It’s hard to believe that the holidays are right around the corner, and considering that we are in the midst of Open Enrollment, you might have just stumbled upon the perfect gift for your employees: 2017 health insurance coverage!
The health plan you choose will ultimately depend on the size of your company and your employees’ needs. For instance, some employees might rarely (if ever) need to make a visit to the doctor’s office and would prefer only minimal or catastrophic coverage. Or, certain employees might be dealing with chronic conditions that require more extensive coverage with higher premiums and lower deductibles. Luckily, you have a significant amount of choice when it comes to choosing health coverage for your employees.
You could choose an HMO or PPO; a Platinum, Gold, Silver, or Bronze benefit level; and/or a narrow, medium, or full network for your business. Additionally, you could offer a single plan to all employees (assuming their health needs and interests align) or several different plan options (assuming their health needs and interests differ) from which they can make their own choice. The possibilities are nearly endless, so be sure to survey your employees before deciding on a plan.
Is My Company Eligible for Covered California for Small Business?
Before you begin your holiday shopping, be sure that you are eligible and that you know how and where to find the perfect plans for your employees. Before January 1, 2016, small group regulations only applied to businesses with between 2 and 50 employees. However, that figure has since been updated to include all business that employ 1-100 full-time employees.
The two primary requirements for small group medical insurance in California include:
- Employer Contribution: Employers must contribute at least 50% of employee-only premiums
- Employee Participation: Most ― but not all ― insurance companies require at least 70% of eligible employees to enroll in the plan offered by the employer.
Are My Employees Eligible for Covered California for Small Business?
Additionally, employees must work a minimum of 30 hours in order to be considered eligible for the small group insurance offered by their employer. According to the California Insurance Code, the lone exception includes permanent employees who work no less than 20 hours and no more than 29 hours per week and meet each of the following requirements:
- The employee otherwise meets the definition of an eligible employee except for the number of hours worked.
- The employer offers the employee health coverage under a health benefit plan.
- All similarly situated individuals are offered coverage under the health benefit plan.
- The employee must have worked at least 20 hours per normal work week for at least 50 percent of the weeks in the previous calendar quarter.
What Are My Employees Looking For?
The three most important elements of any small group health insurance plan are:
- Price: The health insurance company you choose to work with will review and assess the number and ages of your employees, as well as your location and several other factors to determine your monthly premium – the costs of which are split between employers and employees. If your business employs 25 or fewer people who each have an annual income of less than $50,000, you could be eligible for a tax credit of as much as 50% of employer premium contributions.
- Benefits: Another vital aspect of your small group health insurance plan is determining which benefits are included and excluded. Among the most important of these include:
- Doctor’s visits copayments
- Hospital co-insurance percentage
- Prescription copayments
- Providers: Whether you’re looking at an HMO, PPO, or metal level plan (Platinum, Gold, Silver, or Bronze), it’s important that the network associated with your company’s plan is broad and inclusive enough to offer your employees convenient and transparent care from in-network primary care physicians and specialists alike. All HMOs in the state of California are required to cover all medical costs related to services rendered by out-of-network providers.
The holidays will be here any day now, but luckily you can purchase small group insurance for your business all year. Your employees are counting on you to provide them and their families with excellent, affordable, and convenient healthcare, so please visit Covered California for Small Business to give your employees the gift of good health throughout 2017!
Insurance Code Section 10700-10701. (2012). California Law.