Many small businesses have long struggled to provide health benefits to their employees.
The Affordable Care Act (ACA) or Obamacare as it is often referred to, includes a separate online health-insurance marketplace for small businesses, those with fewer than 50 employees.
Here are some other key ACA changes, some of which took effect this year:
- Essential health benefits: Non-grandfathered plans – plans not exempt from many of the ACA’s requirements — offered by small and large businesses alike now have to cover, at a minimum, a list of “essential health benefits” that includes 10 categories of benefits.
- Preventive services: Non-grandfathered plans also are required to cover specific preventive services without cost sharing. This means the cost of covering preventive services, such as childhood immunizations and cancer screenings, must be covered 100 percent by the insurer.
- Waiting periods and appeals: Employers no longer can impose health coverage waiting periods for new employees that exceed 90 days. An internal and external appeals process for members who object to coverage decisions are also required.
- Rating: Employers now cannot be charged higher premiums because of their employees’ health status or pre-existing conditions. Changes in how rates are determined allow the cost of insurance to be based only on age, where employees live, family size and whether or not they use tobacco.
- Added costs: Another important change under the ACA is that all health plans will cost more to help pay new taxes and fees, such as the Patient-Centered Outcomes Research Institute fee and the Health Insurance Provider fee.
Strategies to help small businesses
There are a number of strategies that may make the most sense for small business owners in the post-ACA era. Transitional relief policies, where available, are one of the most popular options. These non-ACA-compliant plans – also labeled “keep what you have” plans – allow small business employers to continue offering more inexpensive plans with limited coverage until 2016. However, the option is available only in states or portions of states where the state has agreed to go along with the HHS extension. Other options include:
- High-deductible plans: these plans can save employers money while promoting greater use of preventive and wellness services by employees.
- Insurers and brokers: Insurers and brokers remain a great resource to help make sense of it all.
- SHOP: The start of online enrollment in the Small Business Health Options Program (SHOP) – the new online public marketplace or exchange for small business coverage. However, small businesses still have the option to buy SHOP health insurance plans through agents or brokers who are certified. They can assist with filing a paper application.
- SHOP is designed to help owners of small businesses – those with fewer than 50 full-time-equivalent employees – provide health insurance for their employees in a cost-effective way. Small business owners who enroll may qualify for a health-care tax credit worth up to 50 percent of the cost of premiums.
- As with online exchanges for individuals, the SHOP exchanges (one for each state and the District of Columbia) can be accessed via HealthCare.gov. The site will direct you to your state’s exchange.
- Private exchanges: Small businesses also can consider private exchange options, which are growing in number. Private exchanges give employers the ability to offer employees an easy online shopping experience for health coverage with rates provided automatically.
If you have any questions, please feel free to contact JV LAW GROUP. Call us today at (714) 752-3270.
