Small Group Health Insurance
Small businesses, often those that are under 50 employees, are able to offer their employees health insurance through the small group market. The small group market is rated based on location or age, rather than by plan utilization and claim history. The cost of small group health insurance is the same across all individuals in a certain zip code and/or a certain age group, depending on the state.
Companies that have under 50 employees are not required to offer their employees health insurance coverage, and if they do, there is no limit to the cost that employees are required to pay for this coverage. However, larger companies are required to offer insurance that is considered “affordable,” or else they will face large monetary penalties.
Despite not being required to offer benefits, small business owners are able to claim the cost of health insurance on their taxes, which is an advantage. Offering employees insurance also leads to better employee retention, job satisfaction, and candidate applicant pools, since employees feel their employer is concerned about their health and well being.
There is a large variety of different benefit plan designs for small group insurance. Each geographic area has certain insurance carriers that offer small group products for that location, and each of these carriers offer plans of varying cost and coverage levels. For example, New York small group premiums are based on the zip code of the employer. The health status, age, or gender of the employee enrolling in NY small group health plans do not factor into the cost.
There are multiple types of plans available based on carrier and geographic location. Employers can choose to offer one or more of these plan types, such as HMO, EPO, or PPO. HMO (Health Maintenance Organization) plans often have a more limited network of participating providers and may require the insured to designate a primary care physician in order to monitor their care and make sure they are referred to appropriate in-network specialists when needed.
Another benefit of small group health insurance is that these plans are governed by the rules of the Affordable Care Act (ACA). The ACA mandates that certain essential health benefits must be included in every health plan; otherwise, these plans are not considered to provide comprehensive and valuable coverage. Some of the included essential health benefits are preventive care, which allows individuals to get regular check-ups at no cost for the purpose of avoiding more costly medical care in the future.
Also included is care for maternity and newborn children, mental health and substance abuse treatment, prescription drug coverage, emergency care, and more. In addition, true emergency care is required to be treated as in-network even if rendered by a non-participating provider. One of the most notable provisions of the ACA was the removal of pre-existing condition limitations on medical coverage. Insurance carriers cannot deny medical coverage to someone based on whether or not they had previously sought treatment for this condition prior to being insured by their current insurance carrier.