In addition to offering flexibility of options for employers, the Personal Marketplace allows employees to be more involved in their health care choices. They will have more transparency to their total health care expenses, including premium and out-of-pocket costs, which helps them become better healthcare consumers.
Watch a short demo of the employee shopping site.
Questions? Please contact your Paychex Account Manager
Frequently Asked Questions
The Paychex Insurance Agency Personal Marketplace (Personal Marketplace) is a private insurance exchange (or marketplace) where employees can shop, compare and purchase individual health insurance from a variety of insurance carriers.
In the Personal Marketplace, employees have access to individual health insurance policies from a wide range of national and regional carriers, and can shop for coverage among “on-exchange” and “off- exchange” plan options. “On-exchange” refers to subsidy-eligible plans available through the state and federal Health Insurance Marketplaces. “Off-exchange” refers to private market policies that are not available through the federal or state Health Insurance Marketplace and that a consumer cannot use a subsidy to purchase. However, most private market plans have benefits very similar to those available in the public market.
In the Personal Marketplace, employees have the flexibility to choose the carrier they prefer and the type of health plan that best suits their needs and budget. Employees receive personalized recommendations based on their specific circumstances and can create side-by-side comparisons to see how features and benefits of different health plans compare.
Most importantly, the Personal Marketplace provides employees with an estimate of the total annual costs associated with each plan – not just the monthly premium, but also the employee’s anticipated out-of-pocket costs based on the employee’s own demographic profile and expected use of health care services.
The Personal Marketplace offers live, on-demand assistance to employees. There is an extensive Resource Center available online through the shopping site, at paychex.connectedhealth.com. It is written in plain language and helps employees navigate common insurance terms and build their confidence in understanding how to select a plan.
In addition, employees can call our Service Center toll-free at 866-608-8030. The Personal Marketplace is staffed with licensed insurance agents and is available on business days, Monday through Friday between 9:00 a.m. and 9:00 p.m. Eastern Time.
Employers can ask their account manager to enroll them in the Personal Marketplace. They must provide the account manager with a list of eligible employees, along with contact information for the employees (email addresses and phone numbers), as well as their city and state of residence.
Using the contact information provided, we will then send the employees an email to invite employees to shop using the Personal Marketplace. Employers may distribute hardcopy materials to employees if email is not available or in addition to the email invitation we send.
Employers may contact their account manager with any questions.
Employers may not pay employees’ premiums for individual insurance. However, employers may provide employees an increase in their wages to use toward their health insurance premiums. This increase would be taxed as regular income, including FICA and all applicable federal and state income taxes.
Yes. The Personal Marketplace is a great way for employers to provide access to their employees who are not eligible for employer-sponsored group health insurance to make it easy for them to shop for and purchase the health coverage they are required to have as part of the Affordable Care Act.
Yes. Paychex Insurance Agency strongly advocates that employers maintain their group benefits programs, even without a group health plan. It is generally more cost-effective to offer ancillary benefits on a group basis, and many ancillary benefits are deductible to both the employer and employee when structured through a Section 125 cafeteria plan.
Employers can provide Paychex Insurance Agency with employee email addresses and have us reach out to employees directly, or they may distribute hardcopy and/or PDF materials to employees.
Open Enrollment for the public state and federal Health Insurance Marketplaces for 2014 coverage runs through March 31, 2014. Most private market carriers are following the same enrollment schedule as the public marketplaces. Employees must submit their application by March 31, 2014, to obtain coverage in 2014.
Employees are not able to purchase a Qualified Health Plan (also known as a subsidy-eligible plan or a public marketplace plan) for 2014 after March 31, unless certain circumstances are met. (Most private marketplace carriers are following the same Open Enrollment schedule.)
Special enrollment after the Open Enrollment period ends is permitted for consumers experiencing one of the following qualifying events:
Losing minimum essential health insurance coverage (for example, losing group employer-sponsored coverage)
Gaining or becoming a dependent through marriage, birth, or adoption.
