Our mission is always to maximize the benefits and the provider-access of the programs we design—no matter the budget or the size of the company--so that our clients can attract and retain top-quality employees.
We can assist with even the most sophisticated large-group self-funding arrangements, while still helping individual employees, who may be in crisis, to find in-network physicians or to fight an insurer who has refused to approve a necessary treatment.
We also simplify compliance with the Affordable Care Act with an assortment of HR solutions.
The following information is from an article I've written for one of my professional associations, explaining what's new for Small Groups (up to 100 employees) in the 4th Quarter. I hope you'll find this helpful, and, of course, I hope you’ll reach out to us, as it would be our privilege to design a benefits package for your company.
Anthony Elliot, August 31st, 2016
EMPLOYERS CAN NOW OFFER MULTIPLE HMO NETWORKS
Years ago, insurers introduced less-expensive subsets of their full HMO networks; think of them as “Medium” and “Small”. While a full network will have all the medical groups contracted with an insurer, a Medium network excludes the expensive ones, like Cedars-Sinai and UCLA, while a Small network excludes even more. Many employers switched to smaller networks out of necessity, causing some employees to lose the doctors and hospitals they prefer.
This year, for the first time, almost all major insurers will permit small groups (1 to 100 employees) to offer multiple HMO networks, side-by-side, in the 4th quarter. Here’s how this helps: if your company has some employees in, say, Pasadena, and they’re using Healthcare Partners Medical Group, these employees can choose an affordable Medium-network HMO and be well-served; meanwhile, employees on the West Side, who need UCLA or Cedars-Sinai medical groups, can opt for a full-network plan. Further, young and healthy workers who hardly care about coverage can choose a Small-network plan at very low cost. As always, PPO’s can also be offered. With this flexibility, employees will no longer waste money on network access they don’t need, while everyone can finally reach the doctors and hospitals they prefer.
CARRIERS HAVE RELAXED PARTICIPATION REQUIREMENTS – EASIER TO MIX AND MATCH
Until recently, enrolling your business in a small group health plan meant bringing a very high percentage of eligible employees to your insurer. This is called the “participation requirement”, and it used to range from 70 to 80 percent. No longer. Anthem and Blue Shield will accept groups in the 4th Quarter with fewer than 30% of eligibles enrolling, as long as you have at least 5 enrolling. Health Net requires only 50%. So it’s never been easier to mix, for example, Anthem or United Healthcare PPO’s (extremely competitive!) with Kaiser or Aetna HMO’s.
EMPLOYERS AND EMPLOYEES SHOULD TAKE ADVANTAGE OF TAX BREAKS AND CREDITS
Group health plans are superior to those sold on the individual market in terms of network size and value, especially when you consider the tax benefits. Monies contributed by an employer toward qualified employee benefits are a deductible business expense; employee contributions, made through payroll deduction, can be made with tax-free dollars, as long as the employer establishes a Section 125 Premium Only Plan. Further, employers, no matter how small, can now set up a low-cost Flexible Spending Account, so that employees can use tax-free dollars to pay their out-of-pocket costs for qualified medical and dental expenses. Your broker can recommend reliable, low-cost administrators to establish your Premium Only Plans and FSA’s.
Employers with fewer than 25 employees may be eligible for generous year-end tax credits if they purchase a health plan through California’s small business exchange, known as “Covered California SHOP”. The SHOP exchange lets each employee choose his or her health plan from several different companies, including Kaiser, Blue Shield and Health Net. Please be aware that SHOP will improve on January 1st of 2017, with the arrival of high-end PPO’s from Blue Shield.
BE CAREFUL ABOUT INSURANCE ON THE INDIVIDUAL/FAMILY MARKET
Individual/Family health plans use smaller networks than group plans, and they’re susceptible to greater instability. California has already lost Assurant/Aetna PPOs. This year, Anthem Blue Cross will withdraw their PPO products and replace them with EPO’s, which have no out-of-network coverage.
Employers who are disinclined to provide benefits should strongly consider creating a group health plan under the Special Enrollment privilege. Employees can pay their own premiums 100% with tax-free dollars through payroll deduction, and they can enjoy the superior benefits and provider-access of group insurance. Employers also benefit, as wages re-directed to pay insurance premiums will not be subject to payroll taxes or work comp premiums.
WORK WITH A TECH-SAVVY, ENTHUSIASTIC INSURANCE BROKER
Providing so many choices to employees might sound complex, but it’s simple when your broker can prepare easy-to-read menus and enrollment guides, and when he or she gives personal attention, so that employees can make informed choices.
GET STARTED NOW
Please don’t wait, because brokers and insurers become inundated as virtually all California groups and consumers renew their plans at the end of the year.
Anthony Elliot is President of Anthony Elliot Insurance Agency, Inc. in Studio City, CA. He is a past Legislative Chairperson of the Los Angeles Association of Health Underwriters.
Copyright 2016 Anthony Elliot