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Insurance Now
Specializing in Affordable Health Insurance Plans in Georgia In Atlanta Call 770-396-9517 or Toll Free 1-877-711-8376
Specializing in Affordable Health Insurance Plans in GeorgiaIn Atlanta Call 770-396-9517 or Toll Free 1-877-711-8376

Why Small group?

This year many business owners are exploring their options when it comes to insurance plans for their family and employees. Small group plans are great for business owners who aren’t getting a tax credit or who aren’t getting much of one. These plans premiums are tax deductible, offer more benefits, and are about the same cost of what an individual plan costs today!

Comparing Individual to Small Group

Years ago small group became much more expensive than individual, and thus made small group unappealing and even unaffordable for small business owners. But with the increases in premiums for individual, they are now the same cost, and small group has actually much better benefits than individual. Take the below example.

 

Individual Plans

*Prices based on a 37 and 38 year old in GA*

BCBS

Kaiser

BCBS

Plan Details

Plan Details

 Plan Details

 Plan Details

Network

HMO

HMO

POS

Tier

Silver

Silver

Silver

Deductible

$3500

$3000

$3500

Out of Pocket

$4850

$7150

$6500

Coinsurance

25%/50% (depends)

30%

10%/50% (depends)

Office Copay

$20/25% after Ded

$30/$60

$50/$75

Urgent Care

$90

$100

$50 + 10% after Ded

Inpatient Hospital

$500/stay + 50% after Ded

30% after Ded

$500/Stay + 50% after Ded

Generic Drugs

$5

$15

$10

Pref Brand Drugs

$40 After $1k Drug Ded

$45 after $500 Drug Ded

$40

Price

$670*

$734*

$850*

This is the cost for 38 and 37 year old John Joe and Mary Margeret on an individual silver plan currently available in Georgia. (I’ve put them together on one plan for this example) Mary is John’s employee at Example Associates, who he pays a portion of her individual health insurance for. STOP: John, this is not allowed, and is against the law under the current ACA law. Please read on about how YOU could be penalized for doing this. Even so, John is still over spending on sub-par insurance he could be offering legally to Mary and himself. Now, lets look at 4 plans from 4 different carriers offering small group options:

 

Group Plans

*Prices based on a 37 and 38 yr old in GA*

Kaiser

Aetna

 

Humana

BlueCross

Plan Name

Silver HMO KP 3000 20 40

GA silver OAMC 5000 100/70 Choice

GA Simplicity HMO 17 OA Premier Opt 6 Silver

BCBSHP Silver Open Access POS 5000/20%/6750 Focus-2FEF

Network

HMO

POS

HMO (avail. As POS)

POS

Tier

Silver

Silver

Silver

Silver

Deductible

$3000

$5000

$0

$5000

Out of Pocket

$7150

$5750

$7150

$6750

Coinsurance

80%

100%

100%

80%

Office Copay

$40/$70

$30/$60 after Ded

$55/$110

$30/$60

Urgent Care

$80

$75 copay after Ded

$125

$100

Inpatient Hospital

80% after Ded

$250 Copay After Ded, Per Adm.

$2350 copay per day, 1st 3 days

$350 Copay per adm, After Ded

Generic Drugs

$5/$25

$3/$15

$10

$5/$20

Pref Brand Drugs

$50

$45 after $5000 Ded

$50

$50

Price

$697*

$704*

$714*

$765*

 

Before we get into the technical benefits, I want you to look and Identify 3 things that immediately grab your attention. Here are my top 3:

  1. Carrier choices. While individual only has 2 off exchange carriers available, Small group has 4 that we carry. This opens the door to more choices for you.
  2. Networks. Believe it or not, there are more affordable POS plans available with Small group than there is on individual. Even with the HMO’s, you have more network than you do with pathway HMO on BCBS.
  3. Price. While the Silver Pathway HMO plan may be cheaper, take a look at what the first POS in both individual plans and group plans cost as a silver level. $704 on small group, $850 on individual. That is a $146 difference! 70% of our clients in 2016 would rather be on a humana POS plan than an HMO plan and would pay more for it if it meant they could keep their doctors. With small group, you don’t have a huge difference in premium between HMO’s and POS plans, which means you get to offer your employees a benefit that they don’t feel like has disadvantages.

