Four Facts to Know Regarding Employer-Sponsored Health Plans

June 9, 2016 | 2016 CEO Survey: Workforce, Health Care are Top Priorities Michael Teachout, Focus OneSource,

With the changing health care landscape, there are a lot of hurdles small and medium-sized businesses need to pay attention to. If you want to make sure you are making the best decisions for you and your employees, here are four facts employers should know as we advance to the full implementation of the Affordable Care Act.

  1. Know the marketplace. Make sure you shop plan designs and other carriers to better understand what you are paying for. You may change carriers, or change or adjust plans and networks to manage premiums and/ or better meet your employee’s needs. Keep in mind, Jan. 1, 2020, is when the government is scheduled to impose a 40 percent excise tax on insurers of employer-sponsored health plans with aggregate expenses that exceed $10,200 for individual coverage and $27,500 for family coverage.
  2. Know your full-time employee count. Know how to calculate your full-time employees (FTEs) number and know if you plan on going over 50 FTEs in the near future. The rules of group health care vary greatly if you are under 50 FTEs (The Affordable Care Act defines small business as under 50 FTEs). For example: If you are currently on a grand mothered plan and under 50 FTEs, pay attention to the metallic plan designs and their pricing at your next renewal. January 1, 2018 you will no longer have the option of an underwritten plan and will be required to move to a metallic plan.
  3. Know alternatives beyond traditional fully funded group health care. Self-funded and level-funded plans could be an option if the group is reasonably healthy. In order to successfully maintain a self-funded and levelfunded health care plan, employers need to correctly assess upcoming costs and set rates accordingly. Other things to consider when deciding if self-funded and level-funded could be right for you would to be to look at cash flow and utilization.
  4. Another option could be joining a professional employer organization (PEO). Some PEOs offer a master group health policy that could benefit the employer and employees with expanded choice and increased value. Know if you are compliant under the Affordable Care Act. Understand the different options that depend on your FTE count for health care offerings, allowed reimbursements, reporting to the IRS, potential tax liabilities and provisions.