The In’s & Out’s of Small Group Health Insurance
How many employees do I need for a group health care plan?
You need 2 full time employees to enroll
What is considered full time?
Any employee regularly working 30 hours or more hours a week.
May I offer health coverage to part time employees?
No, it must be for full time employees only.
Do I have to meet any participation requirements?
Yes, you need to have 50% of eligible employees enroll after valid waivers.
What is a valid waiver?
- Other group coverage through a different employer
- Other group coverage through a spouse or parent
- Coverage through Medicare, or Tricare
How Premiums are determined for Small Groups
Under the Affordable Care Act, employers with under 50 full time employees in Ohio use community based rates to offer health insurance policies within a given territory at the same price to all persons without medical underwriting regardless of their health status.
Premiums are based on the following;
- Age
- Sex
- Tobacco Use
- Home Zip Code
Will premiums be higher or lower than another broker?
Premiums will be the same among brokers for small group health insurance. Any differences will be based on differences in the census or discounts.
What discounts do you offer?
We offer a Chamber of Commerce discount through Anthem, the same that is available to all brokers with Anthem.
What Insurance Companies do you work with?
- Anthem
- United HealthCare
- Medical Mutual
- Aetna
- National General
- Starmark/Trustmark
Should I consider a Multiple Employer Welfare Association (MEWA)?
Yes, MEWAs pool the risk factors of multiple small groups into one large risk pool. Each employer contributes to the MEWA plan based on the number of employees their respective group has. However, keep in mind MEWA’s require medical underwriting from every employee (not just the employees taking coverage) and will decline groups with poor health.
Should I consider a Level Funded Self Insured Plan?
Yes, if you have 5 or more employees enrolling, but keep in mind Level Funded Self Insured Plan’s require medical underwriting from every employee (not just the employees taking coverage) and will decline groups with poor health.
Do you offer group life, disability, dental, & vision?
Yes, we do with a variety of insurance companies
May I add group life, disability, dental, & vision to a small group health insurance plan?
Yes, but we typically recommend other companies that specialize in those products
How do we get started?
Complete a small group census and return. Please keep in mind that every change to the census or update will affect the premium, so please complete the census as accurately as possible.
Questions?
Call, text, or email Liz at 1-740-397-1234 or liz@dumbaughinsurance.com