Health Insurance Options For Small Employers

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1 1 Health Insurance Options For Small Employers

2 Copyright No part of this consumer report may be reproduced or transmitted in any form without the written permission of the author. This electronic book is optimized for viewing on a personal computer screen, but is optimally organized so that it can be printed out and assembled in a traditional book form. Since this electronic book is optimized for viewing on a personal computer screen, the type used is larger than that of which is traditionally utilized in printed books. Disclaimer This report was diligently researched and compiled with the intent to provide information for persons wishing to learn about the landscape of health insurance reform and the opportunities they present. Throughout the making of this consumer report, every effort has been made to ensure the highest amount of accuracy and effectiveness for the techniques suggested by the author. The report may contain contextual as well as typographical mistakes. No information provided in this report constitutes a warranty of any kind; nor shall readers of this report rely solely on any such information or advice. All content, products, and services are not to be considered as legal, medical, or professional advice and are to be used for personal use and information purposes only. This report makes no warranties or guarantees express or implied, as to the results provided by the strategies, techniques, and advice presented in this report. The publishers of this report expressly disclaim any liability arising from any strategies, techniques, and advice presented in this report. The purpose of this consumer report is to educate and guide. Neither the publisher nor the author warrant that the information contained within this consumer report is free of omissions or errors and is fully complete. Furthermore, neither the publisher nor the author shall have responsibility or liability to any entity or person as a result of any damage or loss alleged to be caused or caused indirectly or directly by this report. Safe Harbor Notice Certain statements in this presentation relate to future results that are forward-looking statements as defined in the Private Securities Litigation Reform Act of This presentation contains statements involving risks and uncertainties, including statements relating market opportunity and future business prospects. Actual results may differ materially and reported results should not be considered as an indication of future performance. Factors that could cause actual results to differ are not included. 2 Health Insurance Options For Small Employers

3 Contents 2014 Market Reforms... 4 Option #1: Move into an ACA-Compliant Plan... 5 Option #2: Stay Grandfathered... 5 Option #3: Stay Grandmothered... 6 Option #4: Self-Insure... 6 Option #5: Drop Group Health Coverage... 7 More Risk: Increased compliance exposure... 8 More Headaches: Member-Level Rating... 8 Less Demand: Employees Have Other Options... 9 No Incentive: Employer Mandate Doesn t Apply About Health Partners America Health Insurance Options For Small Employers

4 We all thought the guessing would be over by now, but for anyone who s had to deal with the Affordable Care Act (ACA) agents as well as employers we know all too well that this isn t the case. We re approaching the fourth quarter in 2014 and, believe it or not, nobody really knows what s going to happen at the end of the year, particularly in the small group market. In this paper, we ll explain the options small employers have and make some predictions about what they will or at least what they should do on their next renewal MARKET REFORMS The Affordable Care Act creates a number of market reforms that impact the benefits insurance companies offer, the cost-sharing on those benefits, and the rating rules insurance companies must follow. In the small group market, the impact of these reforms is pretty severe not only do small employers (50 or fewer total employees in most states) have to add additional benefits such as pediatric, dental and vision to their already-costly group health plans, there s now a statutory maximum on the member s cost-sharing for those benefits and new metallic levels that the plans must fit within. The biggest impact from the market reforms, though, has to do with the new Modified Adjusted Community Rating rules insurance companies must follow when pricing plans in the small group market. These rules allow for rating based on age, but only on a 3 to 1 basis, and permit up to a 50% surcharge for tobacco use, but that s about it. Insurance companies can no longer rate based on group size, industry, gender, or medical conditions. Depending on the state and the rules that were in place prior to the ACA, these new rules could have a small impact or they could have a huge effect on small group premiums. In states that previously allowed a wide range of premiums, some small employers are seeing their prices drop particularly older groups with some pre-existing medical conditions while others are seeing their premium rise significantly. 4 Health Insurance Options For Small Employers

5 Obviously, the strategy these small employers will adopt at renewal time in 2014 when the changes go into effect will depend on whether they benefit from or are hurt by the new rules. Many small employers have already renewed their group health plan in 2014, so they re already feeling the impact good or bad of the law. Others, though, had previously shifted their renewal date to December 1st in an effort to delay the impact of ACA. Those employers have some decisions to make in the very near future. Their options are detailed below. Option #1: Move into an ACA-Compliant Plan For older, less healthy groups, this is likely the best option. Because insurance companies are no longer allowed to rate based on gender or medical conditions, and because the difference in premium between the oldest and youngest employees in the group has been reduced, many employers that previously paid above-average premiums are seeing their price come down some. Many have already renewed under the new rules and are enjoying the lower premiums, because the law benefits them. Unfortunately, not every employer is so lucky. For those who were previously paying below-average rates, their price is likely to increase at renewal time, and they need to consider some other options. Option #2: Stay Grandfathered While only a small percentage of employers in the small group market still have a grandfathered plan in 2014, hanging on to that plan is likely the best option for them. Grandfathered plans avoid many of the new patient protections that are driving premiums up so much, including the essential benefits requirement and the new modified adjusted community rating rules. As long as these employers continue to renew as-is, they should be able to keep their premiums somewhat under control, though the decision to continue to offer these old plan designs is completely up to the carrier. 5 Health Insurance Options For Small Employers

