• Maneuvering through federal rules and tax regulations has never been an easy task, especially when you are simultaneously trying to grow your business. The Affordable Care Act makes those waters murkier to navigate with the various stages of implementation and rules for different sized companies. 

    As a small or medium sized business owner, there are some significant dates to keep in mind in 2014 as the Affordable Care Act begins to take effect. 

     

    January 2014

    • The Health Insurance Marketplace coverage begins January 1, 2014
    • The tax credit for small business will only be available if you buy coverage through the Small Business Health Options Program (SHOP) Exchange
    • The tax credit can be as much as 50% of your contribution toward health insurance premiums
    • Individuals who are eligible for employer-provided health coverage will not have to wait more than 90 days to begin coverage
    • The Transitional Reinsurance Program begins and runs through 2016. This program reimburses insurers in the individual insurance marketplaces for high claims costs.  The program is funded through fees which will be paid by employers (for self-insured plans) and insurers (for insured plans)
    • The maximum reward to employers using a health-contingent wellness program will increase from 20% to 30% of the cost of health coverage. Programs designed to prevent or reduce tobacco use could increase to as much as 50 %. 
    • Those with pre-existing conditions cannot be denied health coverage
    • Medicaid coverage is expanding in many states
    • Small businesses with fewer than 25 full-time employees making an average of about $50,000 a year or less may quality for employer health care tax credits
    • Individuals without health care will be charged a fee based on household income or on a per person basis

     

    March 2014

    • Open enrollment for health insurance marketplace ends

     

    October 2014

    • Open enrollment begins again

     

    If you are not yet sure how the changes brought on the Affordable Care Act will impact your business, or if you’re considering making major changes to your employees’ health plans (including eliminating it altogether) to combat rising group premiums, contact us today. We provide solutions that enable you to provide quality health insurance to your employees while limiting increases to your healthcare costs.

  • When Donald Trump ran for the Presidency in 2016, a major plank of his platform was the repeal and replacement of the Affordable Care Act. In fact, pretty much every Republican in 2016 ran on that promise.

    In the summer of 2017, several Republican Senators and every Democrat Senator torpedoed that promise by not agreeing to a plan. Since then, this administration has made several attempts to sink the ACA where they could.

    A gavel of a judge blocking new association health plan rules meant to sink the affordable care act.

    The Trump Administration’s Attempts to Sink the ACA Through AHPs

    The first, and perhaps most powerful as far as Washington D.C. is concerned, attempt is the decision to no longer enforce the individual mandate. If you recall, there was supposed to be a financial penalty on any individual who didn’t have an insurance plan through an employer or on their own. The problem with that plan was always twofold:

    • If you weren’t working or weren’t filing taxes, there was no way for the IRS to collect that penalty.
    • In many instances, the penalty was less costly than the insurance itself.

    The administration began creating new rules for Association Health Plans (AHPs). These AHPs allowed “businesses and individuals [to] band together to create group health plans that offer less expensive coverage than the ACA.” In other words, Associations could pull together multiple employers and individuals into a larger group, offering better rates. In most cases, the trade-off was no protections for what was deemed “minimal coverage.”

    Recently, a federal judge ruled that the Trump Administration attempted an “end run” around the ACA and, in effect, violated the Affordable Care Act.

    Affordable Healthcare Options for Business Owners

    If you are a business owner and you thought these plans were a way to get out from under the considerable financial burdens of the ACA, you may be back at square one.

    Well, there may still be a multiple-employer healthcare option for you. If you would like to learn more about the large group buying power of a Professional Employer Organization (PEO), as well getting additional HR services and regulatory and tax protections, please contact GMS to talk to one of our experts today.

  • Health insurance is one of the most sought-after employee benefits, but not all health plans work the same way. There are several different types of group health insurance that differ in terms of how the insurance is purchased and how it affects the group’s premiums and plan options.  

    What Is Group Health Insurance? 

    Group health insurance is a type of health care coverage that’s provided to a group of individuals, typically employees of a company or members of an organization. This form of insurance means that all members of the group are covered under one policy. As opposed to individual insurance policies, where each person’s risk is assessed individually, group health insurance allows for the pooling of risk across all members. This often results in more favorable premium rates for the entire group. 

    One of the key advantages of group health insurance is that it can provide coverage for individuals who might otherwise struggle to obtain insurance on their own due to cost or pre-existing conditions. Employers or organizations purchase the policy and offer it to their members, often extending the coverage to include dependents. 

    Benefits Of Group Health Insurance

    Group health insurance offers numerous advantages for both employers and employees. For employers, it’s a powerful tool for attracting and retaining top talent, as it demonstrates a commitment to the well-being of the workforce. Employees benefit from lower premiums and better coverage options, often with pre-existing conditions covered. The buying power of a group ensures more comprehensive coverage at a reduced cost. In addition, group health insurance plans contribute to a healthier workplace, leading to a reduced absenteeism and increased productivity. Overall, it’s a win-win situation that fosters a supportive and healthy work environment. 

