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  • On April 29, 2024, the U.S. Department of Labor (DOL) finalized a rule reversing a Trump-era regulation designed to expand the formation and use of Association Health Plans (AHPs), without having to comply with the requirements of the Affordable Care Act (ACA). AHPs are group health plans that cover small employers and self-employed individuals in the same or different industries. AHPs, which are governed by state and federal laws, have historically varied significantly in size and membership.

    The 2018 Trump Administration Rule

    The 2018 rule from the Trump administration that expanded AHPs was struck down by a federal judge in 2019 and was never fully implemented. The DOL stated the 2018 rule expanded the definition of AHPs in a way that would have allowed some individual and small group health insurance coverage to be treated as large group coverage. This change could potentially evade critical consumer protections under the ACA, which requires coverage of essential health benefits such as emergency and maternity newborn care.

    The New Final Rule

    The new final rule from the Biden administration, issued by the DOLs Employee Benefits Security Administration, will take effect 60 days after its April 30th publication. It is intended to ensure consumers have access to quality health coverage consistent with federal law, including the ACA’s requirements for essential health benefits.

    While some proponents of the AHP argue they can provide small businesses and self-employed individuals with better bargaining power and lower prices, critics contend the 2018 rule would have undermined important ACA consumer protections. The new rule has been supported by the Biden administration but criticized by some Republican lawmakers as limiting workers’ health care options.

    Managing These Changes

    GMS can help your company stay compliant with the DOL’s new rule on AHPs and managing the associated challenges. Our team of HR and benefits experts can assist with analyzing your current health care plan offerings, determining the appropriate compliance requirements, and implementing necessary changes to ensure you are providing employees with quality, ACA-compliant coverage.

    In addition, we provide guidance on navigating legal and regulatory uncertainties, training programs for managers and employees on the new rules, and ensuring your benefits administration processes are updated. By partnering with GMS, you can confidently navigate these complex regulatory changes and avoid potential penalties or disruptions in your employee health benefits. Contact us today to learn more.

  • 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.

  • Open enrollment is here again, and it brings the stress of navigating and enrolling in the ideal health care plan. Under the Affordable Care Act (ACA), employers with 50 or more full-time employees or the equivalent must provide health care to their team. Regardless of your team’s size, health care is a leading benefit that can assist with hiring and retention efforts due to the rising cost of personal health expenditures. Therefore, offering health care to your employees is something you should take seriously.

    Finding and evaluating multiple plans and pinpointing the best option for you and your team is no easy feat. Moreover, after making your choice, ensuring your team comprehends and successfully enrolls in their chosen plans adds another layer of complexity.

    So, how can you best prepare your workforce and ensure a seamless experience for all? Collaborating with a professional employer organization (PEO), like GMS, can effectively reduce some of the stress and complications associated with open enrollment. In the meantime, we’ve gathered some strategies to help you get started.

    Open Enrollment

    Open enrollment occurs annually, usually from November to January. During this time, employees can enroll in a new health insurance plan, tweak their existing coverage, or, if necessary, say goodbye to their current coverage.

    The significance of this period lies in the fact that any changes outside this window are restricted and limited. If you miss the enrollment season, make a mistake, or decide you want a different plan after it’s over, you’ll have to wait until the next open enrollment period to make those changes. Some exceptions include qualified life experiences such as having or adopting a child, marriage, or divorce, to name a few. Making informed decisions during this time can significantly impact your financial and overall well-being throughout the year. So, take your time, weigh your options, and ensure you’ve covered everything.

    Mistakes To Avoid

    Open enrollment is confusing enough. Preparing for the most common mistakes can help you and your team have a successful enrollment season.

    Missed deadlines

    Missing deadlines is one of the most common pitfalls because open enrollment can vary from year to year. However, open enrollment typically begins on November 1st and concludes on January 15th. To ensure your employees meet these deadlines, it’s essential to be well-prepared, maintain transparent communication with your team, and consistently send reminders about approaching cut-off dates. Timely submission of enrollment forms is necessary to secure coverage for the upcoming year.

