Columns Group Health Insurance May Be Best for Your Business … Even If You’re an Individual Even if you’re an individual, group health insurance may be best for your business. Published 5 years ago on January 24, 2019 By Marcus Newman Invision November 2018 Issue Share Tweet RECENTLY, I HEARD A business owner tell a frustrating story about how she was forced to spend a surprisingly large sum for the treatment of a health condition. She was angry because her individual health insurance plan, bought through the Marketplace in 2014, had just increased in premium for the fourth time. She expected more from her insurance! INVISION Podcast Bringing Independent ECPs Into the 21st Century With the Technology Solutions a Modern Eyecare Business Needs INVISION Podcast The Making of Bespoke Eyewear, An Acetate Kitchen and Collecting Famous People’s Heads INVISION Podcast Fierce Independence, Southern Hospitality and Little Side of Unsolved Murder? There has been a growing rift between group and individual insurance since 2015 — most owners have not been able to keep up with all of the details. I have heard, erroneously, from many business owners that they believe: They couldn’t do group insurance. They would have to pay for all of their employees. Individual insurance would be cheaper. Not true. Individual insurance contracts (aka Obamacare plans) are no longer the same as group plans. Differences include deductibles, max out-of-pocket financial exposures, and pricing. In most cases, individual insurance is less advantageous for the consumer. Many small business owners are not aware of the increased availability of group insurance. In 2014, the Affordable Care Act changed many of the regulations affecting small businesses and insurance. States have also been tweaking rules applicable to groups employing between two and 50 people (small groups). It is very possible that a small business would be better off with group insurance — and the employees as well. Advertisement Here is the basic situation: In most states businesses with two or more people are eligible to purchase group insurance. Why is this important? Because, in many states, group insurance may be less expensive per person, have lower financial exposures and have access to larger PPO networks. How does it work? There is a little-known aspect of the Affordable Care Act that makes group insurance very accessible for small businesses. If you have an inception/renewal date of Jan. 1, then the business is not required to contribute to the employees’ premiums. Further, there are no participation requirements (i.e. how many people must participate of the employed population), so the business owner could be the only one participating — a “group” of one. Some states do not allow groups of one. In these states, you must have two participants. And note that husband-wife groups are treated differently and may not be eligible. If the group insurance plan renews on any other date of the year, then the group is subject to contribution and participation requirements. These requirements are set by the insurance companies and are typically less stringent than most business owners believe. Typical participation requirement: 70 percent of eligible full-time staff after qualified waivers. A qualified waiver is someone who has an insurance plan from a spouse, the government or an individual plan. Let’s say we have a group of 10 full time employees, four of whom have coverage through their spouse and one who is on Medicare. Here is how we determine the participation requirement: 10 eligible – 5 qualified waivers = 5 employees. In this case, to attain 70 percent participation, only four people must participate! In regard to employer cost for groups that do not start/renew on Jan. 1, requirements may not be as high you think. In most cases, the employer is asked to contribute 25 percent of the cost of individual coverage on the lowest cost plan. Advertisement Here’s how this plays out in the real world: Most small businesses offer two or three plans for the employees to choose from, one of which will be the “lowest cost.” The employer then calculates 25 percent of what it costs for that single person and the employee is responsible for the remaining premium. How much money are we talking about? Typically an employer is asked to contribute $75 to $225 per month per person depending on the age of the employee — only for those who choose to contribute. Related Topics:Featuredgroup insuranceinsuranceMarcus Newman click to Comment(Comment) Up Next Physical Stores Can Thrive As Online Retail Grows … Here’s How Don't Miss Celebrity Clients Are Cool, but Never Forget Who the Real Stars Are Marcus Newman Marcus Newman is Vice President — Small Business Sales with GCG, a full-service financial, employee benefits and risk management firm. A regular public speaker and educator, he can be contacted at firstname.lastname@example.org SPONSORED VIDEO Crizal® Sapphire™ HR: Invisible Shield of Protection Your patients’ main concerns of anti-glare, scratch resistance, and easiness to clean are covered. Crizal Sapphire HR, the latest and most advanced product in the Crizal No-Glare range, is now widely available across lab networks and through all major managed vision care providers. Crizal Sapphire HR is available with Essilor’s advanced lens designs such as Varilux® progressive lenses and Eyezen® enhanced single vision lenses. Click here to learn more. *External laboratory tests and internal technical tests – 2020. Compared to the competitor most known lens-brands by consumers (2019 external brand tracking in 11 countries). The word ’overall’ refers to anti-reflective coatings important criteria, ranked through an external quantitative consumer study – 2019. You may like Arnette’s Skateboard Street Cred on Full Display During New York Fashion Week PPG, Flō-Optics Announce Exclusive Supplier Agreement for First Digitally Applied Optical Coatings Celebrity Eyewear Pics Featuring Beyoncé, The Weeknd, Serena Williams, Blake Lively, and More Promoted Headlines On the Edger Maximizing Profit With In-House Finishing Visionix Made in Italy Italian Trade Agency Turn Patients Into Loyal Eyewear Shoppers Optify Advertisement Latest Trending Videos Photo Gallery3 hours ago Arnette’s Skateboard Street Cred on Full Display During New York Fashion Week Press Releases3 hours ago PPG, Flō-Optics Announce Exclusive Supplier Agreement for First Digitally Applied Optical Coatings Photo Gallery3 hours ago Celebrity Eyewear Pics Featuring Beyoncé, The Weeknd, Serena Williams, Blake Lively, and More Press Releases17 hours ago Hilco Vision Earns Green Seal Certification for New Sustainable Lens Cleaning Solution Press Releases17 hours ago American Optometric Association Releases Survey to Assess Burden of FTC Contact Lens Rule Photo Gallery3 hours ago Celebrity Eyewear Pics Featuring Beyoncé, The Weeknd, Serena Williams, Blake Lively, and More Photo Gallery3 days ago 23 Painfully Relatable Memes About Working Holiday Retail Sponsored Content2 days ago Made in Italy America's Finest4 weeks ago Trading on a Good Name Better Vision4 weeks ago E-Commerce Platforms for ECPs That Are Built for Eyecare and Easy to Use Sponsored Content1 month ago Turn Patients Into Loyal Eyewear Shoppers Sponsored Webinars2 months ago Shop! Masterclass Webinar: Sustainability for Retail: How Retailers Create Social, Environmental and Cultural Innovations Sponsored Content2 months ago Now Available: New Varilux® XR series™ Sponsored Webinars3 months ago Human-Centric Design in a Digital World: Creating Unexpected Moments That Inspire, Educate, and Connect at Retail Sponsored Content4 months ago The Very First of Its Kind: Introducing Ray-Ban Reverse Advertisement Advertisement SubscribeBULLETINS Get the most important news and business ideas for eyecare professionals every weekday from INVISION. Facebook Most Popular Photo Gallery3 hours ago Celebrity Eyewear Pics Featuring Beyoncé, The Weeknd, Serena Williams, Blake Lively, and More Photo Gallery3 days ago 23 Painfully Relatable Memes About Working Holiday Retail Sponsored Content2 days ago Made in Italy True Tales6 days ago The Farting Mom Chronicles: One Optician’s Terrible Tale America's Finest1 week ago At This Alberta Practice, the Eyewear Is Global, the Exams Are Thorough and the Staff Are Valued Sponsored Content1 day ago On the Edger Maximizing Profit With In-House Finishing Cover Stories3 days ago Is Eyecare Ready for the Metaverse? Columns1 week ago You’re In Optometry School… Now What?