Posts Tagged ‘health care coverage’

5 Tips For Implementing A Group Benefits Plan

Tuesday, January 24th, 2017

The post below is a guest blog from Jordan Whichard, IV, GBA who serves as Principal, Health & Welfare Consultant for CAI’s employee benefits partner Hill, Chesson & Woody.

If you operate a startup company, or your established business has recently grown larger than 50 employees, one of the most daunting items on your 2017 to-do list may be implementing a group benefits plan for the first time.  Starting a benefits plan from scratch can be an intimidating – not to mention time-consuming – process, especially without a partner to help you understand the background and minutiae of it all. Here are some tips if you find yourself staring down a brand new group benefit plan in 2017:

  1. Know your timeline and stick to it

Whether you want your benefits plan to begin in June or January, you’ll want to begin the process at least six months in advance of your anticipated start date. That will give you ample time to evaluate different benefit options, plan designs, funding platforms, and other factors that you will need to consider. Medical carriers will generally be able to offer early numbers about three months prior to your effective date.  You’ll want to approach the carriers as close as possible to that date in order to start understanding your potential rates.

  1. Firm up your census

Changes in your workforce are bound to happen, especially if you operate a rapidly growing business.  But beware, medical carriers reserve the right to re-rate your population if your census changes by more than 10% between the date of the quote and the date of final implementation.  If possible, holding your workforce numbers relatively stable for several months before your first open enrollment will help alleviate any stress that a re-rate would generate.

  1. Know your population

All workforces are different, but knowing your employees wants and needs can be a big help when designing your first benefit plan.  A brief employee survey could be a valuable tool in determining what benefits your employees are most interested in.  By the same token, many benefit plans have participation requirements – a percentage required to guarantee rates in the first year.  If you have less than that, the benefits may be more expensive than originally thought.

  1. Beware individual underwriting

Depending on the size of your group, some medical carriers may require individual employees to go through an underwriting process to help the carriers determine the risk associated with your group. If you have a stable workforce and know everyone wants coverage, that may not be a problem; but groups with a geographically or economically diverse workforce will want to think twice before committing to the individual underwriting process. Either way, you should understand that the first numbers a carrier presents may not necessarily be their final proposal!

  1. Tie it all together

Once you have all of your plans in place, you’ll want to make sure that the benefits are working effectively for you and your employees.  Ensure that the appropriate plans are written under Section 125 of the IRS code so that employees are able to pay their premiums before any taxes are deducted from their paychecks.

If these tips sound like things that you’d like explained or explored further, contact a consultant at HCW today.  Implementing the plan is just the beginning – next comes developing your long-term strategy, ensuring regulatory compliance, and managing your costs. We’re ready to help guide you through the process from start to finish.

Two Considerations For The Marketplace Open Enrollment Period

Tuesday, December 20th, 2016

The post below is a guest blog from Jay Lowe who serves as Principal, Health & Welfare Consultant for CAI’s employee benefits partner Hill, Chesson & Woody.

The Affordable Care Act provides the ability for individuals to buy coverage regardless of any underlying medical condition.  This guaranteed issue provision has provided millions of Americans the access to health care that was not there before.  Many who had access to group coverage have also shifted either themselves or dependents to individual plans when their group plans were too expensive or did not provide the coverage they needed.

This year’s annual Open Enrollment Period for the Marketplace has opened and we are seeing, on average, a 25% increase to the cost of individual plans.  This cost increase is forcing many who are enrolled there to re-evaluate if an individual plan is still the best option for them when other group coverage is available through an employer.  When making this decision around where to be covered, there are two important items that should be understood about moving onto or coming off of an employer-sponsored health plan.

First, the annual Open Enrollment Period for the Marketplace is not considered a qualifying event under the IRS guidelines to allow someone to drop their individual policy and enroll in an employer-sponsored group plan.  There seems to be a common misconception around this with both employers and employees.  As the costs for individual plans continue to rise, many are looking for ways to move back to an employer’s plan.  The only instance in which someone could leave their individual plan and move onto their employer’s group plan is if the group plan is in an open enrollment period.

Another thing to consider is that the Marketplace Open Enrollment Period is not a qualifying event that will allow someone to drop a spouse or dependent from their group plan (unless the group plan’s annual open enrollment period coincides.)  So those who may be considering moving a dependent to an individual plan would not have the ability to do so at that time.  However, a special provision in the rules does allow an employee the ability to make a mid-year revocation of their group plan (outside of the group’s open enrollment) and enroll in Marketplace coverage.  In order for an employee to move a spouse or dependent to an individual plan during the Marketplace Open Enrollment Period, the employee must also drop coverage for him or herself too.

Given the rising costs of individual plans it seems unlikely that many will want to shift away from the group coverage.  It is important for employers to know the rules around allowing employees to come on and off of their plans outside of their annual open enrollment period.  Employees should understand the potential pitfalls of shifting away their group plan as that could create the opposite impact of what they are trying to achieve.