    Defaulting to past plans

    We know you have a lot on your plate, and sticking with your previous year’s plan might seem like the most straightforward option. However, this can be detrimental in the long run. Health plans and their associated costs frequently change from year to year, and so do the health care needs of your team. Failing to reassess your coverage options can result in inadequate coverage or unexpected costs. It’s imperative to take the time to reevaluate your current plan and determine if it aligns with the evolving needs of your employees.

    Providing too many choices

    While offering various health care plan options is critical, it’s equally crucial not to overcomplicate the selection process. Limiting the choices to the most essential or popular plans is key. Providing too many options can confuse and overwhelm employees, making it difficult for them to make an informed decision. A concise selection of plans can streamline the decision-making process, making it easier for employees to choose the most suitable coverage.

    Ignoring plan details

    Another common mistake employers make is not thoroughly evaluating the details of the available plans. You should review each plan’s specifics to understand the coverage and costs. Ignoring these details can contribute to a poor plan selection, leading to discontent among your team, ultimately affecting employee satisfaction and, in turn, harming your retention and recruitment efforts. Therefore, it’s vital to take the time to thoroughly examine each plan to guarantee you’re making the best choice for your employees’ well-being and satisfaction.

    Not considering family needs

    Health insurance isn’t a one-size-fits-all solution. Failing to consider your team’s and their families’ specific health care needs can result in inadequate or too expensive coverage, which would, in turn, be noncompliant with the ACA. Assess whether the plans you choose meet the needs of your employees, their spouses, and dependents, including any special health care requirements or medications.

    Underestimating the cost-benefit analysis

    While lower monthly premiums might seem appealing, it’s essential to consider the broader cost-benefit analysis. A plan with slightly higher premiums may offer better coverage and lower out-of-pocket expenses, ultimately saving you and your team money in the long term.

    Failing to educate employees

    Proper information is the cornerstone of informed decision-making. Failing to educate your employees about the available plans and their intricacies can result in uninformed choices. To address this, providing clear and comprehensive information about each option is essential, including coverage details, costs, in-network providers, and any changes from the previous year. Consider conducting informational sessions or webinars to ensure your team has the knowledge to make well-informed decisions about their health care coverage.

    Forgetting ancillary benefits

    In addition to health care, other valuable benefits are often available during open enrollment, such as dental, vision, life insurance, and retirement plans such as a 401(k) match program. Overlooking these ancillary benefits can mean missing out on essential perks that contribute to the overall well-being of you and your team.

    By avoiding these common mistakes and investing time and effort into open enrollment, you can make informed decisions that lead to better health care coverage and financial well-being for you and your team.

    Compliance

    Maintaining compliance with the ACA requires meticulous attention to your health care plan choices. This encompasses a thorough assessment of various aspects, such as out-of-pocket maximums and the essential health benefits mandated by the ACA. These requirements are the foundation for ensuring that your health plans align with the legal framework and offer comprehensive coverage for your employees.

    In addition, fostering an inclusive environment is crucial for ACA compliance. It’s imperative that all employees, regardless of their circumstances, have an equal opportunity to engage in the benefit enrollment process.

    This commitment to inclusivity extends to employees with disabilities, who should receive the support they need through auxiliary aids, alternative formats, and other necessary accommodations. These measures guarantee regulatory compliance and cultivate a work environment that respects the diverse needs of all team members, contributing to a more equitable and welcoming workplace.

    Comprehensive Small Business Health Insurance Solutions

    Offering small business health insurance is easily one of the most complicated and costly aspects of running a business. You want to provide your employees with the best health care benefits, but you’re also dealing with rising insurance premiums, compliance, and mountains of paperwork. With a PEO like GMS, you can decrease costs while providing top-tier medical coverage and reducing administrative burdens.

    GMS represents more than 45,000 employees, which allows us to help small businesses purchase group health insurance for an average of 24% lower for employee premiums and 21% lower for family premiums than the U.S. average. GMS is the only PEO that provides an in-house master health plan that helps you avoid large swings in usage, trends, and renewal rates.

    Our experts are here and are ready to provide guidance on how to utilize your plans best. Contact us today and let us help get your team the best health care possible!