How much is the tax subsidy for health insurance coverage for small businesses? Employers with 25 or fewer employees who make an average of $50,000 or less per employee can receive up to a 50 percent tax subsidy for their contributions to an employee health plan. Employers with the fewest employees and the lowest average salaries will benefit the most from the federal tax subsidies. A Small Business Tax Credit Calculator to help you get a better idea of how it will work. Please call 303-471-9424 for a copy.
I have a Small Group with Less than 25 employees and qualify with most of our employees making an average wage under $50,000. How do we benefit with a group plan through the SHOP vs. letting our employees purchase with a subsidy? That’s where a picking a broker who understands employee benefits is crucial. The broker can do a comparison and look at how individual coverage with subsidy compares with small group coverage inside the exchange. Although it may look better for some employers with extremely low wage earners to have their employees purchase with a subsidy through the individual exchange, take a look at both sides.
Before you decide to “dump” your current small group insurance plan or if you are a start up that was thinking of adding small group health insurance think about a couple of items:
1. A group plan is more benefit rich and compared with individual plans on the exchange offers more options to your employees. Currently, there is only ONE PPO option on the individual exchange, all other plans are HMO only. The individual exchange offers a “thinner” network of doctors and hospitals compared with group insurance plans and plans outside of the exchange so will limit coverage and care to employees.
2. A small group health plan will help you to attract and retain quality employees and compete with larger businesses for these employees. A small group health plan shows current and new employees that you care about them.
3. Are you really going to put your employees through the process of applying for MEDICAID/PEAK so they can get DENIED for a subsidy?
4. Effective 1/1/14 small businesses can no longer reimburse employees individual health insurance through an HRA/defined contribution arrangement. It’s now out of compliance with the IRS and you could end up with huge fines and penalties. A small group plan keeps your business in compliance.
How does the SHOP tax deduction work and do we have to purchase through the exchange? The credit is available only for plans purchased through SHOP exchange. Businesses will qualify for the tax credit based on their annual wage base and number of employees. Businesses still can deduct the rest of premium costs not covered by the tax credit from its annual tax bill.
All Colorado brokers work through one of two managing general agencies that have a unique software program that will take your census data and provide a quick spreadsheet of plans designs and premiums with links to brochures embedded in the spreadsheet to make it easy for you to choose. The two MGA’s have been certified by the Colorado Healthcare Exchange (along with their brokers) and have been assigned this task to take the load off of the staff at the exchange as they are experienced and provide an excellent experience for small groups. Connect For Health Colorado will ask all employer groups to pick a broker (please pick us!) to get a group quote.
The broker will listen to what you want to offer (PPO vs. HMO, your past experience with insurance companies, how many employees, or their children live or work outside of Colorado etc) and narrow this down before sending it to you because there are over 100 options and it can get confusing. Starting in 2014, only small businesses with 50 or fewer full-time employees are eligible, but in 2016, businesses with 100 FTEs can apply for insurance through SHOP. If you do not qualify for the Colorado Health Care Exchange the broker will find you other small group options through their MGA. This would be a wage base of over $50,000 a year (example: group of mostly doctors or IT professionals).
Coverage must be offered to every employee who works full-time, under the federal rules, which considers full-time as anyone working 30 hours or more a week.
How do I know if the business will receive a tax credit?
Small businesses with fewer than 25 full-time employees who earn about $50,000 a year or less are eligible for the credit. Businesses must pay at least 50 percent of premium costs, but are not required to offer coverage to part-time workers or any family members. Nonprofit organizations receive a 35 percent tax credit and only businesses purchasing through the SHOP marketplace are eligible. Tax credits are highest for companies with fewer than 10 employees who earn an average of $25,000 or less. The smaller the business, the bigger the credit.
Which companies are writing Health Insurance in Colorado?
In the Denver Region: (1) Humana’s HMO-new!, (2) Kaiser Permanente HMO, (3) CO Choice-new!, (4) Humana’s PPO, (5) Anthem Blue Cross HMO/PPO, (6) COOP-new!, (7) SeeChange Health PPO, (8) Rocky Mountain Health PPO and HMO, (9) United Healthcare PPO and HMO.
