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Attention Small Business Owners
Why would an EMPLOYER want to get into the health insurance space, if they are not presently offering benefits?
Do you need a one person group option?
NEW DEFINITION OF HEALTH PLAN UNDER ERISA
To qualify as a group health plan under ERISA, an employer must have at least 1 eligible non-spouse “common law employee” enrolled. Please note: Children of 1 owner only or owner/spouse only business may be the other common law employee, if she/he is an eligible employee over the age of 18 (i.e., no longer a minor child per state law) and is enrolled for coverage.
Definition of group based on legal business structure:
Sole Proprietor: When the owner is the only eligible and enrolled individual (or the owner and his/her spouse), it is not a group health plan unless at least one other eligible common law employee (W-2 or 1099 for this business type) is enrolled in the plan.
Partnerships / LLP / LP / PLLP:
If only partners and/or partners and their spouses are covered, they are not a group health plan unless there is at least one other common law employee (W-2 or 1099 for this business type) eligible and enrolled in coverage.
Corporations and LLC / PLLC:
Two owners who are not spouses may qualify as a group health plan. An additional common law employee is not required to enroll as an owner may be considered a “common law employee” if working full time at the company – i.e. the group may consist of multiple owners only with no full-time employees, where at least 1 owner is actively working and enrolled. If the Corp/LLC/PLLC has only 1 owner and/or owner and spouse as eligible it is not a group health plan.
Non-Profits: Nonprofits do not have “owners” so a nonprofit group would be allowed if there is at least 1 common law employee enrolled in the plan.
DISCLAIMER: Final rates are based upon actual enrollment data (including dependent data)
What is a provider network?
Written and produced by the Kaiser Family Foundation, the YouTube’s aim to help consumers better understand health insurance. These short videos explain important health insurance concepts, such as health premiums, out-of-pocket health costs, and provider networks. This year, open enrollment begins on November 1, 2017, and ends December 15, 2017.
People may qualify for Special Enrollment Periods allowing them to enroll outside of Open Enrollment if they have certain life events, like getting married, having a baby, or losing other coverage.
You can apply for Medicaid or CHIP at any time of the year.
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Choosing the right health plan for you and your family is an important decision.
Learn why encouraging healthy living is a good business strategy and so much more.
Understanding the Affordable Care Act:
In a traditional fully insured health plan, your company pays a premium. The premium rates are fixed for a year, and you pay a monthly premium based on the number of employees enrolled in the plan. Your monthly premium only changes during the year if the number of enrolled employees in the plan changes.
The insurer collects the premiums and pays the health care claims based on the benefits in the policy you purchased. The covered persons are responsible to pay any deductible amounts or co-payments required for covered services under the policy.
Preventive care helps you stay healthy. A doctor isn’t someone to see only when you’re sick; doctors also provide services that help keep you healthy.
The Affordable Care Act is making health insurance coverage more affordable and accessible for millions of Americans. During the first annual enrollment period, more than 8 million Americans signed up for coverage through the Health Insurance Marketplace, including more than 4.3 million women. And that doesn’t include the more than 3 million young adults who have gotten coverage through their parents’ health plans, or the millions who have learned they are eligible for Medicaid coverage. These people are enjoying high quality, affordable coverage that can’t discriminate based on a pre-existing condition, or charge women more because of their gender.
Learn more about …
The Marketplace is a new way to find quality health coverage. It can help if you don’t have coverage now or if you have it but want to look at other options.
With one Marketplace application, you can learn if you can get lower costs based on your income, compare your coverage options side-by-side, and enroll. Learn more