    Group Health Insurance Options

    While all these health plans have certain advantages and disadvantages, it’s up to you to decide which makes the most sense for your needs. Here are some of the common types of group health insurance options available for small businesses.

    Fully-Insured Plans

    Of all the types of group health insurance, the fully-insured plan is one of the more traditional options. Fully-insured plans involve the insurance company taking on the risks involved with healthcare costs and charging your business an annual premium for the benefits in the insurance policy, which is partially paid for by the employees. 

    The insurer uses a variety of factors used to calculate group health insurance premiums, including:

    • Size and health of the group
    • Average age of the group
    • The employer’s claims history
    • Types of occupation
    • Level of coverage and add-on benefits

    Self-Funded Plans

    While the insurance company covers the expense of employee health costs in a fully-insured plan, self-funding places that burden on the employer. This can often lead to more affordable rates and more control over a plan, with the tradeoff of your business accepting the risk of having to pay for any catastrophic claims. 

    This path is often seen as an option for large businesses, but small groups can also take advantage of self-funded plans. Small businesses can opt for a partially self-funded plan with stop-loss insurance. This option limits your risk so that you can still reap some of the benefits of self-funding without taking on the entire burden in case any catastrophic claims occur.

    Level-Funded Plans

    Unlike the more traditional plans with annual premiums, level-funded plans are based on a monthly payment rate. Insurance carriers will use census information to determine the amount your small group should pay. This rate is based on factors like claims allowances, fees, and stop-loss coverage premiums. Once the year is finished, the carrier will adjust the monthly level based on group performance.

    Health Maintenance Organization (HMO)

    An HMO is a group coverage setup where group members pay for specific health services through monthly premiums. Through an HMO, you’ll have access to a network of healthcare providers and locations, but services will be limited to those that fall under that network. This arrangement allows HMOs to be more affordable than other types of health insurance plans, although seeing any physicians or facilities not included in your HMO network can result in a group member having to foot the full bill.

    Preferred Provider Organization (PPO)

    PPO plans are like HMO plans, except with more flexibility. PPOs feature a network of healthcare providers and facilities, but group members have the option to go to physicians or locations without being completely on the hook for the entire bill. Instead, these visits will result in higher co-pays and additional service costs, giving members some more freedom than HMO plans.

    High-Deductible Health Plan (HDHP) with a Savings Option (HDHP/SO)

    An HDHP is based around lower premiums and higher deductibles for group members. This means that members with this type of healthcare insurance will have to pay more out-of-pocket before the plan pays for its share. The tradeoff, however, is that this route allows monthly premiums to be lower, making it a good group health insurance option for employees who don’t use many medical services. 

    In addition, HDHPs can be paired with savings options like a health savings account (HSA). These accounts allow members to make tax-free contributions to an account that can be used to pay for healthcare costs, ranging from copays to major medical services. The funds in these accounts rollover every year, making them a great retirement savings option, too.

    Health reimbursement accounts (HRAs) are another potential savings option that can be tied to an HDHP. These accounts are similar to HSAs, except employers make the contributions instead of employees.

    Choose the Right Type of Health Insurance for Your Small Business

    It can be difficult to find the right group health insurance plan for your budget. Balancing benefits administration and budget can be overwhelming for anyone without a strong grasp of the healthcare system. 

    That’s why many small business owners work with a Professional Employer Organization (PEO) to help weigh their group health insurance options and handle the administrative burden of healthcare coverage. Contact GMS today to talk to one of our experts about how we can help you offer quality healthcare plans that work with your budget.

  • Between offering competitive benefits and combating rising premiums, managing your business’ healthcare needs is a complex situation. Group health insurance plays a key part in attracting and retaining top talent. However, selecting and managing the right health plans for your company and employees takes an enormous amount of time and effort. It’s a delicate balancing act that can be difficult for any small business owner.

    Fortunately, you don’t need to go through this balancing act alone. A Professional Employer Organization (PEO) can not only help you offer quality, cost-effective healthcare benefits, but also give you the support necessary to develop benefits strategies and navigate any future changes. Let’s break down seven major reasons why a good PEO is a great choice for your small business’ health insurance.

    Cost savings from a PEO processing a claim for a small business’ health insurance plan. 

    Greater Buying Power

    It’s not easy dealing with health insurance companies directly. Policy administration and billing is not only difficult, but also expensive. For small and mid-sized businesses with fewer employees, you could end up being charged higher premiums because you simply don’t have the buying power of a bigger organization.

    That’s where PEOs can help. A PEO represents multiple organizations and all the employees hired by those groups. As such, PEOs can leverage their collective buying power to act as one large company. This arrangement means that small to mid-size companies working with a PEO can get the competitive benefits and smaller premiums of a big business, all thanks to a convenient partnership.

