Employers remain in limbo after the Protecting Affordable Coverage for Employees (PACE) Act was passed and signed. This eliminates the Affordable Care Act’s expansion of the “small group” threshold to employers with 51-100 employees.
Whether individual states expand the definition is up to their state legislature. There is no guarantee that Illinois will choose to keep the small-group ceiling at 50 employees, even though that is all that ACA will now require.
The result is that employers in that bracket will not be subject to small-group market rules. The main requirements of small group plans are providing the 10 essential health benefits and fewer underwriting criteria.
The only underwriting criteria insurers covering small group employers are permitted to use are age, geography and the number of smokers in the covered population. Criteria they are no longer permitted to use include gender and claims experience.
Self-insured employers were never impacted by this issue.
This is a big deal if you’re in the 50-100 employee space. This also creates many opportunities – contact us to find out more!
Until next week,