Below are a few basics that you need to understand in order to get started:
What Is Group Coverage?
Group coverage basically refers to a policy that is given out to a group of eligible employees, and in some cases, their dependants. You should understand that the rules for group coverage are different because the risks are calculated differently.
Generally, the insurer comes up with a premium price after they have analyzed the risk factors of the entire group. It is not mandatory for small businesses (fewer than 50 full time employees) to provide medical coverage but if they are doing so, they should be aware of the regulations.
When is Small Business Eligible for Group Coverage?
Small businesses are eligible for group coverage if they choose to buy it. A business is considered small if they have 2 to 50 full time employees, and the owner is considered as an employee.
Another question that you might be thinking at this point: who is eligible for the coverage? It is important you know that a full time employee is eligible. When it comes to part time employees it is the employer’s choice. It also depends on the carrier and the residence state of the business.
However, if they are covering one part time employee, they must offer the group coverage to all of them. You should know that you can’t deny group coverage to an employee based on their medical condition. Furthermore, the dependents include children, spouses and – in some cases – unmarried partners.
How Much to the Employers Pay?
That depends; some employers pay full coverage, whereas some of them only a portion. You should be aware that when it comes to group coverage, employers get tax credits, thanks to the Affordable Care Act that helps in paying the cost of insurance.