6 Option #3: Stay Grandmothered When individuals and small employers began receiving cancellation notices last Fall because their plans were not compliant with the ACA s new market reforms, many were surprised because they had heard President Obama say repeatedly that anyone who had insurance that they liked could keep it. Because they didn t understand the grandfathering rules and because the President wasn t clear in the way he explained it, they mistakenly thought that their plans, which had changed at some point since the law was passed back in 2010, could be renewed as well. This was not the case. Following a media backlash and falling poll numbers, President Obama offered an administrative fix at the option of the states and the insurance companies, these non-grandfathered, non-compliant plans could be renewed in 2014, and then again in 2015 and Not every state and not every carrier is offering this option, but where it is offered, these transitional plans, sometimes referred to as grandmothered plans to distinguish them from grandfathered plans, can be renewed under the old plan design and rating rules. Whether a transitional plan really helps an employer will depend a lot on the insurance company. Some are offering pretty good rates on these old plan designs, while others are increasing the price on their old plans along with their ACA-compliant options. They re worth looking into but may not be a great option for every employer. Option #4: Self-Insure In the past, self-funding was an option only for large employers because the risk of one large claim was too big for a small group. However, because of the way the market reform rules are written, self-funding now appears to be a good option for younger, healthier employers who currently purchase coverage in the small group market. Realizing that self-insured plans do not have to offer all of the essential benefits and that they can still underwrite based on medical 6 Health Insurance Options For Small Employers

7 conditions, many insurance companies have started offering new self-funded options to much smaller groups than in the past sometimes down to groups with only ten employees. Called levelfunding, these plans require employers to pay the same amount each month, much like they did with their fully-insured plans, and this represents the worst-case-scenario for the group. The difference between fully-insured and self-funded plans, though, is that employers who have a good year from a claims standpoint could end up getting some money back. Though not for everybody, self-insured options are definitely worth considering for small employers with historically low claims. However, it s also worth noting that some states are looking to kill this option. The reason is because the small group market needs these healthy small groups to purchase coverage in the same rating pool as the unhealthy groups that are currently benefiting from the law. If all of the healthy groups decide to leave the small group market and take on the risk of self-funding, the price would likely move back up for the less healthy groups. That s why some states are introducing legislation that would increase the minimum stop-loss to a point that would be too risky for most small employers. Option #5: Drop Group Health Coverage This is the option that many people expected small employers to take, but when they didn t see a mass exodus from the small group market earlier in the year, they assumed it wasn t going to happen. Not so fast Keep in mind that a lot of employers who were likely to see their premiums increase under the health reform law shifted their effective dates to December 1st last year. That means that they have yet to feel the impact of the law they renewed in 2013 and have been operating by the old plan design and rating rules all year long. When they get their December 1st renewal, though, their smile will likely turn into a frown. While the impact will vary from state to state and carrier to carrier, it s 7 Health Insurance Options For Small Employers

8 easy to predict that prices will be going up sometimes way up for many of these small employers. That alone will be enough to convince some small businesses to drop their group health coverage and send their employees to the individual market, where health plans are now offered on a guaranteed-issue basis, but there are other reasons as well that make this an even more compelling idea. MORE RISK: INCREASED COMPLIANCE EXPOSURE The ACA comes with a lot of new employer reporting requirements, many of which apply to small employers. If a company chooses to offer health insurance, not only does it have to pay the premiums, it may need to pay a third-party administrator to handle many of the compliance requirements. Along with the extra work that s required, employers actually have an increased risk because of all of these tax and labor laws the government is actually increasing the number of audits it s conducting, and the fines for non-compliance are pretty severe: $100 per day per employee in some cases. It the premiums weren t costly enough, the risk of fines will likely send some small employers over the edge. MORE HEADACHES: MEMBER-LEVEL RATING Last year, some insurance companies read the final market rules, which were published back in February, 2013, and assumed that they needed to charge each employee a separate price based on his or her age. This is called member-level rating, and it creates a lot of problems because, when everyone receives different rates, the plans are very difficult to quote, it s challenging for an employer to develop a contribution strategy that will be fair to every employee, and it s almost impossible to explain to workers who were already confused about health insurance. In December, Health and Human Services (HHS) made it clear that composite rating where different family tiers are offered based on average premiums is still permitted, but the agency also warned that it was considering developing uniform tiering structures that 8 Health Insurance Options For Small Employers