In the Boulder Region: (1) Kaiser Permanente, (2) Anthem Blue Cross, (3) SeeChange Health, (4) COOP-new!, (5) Humana, (6) Rocky Mountain Health, (7) United Healthcare.
In Summit County (1) Rocky Mountain Health Plan (2) Anthem Blue Cross (3) SeeChange Health (4) Colorado HealthOP New
Which Insurance Companies will offer a PPO Option on the Colorado Health Care Exchange SHOP for Small Groups? At this time, See Change is the only PPO and they utilize the Cigna network. All other plans on the SHOP are HMO or HMO Hybrid plans. COOP utilizes an EPO/PPO.
What other options are available to provide corporate benefits to help me retain and attract employees? When an employer installs a small group health insurance plan, dental, vision and group life are easier to add and there are less pre-existing limitations for some coverage’s in a group environment.
I have a young, active and healthy group of employees with no major health conditions. We have had group health insurance for a few years but find the rate increases to be outrageous. What can we do to minimize our costs? We have creative products for healthy groups who are able to “medically qualify” for a partially self-funded health insurance plan. Premiums can be 10-30% less than the guarantee issue plans on the fully insured market and if you have a year with few claims, you may qualify for a “participation in the claims fund” in the form of a refund of some of the claims part of the premium or a premium holiday for employees. This option is only useful for HEALTHY groups who can make it through medical underwriting and have over 10 employees. We can also pair with a gap coverage, raise your deductible and sometimes what was a 20% increase becomes a 2-5% decrease. We have to evaluate your group to see what works.
How do businesses receive tax subsidies? Business tax credits related to health insurance coverage already went into effect in 2010 and were up to 35% for qualifying small businesses with employees who make less than $50,000 a year and less than 25 employees. For 2014, the tax credit is 50%. Business owners apply for those tax credits when they file their annual tax returns.
What if my business already offers health insurance to employees? Businesses that already offer health insurance can keep the coverage they currently offer. However, those with 50 or fewer full-time workers can offer a plan via the marketplace instead.Tax credits are only available to businesses who receive coverage through SHOP. Employees can buy health insurance through the Marketplace, but if their business coverage is considered both affordable and meets minimum value, they will not be eligible for federal subsidies, and the business will not have to pay the Employer Shared Responsibility Payment.
What should businesses tell employees about the marketplace? Companies covered by the Fair Labor Standards Act must provide a written notice to employees before Oct. 1. The notice should include information about the marketplace. If employees might be able to get lower costs on insurance by using the SHOP marketplace and if they buy insurance through the marketplace, they’ll lose the employer contribution to their health benefits.
How do employees sign up for SHOP? Once an employer chooses SHOP coverage through their Colorado Healthcare Exchange broker, employees can sign up for it online through the marketplace. There are tools to help create an employee roster and set up an email distribution list notifying employees about the coverage. Employees must verify personal information and review the plan. Employees can see how much they will pay every month, their deductible and their out-of-pocket costs.
What if I’m self-employed? People who are self-employed with no employees can use the individual marketplace for insurance coverage. Business group of “one” is no longer available after 1/1/14 because of the availability on the exchange. The federal government considers a person self-employed if he or she runs an income-generating business but has no other employees. Independent contractors do not count as employees, under federal guidelines. And there are new options under the ACA. Starting Oct. 1, people who are self-employed can go to Connect for Health Colorado to compare features of plans, determine premiums, deductibles and out- of-pocket costs before enrolling. No one is denied coverage based on pre-existing health conditions. People with individual insurance policies might be able to switch to a marketplace plan. Based on annual income, the monthly premiums could be lower If a small employer reports that their business has grown since they created their Small Business account, which now makes them ineligible, will they be kicked out of Marketplace?
As long as employers meet the criteria for eligibility when they join the Marketplace, they will still be eligible regardless of subsequent growth.
How much must an employer contribute to get the tax credit for starting or moving a small group to the SHOP? In the Small Group employers are required to contribute at least 50% of the premium cost or $125.00 minimum, whichever is less. An employer may also pay up to 100% of the premium for the employee and they may qualify for up to a 50% tax credit based on the number of Full Time Equivalent Employees and average wage base. Can we offer our group coverage to 1099 employees? Only Anthem and Humana allow this on a group plan and you must have W2 employees to start.
