Confused about the Affordable Care Act (ACA) health insurance requirements for your business? You’re not alone; these relatively new laws and the challenges and opportunities they present aren’t always easy to sort out. One option is to ask your insurance broker the 6 questions below. Here’s how we answer them:
1. What are my options now that the ACA is the law?
You essentially have 4 health insurance options for your business:
- Keep your group plan, if you have one
- Don't offer any health insurance plan (employers over 50 FTEs will be subject to the employer mandate and shared responsibility fees)
- If you have fewer than 50 FTEs, you can provide additional compensation to employees that they can use to buy health insurance. (This is Gravie's model.)
- If you have 50 or more FTEs, you can do option C and also offer a minimum essential coverage (MEC) plan so you can reduce or eliminate the penalties you're subject to if you don't offer the MEC plan
2. Do these plan options allow my employees to get government tax credits?
Option A doesn't. Just by offering a group plan, you’re preventing employees from being eligible for these tax credits.
Options B & C do.
Option D does as long as the minimal essential coverage plan referenced does not meet minimum value, which means that it covers less than 60% of the total allowed cost of benefits that are expected to be incurred under the plan, and the employee turns down the plan and applies for tax credits.
3. Do I have to provide health coverage to my employees? If yes, what is the best option for my company?
Depending on the size of your company, you may be subject to the Employer Shared Responsibility rules and may be required to provide coverage or else pay a penalty. Read our blog post, “Post-ACA Employer Responsibility Rules: The Madness Made Simple” to find out if your company is affected and learn more about your options.
4. What tools do you have to help me and my employees explore options and alternatives?
In most cases, brokers won’t have tools that allow employers and employees to select their own “best” coverage. Brokers are restricted to group comparisons for the company as an aggregate, not down to the individual evaluation level.
At Gravie, we run a financial analysis against your current group plan to see what your cost savings would be by moving employees to the individual market. For employees, we have an intuitive web experience that allows members to do plan comparisons and access plan details and our advisors help them sort through all the options available to choose the one that fits their needs best.
5. With all of the plan configurations available, why can I only offer 2-3 to employees in a group model?
Group plans typically have a limited number of plans offered because they’re from one insurance provider, and are based on average risk of the group (for companies with less than 100 employees, risk is based on the average of all small groups within the state) rather than an individual’s specific situation.
6. Will the plans you’re offering provide service to my employees – like finding a doctor, resolving a claim, understanding benefits, understanding costs of procedures, etc.?
In most cases, health insurance companies offer basic support to members for issues related to their coverage and claims. With Gravie, our advisors go above and beyond basic support to help remove obstacles, make sense of plan details, unravel the fine print, answer questions about tax credit eligibility, find a less expensive drug option, and much more.
Have any other questions? We’re eager to help in any way we can. We can even complete a financial analysis of your current situation to see how much you could save by switching to Gravie. Call 844.540.8701 or fill out our contact form here. You’ll be glad you did.