Changes to Group Health Insurance Plans by the ACA

Like it or not, changes to group health insurance plans under the ACA affect what employers offer their employees. The ACA creates standards of acceptable health insurance coverage for all Americans. In the past, as a small business, you negotiated group health insurance plans based on the needs of your employees and the affordability. The ACA significantly impacts your ability to do this. Call us for specific advice on how to keep your business profitable and control costs established by the ACA.

Financial Impact on Small Businesses

Estimates show that new fees and requirements established by the ACA could potentially add up to an additional 8% in medical care costs. The fees apply specifically to certain industries, such as health insurers, pharmaceutical suppliers and medical device suppliers, which in turn impacts all group plans. Each business must pay the extra cost to manage health insurance.

We Offer Risk Management Strategies to Offset Costs

We leverage our size and experience to give you and your employees comprehensive benefit plans at the most affordable rates possible. We also provide several money-saving administrative duties. In addition, we can help you manage your costs by setting up risk-management strategies such as:

  • Wellness programs
  • Biometric screenings
  • Online health screenings
  • Eliminating working-spouse coverage
  • High deductible plans, health savings accounts

Requirements for Group Health Insurance Plans

The Group Health Plan Standards in the ACA require coverage to change as well. Sometimes the plan provides more coverage but it may also cost more. Keep these requirements in mind as you consider how ACA changes affect your business:

1. These essential Health Benefits (EHBs) must be included in every group health plan:

     I. Ambulatory patient services

     II. Emergency Services

     III. Hospitalization

     IV. Maternity and newborn care

     V. Mental health and substance abuse disorder services, including behavioral health treatment

     VI. Prescription drugs

     VII. Rehabilitative and habilitative services and devices

     VIII. Laboratory services

     IX. Preventative, wellness and chronic disease management

     X. Pediatric services, including oral and vision care

2. Deductible Limits for EHBs - $2,000/individual and $4,000/family. No annual and lifetime dollar limits.

3. Out-of-Pocket Maximums for EHBs - $6,350/individuals and $12,700/family.

4. Extended Coverage to dependents up to age 26.

5. No Pre-Existing Conditions Exclusions.

6. Premium rates can only vary by family size, geography, tobacco use and age.

7. An easy-to-understand Summary of Benefits and Coverage.

Let us worry about the details of FTEs, EHBs and the ACA, so that you can concentrate on BYB: Building Your Business.

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