I am/have employees on Specialty Level Medications or Injectables. How will they be covered in 2014? Please check the Prescription Formulary for the insurance plan you are evaluating. If you are taking a tier 4 or tier 5 level medication some of the new insurance plans both inside and outside the exchange have a CLOSED FORMULARY. If the medication is not listed, it’s NOT covered. Please, please make sure your meds are covered by that insurance company before you enroll for 2014.
I am/have employees on maintenance drugs for: Asthma, Allergies, High Cholesterol, Menopause, Diabetes, etc. What limitations do I have when I pick a plan? Anthem Clear Protection is Generic Only. Some of the other plans are Generic (Tier 1) only. This means after the Rx copay for generic, Tier 2-5 drugs are NOT COVERED on a plan that says “GENERIC ONLY”. Please be aware as you pick a plan. If you choose a plan with Deductible and Co insurance and no Rx copay plan, your Rx will be under that deductible. For example the Asthma drug Advair might cost $400 with a contract amount from the insurance company might be $180 which would apply toward combined and Medical/Rx deductible. Several of the health insurance plans both on and off the exchange say N/A for Tier 5 drugs. This means it’s not covered and you need to find a different health insurance provider.
I have an HSA now and may switch to a non HSA plan what happens to the money in my account? You can keep the account but it’s not tied into a plan. The bank will audit. If there is no medical plan associated with the account, it may be converted to a regular savings account. You cannot fund the account but can spend the funds down to zero for qualified expenses for any qualified medical expense billed by the MD or hospital but not towards the deductibles or co-pay. You use this instead of your copay or deductible until the account is emptied out.
Are Smokers charged more for health insurance? Each family member who smokes will have a smokers load on their rates. Anthem will load 10%, all others are loading 15% on their rates.
What health insurance companies are on the Colorado Healthcare Exchange enrolling group insurance?
- Anthem (HMO Colorado and Rocky Mountain Hospital & Medical Service) (Individual & Small Group)
- Colorado Choice Health Plans (Individual & Small Group)
- Colorado Health Insurance Cooperative (Individual & Small Group) PPO and EPO utilizing Cigna (Gold Plans) and Cofinity Networks
- Denver Health Medical Plan HMO (Individual) (note this is limited to Denver Health and associated hospitals)
- Kaiser Foundation Health Plan of Colorado HMO (Individual & Small Group) (note this is limited to Kaiser clinics and Kaiser contracted hospitals)
- Rocky Mountain HMO (Individual & Small Group)
- Rocky Mountain Health Care Options (Small Group) PPO 2+ employees
- See Change Health Insurance Company (Small Group) PPO 2+ employees
What health insurance companies are writing coverage OUTSIDE the Colorado Healthcare Exchange?
- Anthem PPO and HMO
- Assurant (Individual/Family) and Partially Self Funded 10+ Groups utilizing Aetna and Cigna Networks
- Cigna PPO Individual/Family and Groups of 20+
- Colorado Health Insurance Cooperative
- Rocky Mountain Health Plan (Individual and Group-HMO and PPO)
- Kaiser Permanente HMO (Individual and Group 2+)
- See Change (Small Group PPO 2+) utilizing Cigna network
- Humana Individual and Group (HMO and PPO)
- United Healthcare HMO/PPO
I live in outside of the Denver/Colorado Springs area. What are my choices? Anthem HMO and RMHP HMO for individuals. Anthem HMO and RMHP HMO and See Change PPO for Groups. If you currently have a Cigna individual plan and “early renew” for 12/31/13, Cigna will allow you to stay on the plan but they are not selling Cigna Individual in 2014 outside of Denver and Colorado Springs metro counties.
Anthem HMO and RMHP HMO for individuals are statewide. Anthem HMO and RMHP HMO and See Change PPO for Groups. If you currently have a Cigna individual plan and “early renew” for 12/31/13, Cigna will allow you to stay on the plan but they are not selling Cigna Individual in 2014 outside of Denver and Colorado Springs metro counties.
