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small group health plans

Posted September 5th, 2017 in Producers, Employers, Individuals
No, this article is not about the potential of the age rating ratio changing from 3:1 to 5:1. It’s about a different change that is actually going to happen in the individual and small group markets in 2018.
 
First, what is the age rating ratio? 
 
Posted July 13th, 2017 in Producers, Employers
Group health plans are almost always subject to the Employee Retirement Income Security Act of 1974, also known as ERISA.
 
This means employers must follow certain rules, such as:
 
  • Providing participants with important information in writing about plan features and funding.
  • Establishing an appeals and grievance process for participants to receive benefits from the plan.
  • Providing fiduciary responsibilities for those who manage and control plan assets.
Posted December 30th, 2016 in Producers, Employers, Individuals
Last week, the Departments of Labor, Health and Human Services, and the Treasury (collectively the “Departments”) issued new guidance as the Affordable Care Act (ACA) continues to evolve.
 
 The guidance has been summarized into three different categories shown below:
 
1. Group Health Plans
 
Posted October 21st, 2016 in Producers, Employers

The only way for an employer to provide certain benefits tax-free to its employees, such as health, dental or vision insurance, is through a Cafeteria Plan, as defined under Section 125 of the Internal Revenue Code. The only way for an employer to have a Cafeteria Plan is by preparing a written plan document which meets the requirements of Code Section 125. Failure to have a written document, or failure to operate a Cafeteria Plan in accordance with the terms of Code Section 125, disqualifies the plan as a Cafeteria Plan and results in gross income to the participants. In other words, any participant in the plan will lose the tax favorable status of the benefits that he or should would have otherwise received.

Posted October 3rd, 2016 in Producers, Employers
Group health plans typically make coverage available to current or former employees and their spouses and children. However, some employers extend coverage to certain groups of non-employees. The most common example would be letting a business owner participate in the plan. Most types of business owners aren’t classified as employees for tax purposes, but rather they are said to be self-employed. 
 
Posted December 10th, 2015 in Producers, Employers, Individuals
Below is a list of some key Affordable Care Act (ACA) changes and facts that will be effective in 2016:
 
  1. The Individual Mandate penalties increase to $695 per adult ($347.50 per child) or 2.5% of household income, whichever is greater. 
  2. The Employer Mandate expands to include all employers who have 50 or more employees. 
  3. The Employer Mandate offer rate increases from 70% to 95%. 
  4. Employer reporting related to the offer of coverage is due for the first time during Q1 2016. 
Posted October 23rd, 2015 in Producers, Employers

The Protecting Affordable Coverage for Employees (PACE) Act, signed into law by President Obama on October 7, 2015 gives states the ability to continue to determine the size of their small group market rather than conforming to a national standard.

Most states currently define their small group market as employers with up to 50 employees, but the Affordable Care Act (ACA) was set to expand that definition in 2016 to include employers with up to 100 employees. The PACE Act allows each state to independently decide what small group market definition makes the most sense.

Posted February 13th, 2015 in Producers, Employers

The Affordable Care Act (ACA) defines a small employer as one with up to 100 employees, but the law gave states the ability of using a definition of up to 50 employees until the end of 2015. As a result, most states, including Illinois, used a definition of up to 50 employees. However, that will change in 2016, and all states will be required to classify their small group market as up to 100 employees.

Why does this matter?

Posted April 11th, 2014 in Producers, Employers

On April 1, 2014, President Obama signed into law the “Protecting Access to Medicare Act of 2014.” Although much of the law is designed to fix problems with the Medicare program, the law also included a repeal of the deductible limits that apply to small group health plans. In 2014, the Affordable Care Act (ACA) established deductible limits for health plans offered to small employers (defined as up to 50 employees in most states).

Posted March 14th, 2014 in Producers, Employers, Individuals

Last week, the Obama administration released several new Affordable Care Act (ACA) guidelines. Of particular note, any individual or small group with a non-ACA compliant plan will be able to keep that plan in place for additional time.