small group health plans
As an insurance producer working in the small group market, you know that many small employers are struggling with the rising cost of healthcare. Your job is to help your clients find the most cost-effective benefits solutions that will save them money but still provide the competitive benefits package necessary to recruit and retain qualified candidates. Understanding the different products and services available in the market space is imperative to your success
- 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.
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.
- The Individual Mandate penalties increase to $695 per adult ($347.50 per child) or 2.5% of household income, whichever is greater.
- The Employer Mandate expands to include all employers who have 50 or more employees.
- The Employer Mandate offer rate increases from 70% to 95%.
- Employer reporting related to the offer of coverage is due for the first time during Q1 2016.
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.