Colorado Health OP is Colorado’s new Health Cooperative with PPO/EPO PPO Networks: Cigna for GOLD plan and Cofinity Network for Bronze and Silver plans (Cofinity is Aetna). The EPO will have their provider spend more time with you. EPO is a smaller network that is only available in Arapahoe, Boulder, Broomfield, Clear Creek, Denver, Douglas, Gilpin, Grand, Jefferson, La Plata, Larimer, Logan, Morgan, Park, Summit and Weld counties. EPO works like an HMO has NO out of network coverage, but you may choose a specialist without permission from a PCP. Out of network and out of state is considered out of network unless it’s an emergency, just as it is with any HMO. This may not be appropriate for folks with children who live out of state. Chiropractic is covered if it’s a Cigna or Cofinity network provider depending on the network as an “other office visit” copay
How Do I Find Out If My Doctor is In The Network? Don’t assume that your MD is in the network in 2014 if you stay with the same insurance company. A switch to the exchange and/or individual plans outside of the exchange may have a different network that is smaller than the network used in 2013.
Network List and Links:
Cigna www.Cigna.com/ifp-providers Individual Only PPO Exchange/Non Exchange
Colorado HealthOP http://www.cohealthop.org/BenefitPlan Exchange/Non Exchange Individual/Group EPO/PPO Utilizes the Cigna Network for GOLD plans and Cofinity Network for Silver and Bronze Plans
Humana http://pfp.humana.com/Pfp/PfpMain.aspx?cust=1059&pfpkey=733 Individual HMO Exchange, Non Exchange Individual/Group HMO, PPO
Kaiser Permanente https://healthy.kaiserpermanente.org/html/kaiser/index.shtml?region=DB
Rocky Mountain Health Plans https://rmhp.healthtrioconnect.com/public-app/consumer/provdir/entry.page Individual HMO Exchange, Non Exchange Individual/Group HMO, PPO
SeeChange Health http://www.cigna.com/web/public/hcpdirectory Group 2+ Exchange/Non Exchange Utilizes the Cigna Network
United Healthcare http://www.providerlookuponline.com/uhc/po7/gateway.aspx?delsys=92 Group 2+ Non Exchange UHC
Access Health Colorado http://www.accesshealthco.com Medicaid/Medicare and CHip
Colorado Choice Health Planshttp://www.slvhmo.com/broker/index.php Outside of Front Range
All the questions about health insurance and health care reform have me thinking about all of my coverage. What other options are available to help my family and I round out our coverage and fill the gaps? As your broker, we can look at all the coverage you currently have in place and supplement your health insurance where needed. Items we think should be reviewed/audited yearly:
Are you and/or your children active in sports, sports leagues, skiing, mountain biking, dirt biking, etc? Have you experienced a sports injury? What did you pay for a broken bone or surgery for a torn ACL? Accident coverage is inexpensive and helps pay your deductible with the high deductibles on these new health insurance plans. We have plans that cost around $1/day and can cover those big bills. A broken bone and minor surgery can easily set you back $7500-$12,000 (deductible/coinsurance)
Do you have adequate life insurance in place? A good rule of thumb is to have a minimum of ten times your salary and if you plan on sending kids to college and your spouse does not have nearby help should something happen to you.
Do you have disability coverage? SSDI does not kick in unless you are almost a vegetable and can take 2 years to qualify for usually a $800-$1000 amount. Can you live on this? We have affordable options to “continue your salary” if you are disabled.
Does cancer, heart disease or diabetes run in your family? Critical Illness coverage is a popular option to help cover high deductibles and cover the cost of non medical items, travel for treatment and the peace of mind to have extra cash on top of your (60%) short term disability payment to pay your mortgage and utilities while you recover. For a low cost you can cover you and your family and if you die of other causes, one of our plans PAYS BACK ALL PREMIUMS (for death of other causes)…so you never lose.
Are you over 50 and have you experienced the cost of and extended care facility with a parent or grandparent? It’s over $70,000 a year today. There are some great options that you can lock into with hybrid products that combine life insurance and long term care and help protect your nest egg.
Do you have a health condition and know you can’t qualify for life insurance or long term care coverage? We have excellent short term care policies that are under $1 a day in cost that pay a daily benefit for home health care only for one year and the app doesn’t ask a lot of questions. Your health insurance has limited home health care, nursing and rehab that is usually to 15 days. What will you do when that runs out?
We have great supplemental insurance plans (at a discount to “duck” prices) that pay out more at point of claim and don’t cost the employer anything to offer, in fact employers will save on FICA with a FREE Premium Only Plan to pre-tax your benefits.