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Health Insurance Essentials

What business owners need to know about planning, purchasing, and avoiding penalties.

Jennifer Kauffman

on 18 October 2016

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Transcript of Health Insurance Essentials

Who do you need to insure?
Group health plans allow the employer to select a plan (or set of plans) to offer to W-2 Full-Time employees. The employer often pays a portion of the premium.
New employees may be added to the plan throughout the year, rather than waiting till the next enrollment period.
Must be offered to all eligible employees.
Can also be purchased through the health insurance marketplace with potential tax benefits, or directly through a private exchange.

How to get Covered
Determine who you will be insuring
Employee & dependents or are spouses included?
How much of the premium will the company be paying?
Create an employee census
Include all eligible employees, even if they will be waiving coverage.
Find your Standard Industrial Classification (SIC) Code - www.siccode.com
Any information on preferred plan types, doctor & hospital networks, and budget will be helpful in narrowing down the available choices to those that are affordable and relevant to your company's needs.
SHOP Marketplace
The Health Insurance Marketplace is also available for small employers.
Currently available for groups up to 50, will go up to 100 for 2016
The employer chooses a plan or set of plans for employees to choose.
Small Business Tax Credit may be available
Business must have no more than 25 FTEs*
Must pay employees wages averaging less than $50K per year
Business must contribute at lt 50% of the cost of self-only coverage (not family coverage) for each employee

Off-Exchange Group Plans
Available to groups of any size
Not eligible for small business tax credit
Offers a wider range of plans & networks
May offer additional employee benefits, such as wellness incentives
Easier to incorporate additional lines of insurance, such as:
If you have 50 or more FTEs, you must offer them group health coverage or face potential tax penalties
Known as the Employer Shared Responsibility Provision or Employer Mandate
Employee coverage must be considered:
Adequate - Bronze level or better coverage
Affordable - employee's self-only premium does not exceed 9.5% of their wages
Businesses with common ownership are combined when calculating FTEs
For the ACA*, full time is considered an average of 30 hours per week

Health Insurance Essentials
What business owners need to know about planning, purchasing, and avoiding penalties.
Individual & Family Plans
For businesses with at least 2 W-2 Full Time Employees
Offering benefits is an excellent way to attract & retain talent
Employer Contributes to insurance premiums
Family Businesses
W-9 Contractors
Greater freedom to choose the right plan for your personal needs
Packaged Benefits for Owners & Employees
Customized Coverage for Contractors & Self-Employed
Self Employed? Individual coverage may save you money.
Plans may be obtained through the Health Insurance Marketplace or through a private exchange
You may qualify for a premium subsidy based on household income
Additionally, you may qualify for a plan with lower copays, coinsurance, and deductibles
Your premium may also be tax deductible

How to get Covered
Individual Mandate
Consult a broker or subsidy calculator to see if you may qualify for assistance
If you do, you must go through the Health Insurance Marketplace to apply for financial assistance and choose your plan. An insurance broker may assist you with your application and facilitate enrollment in a health plan.
If not, there are many additional plans and options available off the marketplace through private exchanges. These are available through a health insurance brokerage or by going to an insurance carrier directly.
You may enroll during the Annual Enrollment Period from Nov. 1st - Jan. 31st, or during other times with a qualifying event (special election period).
What's the difference?
What your agent or insurance carrier will need to know
On-Exchange Health Insurance for Groups from 2-100
Need to Know
Businesses cannot pay premiums for individual health plans, nor are additional wages intended to pay premiums pre-empted
You are subject to the Individual Mandate, but are not required to offer benefits to employees (for businesses with less than 50 FTEs)
If you have 50 or more FTEs, you must offer them group health coverage or face tax penalties
Employees may choose to waive group coverage and select an individual plan, but will not be eligible for subsidized coverage
Going without a QHP for 3 or more months during the calendar year will result in individual tax penalties
Cannot add or switch plans mid-year without a valid election period
The election period is Nov. 1st 2016 - Jan. 31st 2017
Special Election Periods are triggered by qualifying events, such as marriage, birth, or involuntary loss of a Qualified Health Plan (QHP)
Employer Mandate
Individual & Family Plans
Self Employed? Individual coverage may save you money.
Are you Self-Employed or a Small Employer?
If you run a business that produces income and has no employees, you’re considered self-employed
W-9 Independent Contractors are not considered employees
Employees are defined as workers whose income you report on a W-2 form at the end of the year
Thank You!
Jennifer L. Kauffman


Benefit Concepts, Inc.


Full-Time Equivalent employees
*Affordable Care Act
Full transcript