 

 Aetna’s plan, while similar in limitability on benefits with the $670 individual plan, still has major differences that are going to make a difference. For starters, 100% coinsurance after deductible, vs 25% coinsurance for SOME benefits, and then 50% for major things (surgeries, inpatient hospital stay, etc) and the network. While Aetna’s plans that do not have specialist visits before deductible are normally ones we try to veer away from, they do offer a great opportunity to show that even a more limited plan under small group has better benefits than an individual plan.

The Catch

Everyone always wants to know the downsides of doing small group. The “catch.” While I wouldn’t consider them downsides or catches, there are guidelines insurance companies follow, and pricing differences that are something to consider.

  1. Husband-Wife Businesses do not qualify for small group if you have no other W-2 employees. This is a relatively new rule and is one we’ve found frustrating. According to insurance companies, if you are a 2 person group composed as such, you should be on individual.
  2. You must have at least 1 W-2 employee that is not yourself. Self-explanatory. Most insurance companies require 2 enrollees, but some will take just 1 if your other employee has other coverage through a spouse or similar.
  3. Coverage has to be offered to all full time employees (you decide whether this means 30hrs-40hrs). this is simply to protect you from a law suit for discrimination.
  4. At least 50% of employees that are eligible for coverage (i.e. does not have coverage through a spouse) must take the plan you offer.
  5. you must cover between 50%-99% of the employee only rate, you can cover however much of the family/spouse rate as you wish, even if it means 0%.

Other Benefits

 With the guidelines out of the way, if I still have your attention it means you are still curious enough to consider small group for your employees and self. Here is a list on why we like Small group from an agent standpoint and as a receiving employee of a group plan.

  1. Problems are easier to solve. Any issue you have, just send it over to us. 9/10 times we can solve the issue within a day. Groups tend to get more attention when an issue arises than an individual does from insurance companies. (bigger possible losses mean better responses to get things fixed. While we wish it wasn’t true, time and time again this statement has proven correct)
  2. Better benefits. I’m going to constantly drive this point home. Our blue cross plan right now is a $0 deductible/ 2000 OOP plan, 10% coinsurance. While this is a better plan than most choose to go with, it is available and there is nothing close to it available with individual.
  3. You can offer different plans to your employees from the same company depending on your group size. So if John Joe was wanting a gold tier plan for himself, but knows Mary Margret either can’t afford or wants to go with a silver level plan, John can choose another plan option (provided the insurance companies required group size is met, John joe may need to have a larger group.)
  4. Employer login. Some insurance companies offer an employer site to add employees and view billing and census information. It gives the control to you, the employer. We also can access this for you depending on the company and help with changes.

Additional Benefits

Add on benefits or Ancillary products is an easy inexpensive value you can offer to your employees. Most of our individual clients feel like their dental and vision benefits really aren’t the best value. I personally hate the dental plans available through individual, and there’s only 1 vision benefit I really like talking about though individual and they are all EXPENSIVE. Dental for John and Mary is roughly 30 a person based on their age on group, Vision is just $4 each for $130 frame allowance (great if you are like me, and seem to always pick up the highest cost frames in the store.), and most insurance companies that offer ancillary products offer rate reductions if you choose to offer them to your employees alongside a medical plan. Ancillary products are voluntary benefits and require no employer contribution, but is available to do so. Ancillary includes dental, vision, and life products. Life for John and Mary is $1.80/each at the lowest. If nothing else, for us the vision and life benefits are a no brainer. 

Business Benefits

As a business owner, benefits you can deduct as an expense are always nice, but there are many more benefits to offering a health insurance plan to your employees.

