Health Care Reform

Eligibility for Toys“R”Us Health Plan Coverage

This means that each American (with certain exceptions) has to have health insurance as of January 1, 2014.

The penalty will depend on your income. You will pay the greater of $325 or 2% of your income that is greater than the single tax filing threshold. For example, if you make $25,000 in 2016, then your tax penalty would be $297. This is calculated by subtracting the single tax filing threshold of $10,150 from your income of $25,000, and multiplying the remaining $14,850 by .02.

Like a single person, the penalty will depend on your income. You will pay the greater of $238 ($95 for each adult + $48 for the child) or 1% of your income that is greater than the tax filing threshold assuming you are filing a joint tax return with your spouse. If your 2016 household income is $40,000, then your tax penalty would be $238. This is because 1% of $19,500 (your income of $40,000 less the tax filing threshold of $20,500) is $195 which is less than the $238 flat rate penalty.

Yes. If you’re covered under an “R”Us health plan, you meet the requirements for the individual mandate.

Yes. Hourly team members (full-time or part-time) who've worked average of 30+ hours per week over a predetermined 12 month period will become eligible for benefit coverage.  See the Employer Shared Responsibility guidelines for more details.

Yes, you can cover your children for medical up to age 26 and up to age 23 for dental and vision.

No. If you currently have coverage through an “R”Us health plan, you can keep it as long as you remain benefits eligible. If you’re getting your coverage somewhere else (like from the employer health plan of a parent or a spouse/domestic partner), it’s a good idea to check to see if there are any changes to that coverage.

Eligibility for Coverage through Other Sources

A Health Insurance Marketplace is a place where people can go to buy individual health insurance policies when they don’t have or don’t want health coverage through their employer or from another source (like through a parent’s or a spouse’s/domestic partner’s health plan). Each state will have its own marketplace, either set up by the state itself, by the federal government or by a partnership of both the state and federal government. The Health Insurance Marketplace (sometimes called a public exchange) will offer a choice of health plan options so that people who live in the state can choose the type of plan that works best for their health care needs and their budget.

The subsidy that may be available to you depends on your household income. The lower your household income, the higher the subsidy that may be available to you to lower the cost of your premium and other health expenses. To find out if you qualify and how much your subsidy might be, contact the Health Insurance Marketplace in your state or visit Healthcare.gov. They will be the official source for that information.

No. The subsidy is only available for people who qualify when they purchase coverage through the Health Insurance Marketplace in the state where they live. If you are eligible for coverage through Toys“R”Us, then you are not eligible for a subsidy through the Health Insurance Marketplace because the “R”Us health plan provides comprehensive, affordable coverage. This means the “R”Us health plan provides at least the minimum required coverage and the annual cost of the lowest-cost “R”Us health plan isn’t more than 9.5% of your annual household income.

If you do receive a subsidy while eligible for our plans, you may be required to pay it back to the government.

You don’t have to enroll in an “R”Us health plan. If you’d rather be covered under your spouse’s/domestic partner’s plan (through his or her employer or under a plan purchased through a Health Insurance Marketplace), that’s okay. But since you have comprehensive, affordable health coverage available to you through Toys“R”Us, you won’t be eligible for any subsidy from the federal government for coverage purchased through a Marketplace.

If you do receive a subsidy while eligible for your spouse's/domestic partner's plan, you may be required to pay it back to the government.

Yes, you can elect health coverage through your state’s Health Insurance Marketplace instead of through Toys“R”Us. But since you have comprehensive, affordable health coverage available to you through Toys“R”Us, you won’t be eligible for any subsidy from the federal government for coverage purchased through a Marketplace.  If you do receive a subsidy while eligible for our plans, you may be required to pay it back to the government.

No. You don’t have to provide health coverage for your spouse/domestic partner. If you choose not to, your spouse/domestic partner will still need his/her own coverage. It can come from his/her employer, from health coverage purchased in a Health Insurance Marketplace, or from any other option such as Medicaid or Medicare.

If you are eligible forToys“R”Us health plan coverage, you can enroll your spouse/ domestic partner in an “R”Us health plan. Or, your spouse/domestic partner can get coverage through a Health Insurance Marketplace where he/she lives. Your spouse/domestic partner might have other options, too, like coverage through an employer, a parent’s health plan, or even Medicaid or Medicare.

Yes, military benefits such as TRICARE satisfy the individual mandate requirement of the health care reform law. If you are enrolled in TRICARE, you will not pay a tax penalty.

Many different plans are offered through the Marketplaces. Some offer more choice in doctors and other health care providers. When you compare the plans that are available to you, you’ll be able to see which ones let you choose any doctor, and which ones only offer benefits from doctors who are part of a network.

