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Navigating Health Care Compliance For Small Businesses

Navigating Health Care Compliance For Small Businesses

Let's be honest: Managing health care can be challenging and expensive for your business. You might think about putting it on the back burner, but with health care costs consistently rising, you can't afford to wait. In addition to a fair paycheck, your employees expect competitive benefits to take care of themselves and their families. Understanding what your employees want and need is a big part of managing health care successfully, but the complexity lies in ensuring compliance.

Navigating health care can be a challenging endeavor, especially for small businesses. It involves grappling with ethical considerations and data privacy concerns, making compliance a growing challenge. In this context, non-compliance could result in substantial fines and potentially lead to legal ramifications, a scenario you want to avoid.

Partnering with a professional employer organization (PEO) like GMS can be a great option to alleviate some stress. GMS offers an excellent solution for obtaining comprehensive health care coverage for your team while maintaining compliance. However, if you are determined to handle health coverage independently, there are essential things to consider.

Health Care Compliance

Under the Affordable Care Act (ACA) guidelines, businesses with 50 or more full-time employees or the equivalent in full-time equivalents (FTEs) must provide health insurance coverage. In addition, you must provide this coverage to all eligible employees within a maximum waiting period of 90 days. Failure to comply can lead you and your business to face hefty penalties.

You’ll also need to provide employees with a comprehensive Summary of Benefits and Coverage (SBC). The primary objective of the SBC is to offer a clear and detailed explanation of what the health plan encompasses, as well as the associated costs. This empowers your team to make well-informed decisions concerning their health care choices.

Suppose your business fails to meet these requirements, and one or more of your full-time employees receive premium tax credits or other government assistance to purchase coverage on the Health Insurance Marketplace. In that case, you may be subject to the Employer Shared Responsibility Payment (ESRP). This payment is a financial penalty imposed on the company to ensure large employers play their part. The ESRP ensures that large employers provide access to affordable health care coverage for their employees and prevents them from shifting the cost of health care coverage to government-subsidized programs.

  • Note: Businesses with less than 50 full-time or FTEs are not subject to ESRP.

Compliance For Small Businesses

You may be thinking health care compliance doesn't apply to smaller businesses. While it's true that you're not obligated to offer health insurance, it shouldn’t be overlooked as it can be a valuable tool in recruitment and retention efforts. If you decide to provide health insurance for your staff, it's crucial to customize your coverage to match your team's specific needs while ensuring compliance with the regulations and protections outlined in the Americans with Disabilities Act (ADA). A general framework for achieving this is outlined below:

1. Use anonymous surveys. Seek input from your team regarding their health care needs and preferences by using anonymous surveys. Anonymity can help ensure that individuals feel comfortable providing honest and open feedback without fear of potential discrimination.

  • Focus on health care needs. Frame your questions to inquire about specific health care needs and preferences rather than individual health conditions. For example, you might ask your employees about preferred types of coverage, particular services they value, or what aspects of their current plan they find beneficial or lacking.
  • Avoid discrimination. Be careful not to ask questions that directly or indirectly solicit information about an employee's medical condition or disability. Questions about medical histories, specific conditions, or disabilities are inappropriate and can violate the ADA.
  • Consult legal or HR experts. If you have doubts about the legality or sensitivity of your survey questions, consider consulting legal experts or human resource professionals who are well-versed in ADA and ACA compliance. They can help you craft surveys that are both effective and legally sound.

2. Educate your team. Ensure your employees know their responses will remain confidential and used solely to improve the company's health care offerings. This can help build trust and encourage participation. 

3. Review and adjust coverage. After collecting anonymous feedback, use the information to assess your current health care coverage and identify potential areas for improvement. Seek out insurance plans that align with the stated needs of your employees. 

Traditionally, small-group insurance has been a primary option for small businesses providing benefits to their team. However, several other options may be suitable for your business, including self-funded, level-funded, and health reimbursement arrangements (HRAs).

Supplemental Insurance

To attract and retain top talent, every business owner should understand the importance of providing a comprehensive benefits package. However, in today's increasingly competitive labor market, solely offering traditional group health insurance may no longer suffice. This is where supplemental insurance plans come into play.

Supplemental insurance plans, often referred to as voluntary benefits plans, are not mandatory under the law but have become a crucial component of a well-rounded benefits package. These plans offer a host of valuable benefits that can complement your standard group health insurance, making them an attractive proposition for both employers and employees alike.

At GMS, we recognize the significance of offering diverse and tailored health coverage options to meet the unique needs of your workforce. When you choose to partner with us, you empower your employees with the flexibility to select supplemental health insurance that suits their individual requirements. These supplemental insurance plans can include, but are not limited to:

  • Life
  • Dental
  • Vision
  • Accidental and critical illness
  • Long and short-term disability
  • And more!

By incorporating these supplemental insurance plans into your benefits package, you empower your employees to make choices that align with their unique health care and financial needs. This not only sets your organization apart as an employer of choice but also demonstrates your commitment to the well-being and financial security of your workforce, fostering a loyal and contented team. Contact us today and let us find a plan that meets your team’s needs.

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