For employers with fewer than 50 full-time or full-time equivalent employees, the ACA employer mandate does not apply. However, if such smaller employers voluntarily offer health insurance or other ACA compliant benefits, certain implications could arise for their employees with respect to qualifying for premium tax credits (subsidies) on the individual state health insurance exchanges.

Here are some key points:

1. **Offer of Coverage**: If the employer offers coverage that is both "affordable" and provides "minimum value," then the employee would not be eligible for a premium tax credit on the exchange for him/herself. Affordability and minimum value are technical terms defined under the ACA.

• "Affordable" generally means the employee's share of the premium for the lowest-cost, self-only coverage cannot exceed a certain percentage of their household income (9.12% for 2023, but this percentage may vary each year).
• "Minimum value" means the plan covers at least 60% of the total allowed costs of benefits provided under the plan.

2. **Dependents**: If the employer offers coverage to dependents but it's not affordable for them (even if it's affordable for the employee), those dependents could still be eligible for subsidies on the exchange.

3. **Opting for Employer Plan**: If an employee accepts the employer's offer of affordable, minimum value coverage, they automatically become ineligible for subsidies on the exchange.

4. **Opting for Exchange**: If an employee declines the employer's offer of affordable, minimum value coverage and opts to buy insurance through the exchange, they will not be eligible for subsidies. This is true even if the coverage is affordable only for the employee but not for their family.

5. **MEC (Minimum Essential Coverage)**: Offering a MEC plan that is affordable and provides minimum value would make the employee ineligible for subsidies. Some MEC plans offer minimal benefits and are designed to satisfy the requirement of offering coverage; they may or may not provide minimum value.

6. **Information Reporting**: Although smaller employers are not subject to the employer mandate, if they offer coverage, they might still have certain reporting requirements under Sections 6055 and 6056 of the Internal Revenue Code, which are used to determine eligibility for premium tax credits.

7. **State-Specific Rules**: Note that some states have their own rules and regulations concerning healthcare coverage and subsidies, which might differ from federal requirements.

Betty Health is considered a supplemental benefit, meaning it does not qualify as an ACA compliant health plan or meet the requirements for Minimal Essential Coverage, which is actually a benefit to small employers because there are no reporting requirements and all employees are still eligible for subsidies on the state/federal exchanges.