Becoming newly eligible or ineligible for a premium subsidy (for example, through a reduction in income)
Having new coverage options become available as a result of a permanent move
Experiencing an error in enrollment
Demonstrating the plan or plan issuer substantially violated a material provision in the contract
Becoming newly eligible or ineligible for advance payments of the premium tax credit
The proposed Open Enrollment for individual health coverage effective in 2015 is set to begin November 15, 2014 and run through January 15, 2015.
Losing group health insurance coverage is considered a qualifying event. Employees have 60 days after the end of their group coverage to apply for individual health insurance. Note: If loss of coverage is due to voluntarily terminating coverage or due to non-payment of premium, it would not be considered a qualifying event.
Typically, a consumer’s application is accepted within about two weeks. However, depending on when the application is submitted, coverage may begin either the first day of the following month (if the application is submitted before the 15th of the current month) or the first of the month following 30 days (if the application is submitted after the 15th of the current month). For example, if employees submit their application before March 15, coverage will begin by April 1. If they submit their application after March 15, coverage will begin no later than May 1.
The Personal Marketplace includes a subsidy calculator, allowing employees to determine upfront whether they are likely to be eligible for a government subsidy (premium tax credit) toward their premium.
Subsidy eligibility is based on the number of people in the household, household income, geographic location (zip code), and the ages of the people in the household shopping for insurance.
Employees who qualify for premium subsidies must purchase a qualified healthplan through their public Health Insurance Marketplace to be able to use that subsidy. The Personal Marketplace call center staff can help guide them through this process. Employees can choose to purchase an off-exchange (private marketplace) plan, but they would not be able to use a subsidy to decrease their premium costs.
Yes. Individuals without health coverage in place by May 1, 2014, may be liable for a potential tax penalty due to the Individual Mandate of the Affordable Care Act (unless they qualify for one of nine statutory exemptions).
The annual penalty in 2014 is calculated in one of two ways, and the individual will pay whichever is higher:
1% of annual household adjusted gross income
$95 per person ($47.50 per child under 18 and up to $285 per family)
The maximum penalty is the national average yearly premium for a bronze level plan (a plan that has an actuarial value covering 60% of medical costs covered under the plan).
If individuals are uninsured for just part of the year, 1/12 of the yearly penalty applies to each month they are uninsured or fail to qualify for an exemption. As noted in one of the statutory exemptions, individuals who are uninsured for less than three consecutive months do not have to pay a penalty.
There are four types of Qualified Health Plans available through the state and federal Health Insurance Marketplace. The four plan types are sometimes referred to as “metal plans,” to reflect the names of the levels of coverage available: Bronze, Silver, Gold and Platinum.
Bronze plans cover the lowest percent of the medical costs and Platinum plans covers the highest percent of medical costs. The more that the plan covers (in terms of percent of medical costs the plan covers for the consumer), the higher the premium. The richer plans also typically offer lower out-of-pocket costs.
The following is the portion that each plan type will cover on average for the costs of care received:
Bronze plans will pay on average 60% of the cost of covered services after any applicable deductibles, and the individual would be responsible for paying the remaining 40%. For Silver, the plan will pay approximately 70%, and the individual would be responsible for paying the remaining 30% for the costs of care. The lower the premium (across the types of plans), generally the higher the employee’s share of the costs of care will be.
All Qualified Health Plans sold through the federal or state Health Insurance Marketplaces are eligible for premium subsidies (depending on household income), potentially lowering the premium and out-of-pocket costs. All policies sold through the Health Insurance Marketplace are guaranteed to meet the standards of the Affordable Care Act and provide minimum essential coverage and Essential Health Benefits, such as maternity coverage, newborn care, emergency services, and preventive services.
The same insurance company may offer multiple health plans within each metal tier, with different combinations of deductibles, co-pays and other coverage options, and the insurance company may offer both on-exchange and off-exchange plans in the same geographic region.