small group health plans
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?
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).
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.
The Small Business Health Options Program (SHOP) is a part of the healthcare reform law that is supposed to help small businesses provide affordable health insurance coverage to employees. Last month it was announced that the SHOP Exchange would be delayed until November 2014; however, this statement requires clarification as some of the core features of the SHOP are still available.
The U.S. Department of Health and Human Services (HHS) released final regulations on February 22, 2013 in regards to various health insurance market rules. The new guidance includes information about minimum participation requirements in the small employer marketplace. In most states, small employers are defined as those with 50 or fewer employees.
Insurance companies today require a minimum percentage of employees to enroll in coverage. This is referred to as the participation requirements and helps insurance companies avoid adverse selection. Minimum participation requirements can be up to 75% today.
The U.S. Department of Health and Human Services (HHS) posted final regulations about the deductible and out-of-pocket limitations to the Federal Registrar on February 25, 2013. Section 1302(c) of the Affordable Care Act (ACA) specifies that the maximum deductible for a qualified insurance plan cannot exceed $2,000 for single coverage and $4,000 for family coverage.
The U.S. Department of Health and Human Services (HHS) released the final regulations about Essential Health Benefits (EHB) on February 20, 2013. The guidance defines the benefits that must be included with all fully insured plans sold inside and outside of the public exchanges in 2014. This will impact all individual health plans and most small group health plans. Grandfathered plans and self-insured plans are exempt from the EHB requirements; however, self-insured plans that cover any EHB must provide coverage without any annual or lifetime dollar limits.
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