution program. Employer groups enroll in the Exchange using the broker or advisor they choose to assist them to navigate through the process and assist in educating their employees of their options. Enrollment is essentially done on a web-based platform designed for health care shopping and enrollment.
Rules for Participation To be an eligible small employer, you must have between 2 to 50 eligible employees; at least 75% of them must reside in Utah; and you must fill out an online application, including submission of eligible documents. Once an offer is established the group must have 75% participation of eligible employees. Once you’ve applied, you’ll work directly with your broker or advisor to walk you through the process.
Do you still need a Section 125 Plan? Availing of the Utah Health Exchange Program also requires payroll deduction using pre-tax dollars and this can only be done when the program is run under a Section 125 Plan. Under this arrangement, health care contributions of employees can be completely tax-free.
The tax-advantage status is the biggest benefit that a Section 125 or Cafeteria Plan offers. They are deducted pre-tax, meaning that the employee’s taxable income is reduced by the amount of the premium. As a result, the employee has a lower taxable income, and therefore lower FICA and Medicare taxes payable. The employer gets a benefit, too: a decrease in the employee’s taxable income can lead to a reduced employer share of FICA and Medicare taxes and even FUTA and state taxes.
What is the Default Plan? Employers and tax advisors must choose the most appropriate health plan for the company’s employees, and have them undergo enrollment to this plan, unless:
1. The employee chooses their own plan option online with a different plan through the Exchange. 2. The employee chooses to waive his right of availing of the plan and secures health coverage outside the company. 3. The employee specifically declines coverage in the health benefit plan.