You CAN be just a One Person Group Plan.
'Can I get a group plan?" is asked of us all the time. You might be able to, if you know just a few rules. Group Plans almost always have lower premiums and larger networks than equivalent individual plans. Group premiums are also tax deductible as a business expense. There are two criteria that insurance carriers look at: (1) Are you a ‘group’ and (2) do you meet participation guidelines (usually they want at least 60% of your employees to enroll IF they are eligible).
Are you a Group? If you have just 1 full time OR PART TIME (working at least 20 hours a week) W2 employee (NOT a 1099 subcontractor), you are a Group! You’ve made it through the ‘first door’ of underwriting.
Do you meet participation guidelines? Waivers do NOT count against your participation! If there are just two of you, the employer and one W2 employee, your group would be considered to have 100% participation if one of you could waive coverage because you have it elsewhere including: coverage by Medicare; coverage by MediCAL; covered under a spouse plan; coverage under an individual plan on or off the Covered CA exchange! With a valid waiver, a group of 2 could actually just enroll as a 1 person group! Last year, we enrolled 5 employees out of 34 on a group plan - the other 29 had valid waivers!
Premium Contributions: Insurance carriers want employers to pay for at least 50% of the employee’s premium. They employer CAN pay a portion of the dependents premium. Any portion not paid by the employer is paid for by the employee through payroll deductions. This can be deducted from the employees GROSS PAY, thereby lowering the net cost to the employee AND the employer saves on payroll taxes! It’s a Win-Win for both. Group premiums/plans are tax deductible, usually have smaller increases than individual plans, larger networks and many times, richer benefit designs.
Flexibility: A group can offer multiple benefits AND multiple networks! Most insurance carriers have a large and smaller network. If an employees’ providers are all on the smaller network, they be happy with that network and the smaller premium. A small group of three could have everyone on a different plan and 2 of them on large networks and 1 on the smaller network. You do not have to have a ‘one size fits all’ benefit package that used to be only seen for large groups with 50 or more employees.
Larger employees (50 or more employees) must offer coverage to their employees or face a number of various fines. We can help guide you through this ever changing jungle if you have concerns.
Contact us with any questions and concerns you may have. Our job is to stay on top of the constantly fluctuating health care system to assist our clients in getting the most affordable coverage possible and making the system work correctly for them. We'd like to work for you!