In today’s market, small business owners hoping to hire and retain outstanding employees cannot help but offer health insurance plans to their employees. Not only do health benefits make employees more likely to stay with their companies, but employees are healthier and more productive. Of course, finding affordable health insurance plans for small groups can be a challenge. Fortunately, health insurance options specifically for small businesses are available.
What is Small Business Health Insurance?
Although the Affordable Care Act requires small businesses with fewer than 50 employees not to offer health insurance to their employees, that doesn’t mean they can’t offer the option to attract the best and brightest workers. Fortunately, there are many health insurance policies for small businesses to choose from.
How much does small business health insurance cost? It varies. Many consumers have found that obtaining health insurance as a small business is more affordable than individuals seeking insurance on their own. With the small business health insurance option, the company contributes part of the cost as part of the employee’s salary, and each employee pays the difference through payroll deductions.
What a small business health insurance plan covers will vary depending on the insurance company and options purchased, but some basic health care expenses are usually covered by law.
How Does Small Business Health Insurance Work?
How does small business health insurance work? A small business owner can choose the plan that best meets their needs and costs. The business pays a portion of the premiums, and the employee is usually responsible for the difference in premiums paid as a deductible. Then, when the employee seeks health care, they pay copays, deductibles and other non-covered costs while the insurance company pays the entire medical bill, as long as it is not out of network care.
What is Small Business Health Insurance?
Like other health insurance, small business health coverage benefits include a variety of medical services, although the amount of coverage can vary greatly between plans. Typical installations include:
Prescription Drug Supply
Small business health insurance covers prescription drugs, although specific costs and limits will vary based on the insurance company and insurance plan.
Emergency Care
Small business health insurance offers emergency care, paying a portion of the cost when covered patients receive emergency medical care. Of course, the amount of out-of-pocket costs will vary by health plan and insurance company.
Outpatient Care
Small business health insurance also includes outpatient health care as part of health insurance benefits. Specific limits on services and out-of-pocket costs will vary based on the health plan.
Maternity Care
Health insurance companies also cover prenatal and maternity care as part of small business health insurance benefits. In general, covered patients will have very low out-of-pocket costs for delivering the baby, but the amount will vary by health plan.
Protecting Health Care
Many health protection services are fully covered by small business health insurance. The ACA mandates that certain preventive screenings and other health care must be fully integrated, but be sure to check the specific offerings of each health plan available.
Mental Health Care
Small business health insurance also covers mental health care, including many inpatient and outpatient mental health services. Specific coverage options will vary depending on the best health insurance providers and group plans.
Other Medical Services
Many other health care services – including those for pre-existing conditions – are covered by small business health insurance providers, but since group coverage varies it is important for a small business owner to investigate various reports from any medical plans before choosing the best one for their company. and their employees.
What’s Not Covered in Small Business Health Insurance Policies?
While many small business health insurance benefits are comprehensive and cover a variety of health care services, health insurance still has some limitations and exclusions, including:
- Selection procedures and cosmetics – Most health insurance will not cover cosmetic procedures and will have many limitations and restrictions on what covers selected procedures if they are covered at all.
- Out-of-network services – Many health insurance companies have determined the network of health providers they will work with. If a covered patient wants out-of-network health care, they may not have it.
- Experimental or new technology – A small business health insurance benefits package will generally not include coverage for procedures, devices and drugs that it considers to be very new or still in the experimental stage.
- Off-label drug use – Although many doctors will prescribe drugs for an off-label purpose, many insurance companies will refuse to pay for those prescriptions.
Should Small Businesses Offer Health Insurance and Health Benefits?
Under the US Affordable Care Act, small businesses with fewer than 50 employees are not required to provide health care to their employees. Large companies that fail to provide health insurance benefits to their employees face financial penalties from the government. Many small business owners, however, choose to offer group health insurance plans as an added benefit to hire and retain highly skilled employees. Employees of small businesses that are not otherwise covered may qualify for special programs through the ACA marketplace.
What Are the Health Insurance Options for Small Businesses?
A variety of health insurance options are available to small business owners, including:
- Under the ACA, small business owners can purchase health insurance for their employees through an accredited insurance company with the Small Business Health Options Program (SHOP). By offering health insurance through the SHOP program, employers can offer plans from different insurance companies. Small business owners who offer SHOP health insurance to their employees may be eligible for the Small Business Health Care Tax Credit, which can help with the cost of providing it.
- Small business group health insurance options are divided into categories, each containing different monthly premiums, copays and out-of-pocket limits. This way, people can choose whether they want higher premiums with more extensive coverage or less expensive health insurance that may have more limits and restrictions on what you pay. A group health insurance plan can offer gold, silver, bronze and platinum options.
- Small business owners can also choose to work with an insurance broker who will research and compare the health insurance plans available to determine the best option for the small business at no additional charge. A salesperson can help a small business owner understand options such as HMOs, PPOs, group health plans, health reimbursement plans and health insurance acronyms.
- A small business health insurance plan may allow for a small business HSA, which is a type of health savings account. That way, qualified employees can make pre-tax contributions to an HSA and use the funds to pay for non-covered health care expenses.
Small Business Health Insurance Plans Rules and Requirements
In the United States, small business health insurance is governed by the same law as many other health care programs: the Affordable Care Act. The law, which was fully enacted in 2014, requires most US-based employers with 50 or more employees to offer health insurance options to their employees. It also specifies what type of health insurance companies must include in their health plans. The ACA even established a health insurance marketplace where consumers and small businesses can shop for the best and least expensive health insurance options.
Although the ACA does not require most small businesses to offer health insurance to their employees, it has benefited small business owners by establishing a SHOP network through which they can choose from a variety of insurance companies and health plan options.
Employers who offer health insurance benefits to their employees must also comply with COBRA. Under this law, if an employee is terminated, they must be given the opportunity to extend their health insurance for one of the three maximum pay periods. Similarly, employers who provide health insurance to their employees must also follow the Health Insurance Portability and Accountability Act (HIPAA), which protects employees’ confidential personal and medical information.
Photo: Depositphotos
