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Group Health

Group Health options can help you attract and retain top talent.

Group Health Insurance

Group Health Insurance may be a requirement

In a competitive job market, companies with better benefit plans land and retain the best talent. Even as a small business, an owner has to consider what benefit plans they can offer to get the talent they need. One of the best starting places is with Group Health Insurance.

Group health plans are employer- or group-sponsored plans that provide healthcare to members and their families. The most common type of group health plan is group health insurance, which is health insurance extended to members, such as employees of a company or members of an organization.

Group health insurance plans offer numerous tax benefits to both employers and employees. The money employers pay toward monthly premiums is tax-deductible, and employees' premium payments can be made pre-tax, which may reduce their total taxable income.

Some employers must provide group health plans to their employees because of the "Employer Mandate".

Employer Mandate

Employer Mandate 101

Under the Affordable Care Act’s employer shared responsibility provisions, certain employers (called applicable large employers or ALEs) must either offer minimum essential coverage that is “affordable” and that provides “minimum value” to a percentage of their full-time employees (and their dependents), or potentially make an employer shared responsibility payment to the IRS. The employer shared responsibility provisions are sometimes referred to as “the employer mandate” or “the pay or play provisions.”

ALE - Large Employers

Whether an employer is an ALE in a particular calendar year depends on the size of the employer’s workforce in the preceding calendar year. To be an ALE for a particular calendar year, an employer must have had an average of at least 50 full-time employees (including full-time-equivalent employees) during the preceding calendar year.

Requirements

Employers must offer health insurance that is "affordable" and provides "minimum value" to 95% of their full-time employees and their children up to the end of the month in which they turn age 26, or be subject to penalties, otherwise known as the Employer Shared Responsibility Payment.

Penalties

If an employer does not offer coverage, or does not offer at least one medical plan option that provides “affordable,” “minimum value” coverage, the following penalties will apply if any full-time employee purchases coverage on the Marketplace and receives a federal premium subsidy.

No Coverage Offered

Employers are required to offer coverage to at least 95% of full-time employees and dependents.

• Penalty amount: $2,570 per full-time employee minus the first 30.

Coverage offered, but does provide “minimum value”

Employers must offer at least one plan that provides “minimum value” (pays at least 60% of the cost of covered services).

• Penalty amount: The lesser of: (1) $3,860 per full-time employee receiving a federal subsidy for coverage purchased on the Marketplace, or (2) $2,570 per full-time employee minus the first 30.

Coverage offered, but is not “affordable”

Employers must offer at least one plan that is considered “affordable” (≤ 8.39% in 2024)

Penalty amount: The lesser of: (1) $3,860 per full-time employee receiving a federal subsidy for coverage purchased on the Marketplace, or (2) $2,570 per full-time employee minus the first 30.

Affordability

There are 2 ways to calculate Affordable Care Act (ACA) affordability in 2024.

Rate of Pay Safe Harbor

For hourly employees, multiply their lowest hourly rate by 130 and then multiply that by 8.39%. For salaried employees, multiply their monthly salary by 8.39%. The result is the maximum monthly contribution that the employee can pay to meet the affordability standard.

Household Income

The employee's share of the premium for the lowest-cost self-only coverage cannot exceed 8.39% of their W2 gross household income.

Retirement

A health plan meets the minimum value standard if both of these apply:

• It’s designed to pay at least 60% of the total cost of medical services for a standard population.

• Its benefits include substantial coverage of physician and inpatient hospital services

Group Health Solutions

Group Health Insurance Solutions

Whether your a large employer(ALE) or a small business who wants to attract better talent, Heartwood can help you find the right group solution for your unique situation.

There's two broad types of group health plans: Medical Plans and Ancillary Plans

Medical Plan - HMO

Health Maintenance Organization (HMO): A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency.

Medical Plan - PPO

Point of Service (POS): A type of health plan where you pay less if you use providers in the plan’s network. You can use doctors, hospitals, and providers outside of the network without a referral for an additional cost.

Medical Plan - EPO

Exclusive Provider Organization (EPO): A managed care plan where services are covered only if you use doctors, specialists, or hospitals in the plan’s network (except in an emergency).

Ancillary - Dental

Dental Insurance covers services related to the teeth and gums, like preventive care such as annual cleanings.

Not all procedures are covered; cosmetic procedures, such as crowns or whitening, are not.

Deductibles, co-pays, and coinsurance will apply, and many policies have annual coverage maximums that are relatively low, ranging from $750 to $2,000.

Ancillary - Vision

Vision plans generally cover or provide discounts on these products and services:

• Annual eye examinations

• Eyeglass frames

• Eyeglass lenses (including lens coatings and enhancements)

• Contact lenses

• Discounted rates for LASIK and PRK

Ancillary - Critical Illness

Critical illness insurance provides additional coverage for medical emergencies like heart attacks, stroke, or cancer, or Serious illnesses that prevent you from working for a long time.

Because these emergencies or illnesses often incur higher than average medical costs, Critical illness policies pay out cash to cover those overruns where traditional health insurance may fall short.