    Of course, your partnership with a PEO should be about more than just added buying power. You should also consider how the PEOs pool the participants and how it affects your premiums. For example, GMS represents tens of thousands of employees, but it does not pool all those employees together. Instead, GMS built our own plan designs.

    What does this arrangement mean for employers? Essentially, your company is rated for your own group based on your own demographic and your health instead of being grouped in with every other company. This process means that your premiums are dictated by your group’s rating, so you don’t need to settle for a lesser plan to see both short and long-term cost savings. With the right PEO, you can focus on cutting costs, not coverage.

    Ancillary Advantages

    Group health insurance isn’t the only benefit that PEOs can help deliver at competitive pricing. Greater buying power also allows PEOs to offer ancillary options on a mass level. This arrangement is especially advantageous for certain groups where certain ancillary benefits would be cost-prohibitive or even unattainable. 

    For example, imagine you ran a small roofing company. A lot of times, your SIC code serves as the basis for your rate. Because of this, you may not be able to get disability coverage at a reasonable cost through traditional means. However, a PEO’s group buying power can give at-risk employers or small groups cost-effective access to multiple lines of coverage, healthcare, and ancillary benefits.

    Benefits and Payroll Under the Same Roof

    Organizationally, it’s a huge benefit to have healthcare and payroll administration talking to one another through the administrative systems. Non-PEOs typically have a payroll processor or some other system and need someone to manually enter healthcare rates for a new employee or during renewal. When it’s all under one roof, you have one group handling everything instead of needing two different entities to hopefully stay in sync.

    With a PEO, your payroll and healthcare administration have the means to work with one another through the systems and streamline this process. Automatic payroll deductions are set up when your benefits kick in for new hires or at open enrollment. The two systems will also be able to automate paycheck deductions and identify which items should be pre-tax and which shouldn’t.

    By having both payroll and healthcare administration working together, you do more than just streamline the process. This scenario lessens the amount of manual entry required, which frees you or a key employee up for other tasks. Automating the process can also help eliminate potential data error – humans make mistakes, after all. In addition, having payroll and benefits administrators work together allows a PEO to directly resolve any issues for you instead of having you involved in every step of the process.

    Online Enrollment

    Another advantage of having payroll and benefits together is that it allows for online enrollment. The automated system of a PEO can help guide employees during the renewal process and educate them about the products they can elect. Since healthcare and payroll administration is tied together, the online enrollment process allows employees to see exactly how their choices impact them in terms of coverage and pricing. 

    From there, employees can confirm their selections right then and there without ever needing any paper documents. This situation simplifies the process for not only the employees, but also you and any office administrators who would have to deal with the headaches associated with enrollment documents. With a PEO, that’s all generated for the employee to handle and deal with, saving you time and plenty of frustration.

    Audit and Process Claims for You

    Depending on the PEO you choose, these organizations can offer another key benefit: auditing and processing claims for you. While some vendors utilize the fully-insured market and Affordable Care Act plans, this scenario can leave your company at the mercy of the providers. Instead, it’s better to partner with all major insurance providers and provide a better experience for small businesses.

    How can a PEO do this? At GMS, we built our own plan with internal administration to give us more control over that plan and the costs. This arrangement gives us the ability to audit and process all our own claims. In this process, your PEO can make sure that the usual customary rate was charged or fight on your behalf to get a discount or reduction on that claim. 

    The ability to audit claims also opens up opportunities to find other ways to save. Part of the audit is used to analyze how the individuals in your group use your plan. The results of this analysis can indicate certain trends that add avoidable costs – for example, using telemedicine services for free doctor’s calls to avoid copays. Not only will this analysis educate your group on the best, most cost-effective way to utilize the plan, it will also help you save in the long run.

    Free Administration

    If you were to turn to an accountant or lawyer with compliance, legal, or administration questions, that extra time will typically cost you. That’s a very unfortunate arrangement for a business owner. Rules and regulations change every day, so it’s only natural to have some inquiries about how they can impact your business. You also can’t be expected to know everything about healthcare and payroll administration – that’s why people train specifically for those fields. 

    With most PEOs, the time spent answering those questions is covered as part of your main fees. Not only that, but you’ll also have a team of experts on hand to answer whatever questions pop up about healthcare, payroll, or other administrative needs. You get the answers you need, without the fear of having those questions affect your bottom line.

    Ability to Lighten Other Administrative Burdens

    When you run a business, there are a multitude of administrative burdens that rest on your shoulders. A PEO is a tremendous solution for companies that don’t have the time or expertise to effectively manage more than group health insurance.

    While you can turn to a PEO for just health insurance and payroll, an organization like GMS can help you easily take additional administrative burdens off your shoulders when you’re ready. This gives you the ability to have one team expertly run risk managementemployee recruiting, and other key HR functions as your company grows.

    Ready to simplify your business’ administrative needs? Contact GMS today to talk to our experts about small business health insurance today.