  1. Tax deductible for your business. This is just one of those things that speaks for itself. If you can write off the expense it's not only better for your employees, but better for your business.
  2. Appeals to the talent you are looking for. Now days it can be hard to fill a position and keep it filled for small business owners. Large companies are required to offer health insurance to their employees and benefits can be a deciding factor for the employees you want. Attract the talent, boost your business.
  3. Decrease the risks associated with poor health. When your employee goes without health insurance or without insurance they value, they tend to wait until their conditions worsen to seek medical help. This can lead to more days missed of work which inpacts your business.
  4. Enhance your offer and improve morale. Small businesses that offer health coverage tend to have happier employees. Some employees would rather have benefits than a higher salary. having a small group plan not only benefits your taxes, but also theirs. An employee can contribute to their premium pre-tax by having it withdrawn from their paycheck, which increases their take home pay, and decreases their taxable income.

 

Many employers don’t know what they can and cannot do when it comes to insurance. You can find the guidelines for employers offering benefits here and what is required.

 

If you fall under the group of employers that have chosen to pay for employees individual plans, here is some things you should know:

  1. Individual reimbursement is NOT tax deductible. if you choose to do this, it must be out of your own pocket.
  2. If you are reimbursing your employees in any way, they do not qualify for a tax credit.
  3. If you get caught doing this, there are hefty fines associated with it. the normal penalty is $100 per employee per day. In 2016, the IRS began cracking down on these rules.
  4. Not to mention doing this you put yourself at risk for discrimination lawsuits. If you are paying one full time employee’s premiums and not the others this can create issues down the line.

 

If you fall under the group of employers who offer a plan, but do not encourage employees to obtain insurance through the company, you should be aware of the following:

  1. If one of your employees is getting a tax credit, you are given a certain amount of time to respond on why they are not obtaining insurance through the group. YOU can be fined for your employees obtaining coverage through the marketplace.
  2. You can also be fined if it is found that the coverage is not affordable for your employee (9.5% or greater of the employee’s income for the employee only rate) for example. If your employee is making 2,000 gross a month, then their monthly share of the premium cannot be more than 190 (gross monthly income/9.5% or gross income*.095)

HOWEVER, theres an app for that, or rather a form-- to keep you protected. (We have that too in case you were wondering.)

 

We always are available to help make decisions to keep you legal, and we do everything we can to make employees aware that if their employer is paying, they cannot receive a tax credit and their employer cannot write it off if its an individual plan. 

How to explore your options 

Unlike Individual plans, Group policies do not have a time period for when they are allowed to begin. (This is only true to picking up a new group policy, not about when employees can join the policy.) So if you decide you’d like to take a look at group products in June, you can do that.

 

Lets take John Joe again. John is ready to look at plans for Example Associates, but has no idea how to find rates.

 

John can reach out to us, his insurance agents, to get information about what is available for his company. John doesn’t have to go to each company or other agents, because the rates we have are the same wherever he goes. This saves him time and allows him to be able to talk to the same folks whenever he has an issue or needs to make changes, which means he can get back to his business matters faster.

 

John will be given a Census sheet, that he can either type or write in everything from business name and type of business, to giving us a census of current full time employees that will be offered coverage. there is even a spot that allows John to identify what type of plan and deductible he is looking for, as well as ancillary products he may want to price out. from there, John will send back the census to us. Once received, we will create a proposal about what Example Associates wants and needs, and send back the proposal for John to look over.

 

It is that simple.

 

We help with everything. From choosing the plan that is going to fit your company the best, to getting you enrolled and everything after.

 

So what are you waiting for? Let us help you explore your options with small group. Contact us today:

 

Insurance Now

770-396-9517

 

Written by:

Shelly Conley

Email me at: Shelly@insurance-now.com

All examples are for comparison purposes. Rates depend on group size, Age, and Area. Rates are figured for a 37 and 38 year old male and female, located in Fulton, GA. Employers cannot add non-relatives to their individual policy to cover an employee.

Phone:

770-396-9517

Fax:

770-396-4318

Email:

holly@insurance-now.com

shelly@insurance-now.com

2472 Jett Ferry Rd #400-350 

Atlanta, Ga 30338
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