Employee Benefits

As a Gainesville, FL business owner, do I have to provide group health insurance to my employees?

Employers with 50 or more full-time (including full-time-equivalent) employees are generally subject to the Affordable Care Act’s employer rules and can owe a penalty if they don’t offer affordable coverage. Employers with fewer than 50 are not required to provide coverage.

Does group health insurance meet ACA requirements?

Small group health insurance plans are required to meet the Affordable Care Act standards. Large groups may or may not be required to meet the standards depending on their size or plans. Some groups can be grandfathered in and exempt from guidelines. While group plans may offer exceptional coverage, it is important to understand what is covered and weigh your options. You are not required to accept coverage through your employer and may choose to purchase an individual health plan that better suits your needs.

What is group health insurance?

Group health insurance is a form of employer-sponsored coverage. There are a few different options of group health insurance coverage that business can offer to their employees. Costs are typically shared between the employer and the employee, which can include an extension to dependents such as spouses and children. There are a few types of plans that may be offered on a group policy.

1. PPO or “Preferred Provider Organization” plans are the most common. In order for claims to be paid at the highest level, employees covered by PPO’s need to receive medical care from physicians in that corresponding network. In Florida, the PPO network is the largest.
2. HMO or “Health Maintenance Organization” plans offer a range of services through a smaller network of providers that contract exclusively with the HMO. Employees that choose an HMO must also select a primary care physician from the HMO network list at the time of enrollment.
3. HSA or “Health Savings Account” plans are a way to allocate pre-tax money for medical care costs. An HSA is a special bank account specifically for medical expenses. HRA or Health Reimbursement Accounts are very similar but benefit the employer slightly more. The main difference between an HSA and an HRA is that the employer can contribute to either on behalf of their employee… however with an HSA, the funds then belong to the insured to roll over if they wish. With an HRA, unused funds are returned to the employer.
4. While some employers may choose to provide additional benefits such as dental insurance coverage, they are not required to do so.

Group plans for both small and large employers are purchased through health insurance companies. The federal Small Business Health Options Program (SHOP) and its small-business tax credit have limited eligibility, and SHOP plans may not be offered in every county, so ask us what’s available for your business.

What if I leave my employer or am in between jobs?

Federal COBRA generally applies to employers with 20 or more employees and lets eligible employees and family members keep the group plan for a limited time after leaving a job. Smaller Florida employers’ plans fall under Florida’s state continuation law, which has its own rules. Premiums are typically up to 102% of the group rate under federal COBRA, or up to 115% under Florida’s continuation law. Deadlines to elect coverage depend on which law applies, so act quickly after coverage ends. Questions? Call McGriff-Williams Insurance at (352) 371-7977.