9 would apply market-wide. That s exactly what it did, and the result is a two-tiered option that doesn t make a lot of sense and that insurance companies may not be able to implement. While states are allowed to suggest alternative structures to HHS, in states where that doesn t happen, it s very likely that more not fewer insurance companies will move to member-level rating next year. The result? Unhappy employers and even more unhappy employees. LESS DEMAND: EMPLOYEES HAVE OTHER OPTIONS Employee benefits, by definition, are designed to benefit employees. And in the past, group health insurance was the number one employee benefit. However, times have changed. Under the Affordable Care Act, employees with pre-existing medical conditions and employees who need coverage for a particular service, like maternity, have other options in the individual market they are no longer dependent on the employer s plan, so it s less of a benefit than it was in the past. And, ironically, the biggest benefit of the group health plan the employer s contribution to premiums is no longer a benefit at all to millions of employees and could actually end up being a negative. That s because employees and their family members who have access to affordable group health insurance that provides minimum value are blocked from receiving a premium tax credit or cost-sharing subsidy in the individual marketplace. The tax credits are significant much larger than what employers can offer in most cases, and this could cause lower-wage workers to seek out employers who don t offer health insurance. In other words, the benefits designed to attract and retain quality employees could actually end up driving employees away. Employers might find that they could drop their group health coverage, let their employees and their employees family members access the financial assistance from the government, and use the premium savings to purchase other types of coverage, like dental, life, and disability, that could truly benefit their workers. Employers need to be consulted with properly to understand that their employees now have a new choice, and employers and benefits brokers need to also 9 Health Insurance Options For Small Employers

10 understand those choices. Brokers who work with Health Partners America (HPA) ensure this happens. If employees would like to see if they are eligible for a tax credit, they can do so by working with an insurance agent who has partnered with HPA. HPA Partners have access to a powerful benefits assessment tool called the Insight Catalyst Report, which they are able to run for an employer (and ultimately provide the information to employees) to help make the transition to the individual marketplace. When the HPA Partner runs the Insight Catalyst Report they are able to send out customized quotes to each employee with a secure website. Through this site, employees will be able to view and compare their plan options, use a calculator tool to see if they qualify for a subsidy, and talk with a licensed health insurance professional that can walk them through the application process. They can also purchase other types of insurance coverage, including dental, life, accident, critical illness, and cancer policies that may be important to them and their families. NO INCENTIVE: EMPLOYER MANDATE DOESN T APPLY When an employer considers the higher cost, lower benefit, increased exposure, and resulting headaches that come with offering group health insurance, the logical question to ask is what s the penalty if I don t offer health insurance? And, for employers with fewer than 50 full-time-equivalent (FTE) employees as well as employers with more than 50 FTEs but 30 or fewer full-time workers, the answer is ZERO. The employer mandate does not apply to groups with fewer than 50 full-time workers (including full-time equivalents), and applicable large employers with more FTEs are able to exclude their first 30 fulltimers from the count when calculating the penalty. 10 Health Insurance Options For Small Employers

11 IN SUMMARY The good news is that employers have options. Some actually benefit from the law and are currently enjoying lower premiums as a result of the ACA. Others have an option to renew their current plan, at least for a couple more years, or leave the small group market altogether and play by the old rules under a self-insured plan. Other small employers, though, will take a good, long look at their employees and realize that the group health plan that the company is paying so much money for really isn t something that they want or need. Small groups should talk with their insurance advisor to discuss their options. Brokers who partner with HPA utilize the Insight Catalyst Report to help these employers determine what the best solution will be for them. Most employers don t want to hurt their employees, and the truth is that offering group health insurance could do just that. If there s no requirement to offer coverage, your employees don t want it, and providing coverage could end up hurting your workers, why do it? We now live in a post ACA world where the individual health insurance marketplace is robust, level and competitive with the employer sponsored group market place. Smart employers should consult with HPA Partner brokers to proactively understand this, and if they do decide to renew their group plan, they should provide employees a defined post-tax contribution and a private exchange site where they can shop for and purchase coverage to assist employees who are actually better off in the individual insurance market. This way, the employee has a choice. So does the employer to be smart, helpful, caring and wise. 11 Health Insurance Options For Small Employers

12 About Health Partners America Since 2007, Health Partners America has been providing game-changing training and solutions to agents and brokers nationwide. HPA is a technology and consulting company that works with and through brokers in order to engage with the marketplace through healthcare reform. HPA Partners with agents and brokers nationally to bring them technology solutions, private exchange sites, marketing tools, training and leverage to help them be more successful. HPA believes in championing, protecting and nurturing the relationships that exist between brokers, employers, and employees. Using white-labeled technology that extends from us to the broker partnering with us, then to the employer and the end-user employee, Health Partners America s private exchanges facilitate the vast array of options available to employees in a safe, user-friendly environment. HPA s technology connects the broker to their respective clients (employers), and connects their clients (employers) to their employees as the employer of choice. In addition to facilitating government subsidies for health insurance, the Health Partners America marketplace technology goes far beyond just health insurance, delivering the complete universe of insurance needs. The recent changes in health insurance law present a huge opportunity for those who are prepared, and HPA has a plan. Team up with Health Partners America and get started right away. Learn more at Keep up to date by visiting our resources section: 12 Health Insurance Options For Small Employers

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