Employee Health Insurance & Benefits

In many states you are a small group if you have less than 50 full-time employees.  Some states consider you a small group if you have up to 100 full-time employees. Fully Insured small group plans are subject to comply with the ACA and rates are filed with your state, meaning they cannot be altered.  Small groups are able to shop level-funded plans, Association Health Plans (in most states), self-fund, or join a captive.

If an employer has at least 50 full-time employees, including full-time equivalent employees, on average during the prior year, the employer is an ALE for the current calendar year, and is therefore subject to the employer shared responsibility provisions and the employer information reporting provisions. If the business does not offer affordable health insurance coverage that offers minimum value to 95% of full-time employees and dependent children until they turn age 26, it is subject to ACA penalties.

AHP's are large group or self-funded plans offered through membership in an organization of some kind.  Chambers of Commerce and local Trade Associations are common ones.  Smaller companies are able to join these and gain access to plan designs and rates they otherwise would not.  The maximum size of a company allowed to join will vary by state.  These are available in most states, but not all.  We specialize in Associations available nationally, and in Nevada, Arizona, Utah, Oregon, & Washington.

Employers and employees see hardly any difference with these plans from Fully-Insured plans.  Most of the Major Medical Carriers offer these today.  However, other companies exist outside of the major carriers who also offer these plans. Your group would be underwritten and your premiums are determined based on admin costs, a prediction of claims cost, and your cost of Stop Loss coverage.  You never pay more than your assigned premium.  If your group incurs less claims than expected then part of your premium paid is refunded.

Self-Funding differs from Level-Funding by only paying claims as they occur and removes the fixed premium.  There is an opportunity for significant savings in a company that is well established, well financed, and capable of managing a benefits and wellness program.  There is also more significant financial risk involved.  Many will still wish to have reinsurance in place to protect against catastrophic claims.

This takes Self-Funded plans a bit further by forming or joining a company (the Captive) which essentially operates as it's own insurance carrier.  This offers many tax advantages to generate more savings over regular Self-Funding.  However, there are more costs involved with getting started.  Many established Captives exist for companies to join which mitigates risk for a smaller company looking to go Self-Funded.