State Health Insurance Marketplaces will begin its 2016 Open Enrollment on November 1, 2015, and will offer health plans that start providing coverage on January 1, 2016.  The Open Enrollment period ends on January 31, 2016. For more information, contact the Health Insurance Marketplace in your state or visit Healthcare.gov.

The Health Insurance Marketplace Open Enrollment period for 2016 begins in November. If you get your coverage through the Marketplace in your state during its Open Enrollment period, your new coverage can begin on January 1, 2016. Once the 2016 Marketplace Open Enrollment ends on January 31, 2016, you won’t be able to enroll until the next Open Enrollment unless you have a qualifying life event. Loss of Toys“R”Us benefits coverage, either through a status change or dropping coverage at Annual Enrollment are qualifying life events.

The tax penalty will apply if you go longer than three consecutive months without coverage. You will pay a portion of the annual penalty, based on how much of the year you were without coverage. The longer you go without coverage, the bigger the tax penalty.

 

Help With Paying for Health Insurance Costs

Yes. For certain low- and middle-income people who cannot get health coverage at work at a price the health care reform law considers “affordable,” or who are not eligible for comprehensive, affordable health coverage from their or their spouse’s/domestic partner’s employer, the federal government will offer financial help in paying for health insurance purchased through a Health Insurance Marketplace. This financial help is called a “subsidy.”

The amount of the subsidy will depend on each person’s household income. It’s important to know that, generally, if you are eligible for coverage through an “R”Us health plan, you are not eligible for a subsidy.  If you do receive a subsidy while eligible for our plans, you may be required to pay it back to the government.

If you are not eligible for coverage through an “R”Us health plan, you may be eligible for a subsidy depending on your household income. It’s not just your income that counts, but the combined income of everyone in your home.

Contact the Health Insurance Marketplace in your state to see if you qualify for a subsidy.

Check www.healthcare.gov, the website sponsored by the Department of Health and Human Services, to get contact information for the Health Insurance Marketplace in your state.

In some states, eligibility for Medicaid benefits has expanded. Medicaid is a federal program that makes financial assistance available to help individuals who need it to get health coverage. Not all states are expanding eligibility, so visit www.medicaid.gov to learn about Medicaid eligibility in your state.

Health Care Costs

One of the goals of the health care reform law is to make health insurance affordable for all Americans. Toys“R”Us also wants to make sure that our health plans stay affordable for “R”Us team members. Health care costs keep rising, and some of what’s causing prices to go up isn’t in our control. But Toys“R”Us is working hard to control what we can, and we’ll ask our team members to help by knowing how to use their health plan benefits wisely and by becoming better health care consumers. We’ll keep providing you with the information you need to help you keep your costs affordable.

Yes. The health care reform law puts limits on what you have to pay out of your own pocket each year. Whether you get your coverage through Toys“R”Us, through a Health Insurance Marketplace, or from somewhere else, these limits will be in place to help keep your costs down.

No. Reporting the value of your health care coverage is another requirement of the health care reform law. Toys“R”Us puts that value in box 12, code “DD” of your Form W-2. But the value of your “R”Us-provided health care coverage isn’t taxable to you. It’s there just for your information and includes what you pay and what the company pays toward your coverage.

The health insurance coverage you have will be reported to the federal government. Health insurers, employers that sponsor health plans and agencies that administer government health plans will file annual reports to the IRS about who is covered under their plans. They will also provide the people they insure with documentation about the coverage. When you file your tax return for the previous year, you will report whether you and your family members had health insurance coverage. If you did not have health insurance, you will pay a tax penalty.

No. Non-payment of premiums is not considered a qualifying life event, and COBRA coverage will not be available either. If you lose coverage due to non-payment of premium you must wait until the Marketplace’s next Open Enrollment.

For 2016, an uninsured person would pay the fee in 2017, when they file their 2016 federal income tax return.

You can enroll in both plans, but there may not be financial benefit to doing so, since Toys“R”Us uses a “non-duplication” rule when it coordinates its plan benefits with the benefits available under another plan. That means the benefits available from our plan as a secondary payer will be no greater than they would be if our plan had been the only source of coverage. Your spouse’s/domestic partner’s health plan may have a similar non-duplication rule too.

Having a pre-existing condition won't keep you from getting health coverage. An insurance company can't turn you down or charge you more because of your condition. It can't refuse to cover treatment for pre-existing conditions. This is true even if you have been turned down or refused coverage due to a pre-existing condition in the past. The only exception is for grandfathered individual health insurance plans--the kind you buy yourself, not through an employer. If you have one of these plans you can switch to a Marketplace plan during open enrollment and get coverage for your pre-existing condition.

 

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