Small Group Employers
Although some mandates of the ACA apply to all employer groups, others depend on the number of employees you have. Mandates that apply to all employer groups, regardless of size, include:
ACA mandates impacting Small Group Employers (2-50 employees) include:
- The Small Business Health Options Program (SHOP) is available online to employers with 50 or fewer employees as a Marketplace to compare health insurance carriers and purchase employer-sponsored coverage.
- Employers are eligible to claim the Small Business Healthcare Tax Credit (worth up to 50% of an employer's contribution toward their employees' premium costs and up to 35% for tax-exempt employers) if the employer:
- Covers at least 50% of the cost of employee-only healthcare coverage for each of their employees;
- Has fewer than 25 full-time equivalent employees whose average wages are less than $50,000;
- Purchases insurance through the SHOP Marketplace.
- To ensure consumers have adequate coverage, all non-grandfathered health plans in the individual and small group market (groups up to 50 employees) must cover 10 categories of essential health benefits (EHBs) as created and defined by the ACA. SummaCare members will have access to these benefits on their effective or renewal date on or after January 1, 2014. The 10 categories are:
1. Ambulatory patient services
2. Emergency services
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care
- SummaCare has a shopping site - www.MySummaCare.com - making it easy for small group employers to view plan options and learn about small business tax credits. Contact your broker, independent insurance agent or SummaCare for more information about plans available to small group employers.
- Under the ACA, small group health plans are categorized by metal tiers. Small group health plan metal tiers do not reflect the quality of care or amount of care, but rather the percentage of costs covered under the plan. When offering a plan to your employees, it is important to remember lower premiums mean higher out-of-pocket costs for your employees while higher premiums mean lower out-of-pocket costs.
-Bronze plans cover 60% of the total average costs of care
-Silver plans cover 70% of the total average costs of care
-Gold plans cover 80% of the total average costs of care
-Platinum plans cover 90% of the total average costs of care
- Small group pediatric dental coverage through The Dental Care Plus Group is an optional benefit. It can be purchased in addition to your health insurance offering, regardless of whether you purchased a small group health insurance plan on the SHOP or direct from SummaCare. Pediatric vision coverage is included in all small group plans and is offered through Vision Service Plan (VSP).