Group Health Coverage

If you are a business owner, then you have probably thought about whether you should offer your employees a group insurance plan. Most people are generally familiar with the way an individual health insurance plan works. Group health plans are similar to individual plans; however, there are a few key differences.

The Health Insurance SHOP

The Small Business Health Options Program (SHOP) is to group insurance coverage what the Marketplace is to individual insurance coverage. SHOP health plans are designed to allow small businesses to provide essential health coverage for their employees. 

If you want to apply for a SHOP health insurance plan, then you do not have to wait for the Open Enrollment period; you can apply at any time. Applying for a SHOP plan is, generally speaking, the only way for small businesses to take advantage of the Small Business Health Care Tax Credit. An insurance brokerage like Apollo Insurance Group can help you find the right SHOP plan for your business.

When Insurance is Required

If your business has 2-50 employees, then you have the option to purchase group health insurance. As long as you have fewer than 50 full-time equivalent employees, then you are not required to buy insurance by federal law. Once you reach 50 FTE employees, however, you will start receiving a tax penalty of $3,860 per employee if you do not offer coverage. 

If you choose to offer health insurance to your employees, then there are some regulations that must be followed. If you offer insurance to any full-time employees, then you have to offer insurance to all full-time employees. The same goes for part-time employees. It does not matter if someone has a pre-existing condition, a known medical problem, or something else; you must offer the same coverage to EVERYONE of similar employment status. 

In addition, dependents are eligible for coverage on most group health plans. These include spouses, children, adult dependents up to age 26, and occasionally unmarried domestic partners.

How Coverage and Premiums are Determined

Coverage and premiums under group plans work a little differently than they do under individual plans. Insurance providers can’t base their premiums on the health of individual group members because the same plan has to be offered to the entire group. Instead, the premiums are based on the average health of the entire coverage group. 

Since the risk is spread across a wide pool of individuals, premiums for group health insurance plans are generally lower and more affordable than individual plans. 

Apollo Will Find the Right Plan for You

Apollo Insurance Group has agents that are experts on group health insurance and are ready to help you find the right plan. Fill out our contact form to get in touch with an agent today.