FAQs

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  • For employers 2-50 the rates are set by zip code and age.  The term for this is called community rating.  There is no incentive for employers or employees to manage healthcare costs because rates are set by the community rating pool.  Self-funded plans allows you to step outside of the community rating pool and have more control.  For groups over 50 these plans are even more accessible and need to be explored each year.  Contact us more information.

  • Self-funded plans are not required to limit deductibles, which allows more flexibility to the employer to offer high deductible plans at lower costs.
  • Self-funded plans also avoid state premium taxes, which cost participants and employers around
    1.75% of premiums each year.

    In total, a self-funded plan may realize savings of as much as 20% over a fully insured plan.

In 2014, the modified community rating provision of the Affordable Care Act says that for employer groups with fewer than 100 employees, health risk is not allowed to be calculated into their rate. This new modified community rating requirement will eliminate the use of actual claims experience and minimize the amount an insurer can vary its rate development process. Rates are typically based on age, tobacco use, family composition and geographic location.

What this means, from an employer’s perspective, is that groups that have unfavorable demographics and poor claims experience will receive more favorable rates. Conversely, groups that have good claims experience and better demographics will be rated up and not benefit as they previously had from the healthy habits of their employees, which lowered their premium rates.

For example, if a healthy group has a 0.7 risk factor, it could rise to a 1.0 risk factor, representing a 30 percent increase in premium rates. When you add in a 10 percent trend increase, groups could be looking at an overall 40 percent rise. If employers with healthy employees opt for self-insurance and leave the community-rated pool, this could cause adverse selection, resulting in increased rates for the employers left in the pool.

Yes. The Affordable Care Act made it the law that each state have an “online health insurance mall” to make many options available to small businesses. If you have 50 or fewer employees, you can purchase affordable insurance through the Small Business Health Options (SHOP). In some states, SHOP is run by the federal government and in some states it is operated by the state itself.

No. Businesses that have 2-49 full-time equivalent employees do not have to offer health insurance coverage to their employees. Businesses with 50-99 employees will have to offer health insurance coverage by 2016 or they will pay a penalty. Businesses with 100+ more full-time equivalent employees will have to offer health insurance coverage by 2015 or they will pay a penalty.

For more detailed information, visit: http://1.usa.gov/1gmpz68.

Yes, but only for companies that have 25 or fewer full-time equivalent employees. The average annual wages must be less than $50,000. The owner’s wage does not count in the calculation.

The credit can be up to 50% of the amount that the employer contributes toward the employees’ health plans. Go to this link for more information:http://1.usa.gov/1mldfDR.

Work with a broker that represents many insurance companies and make sure they have an electronic application you can have your employees complete. The electronic application can be securely saved so that your employees won’t have to complete a new one each time you shop for quotes. They will only need to take a few minutes to review and update the application.

A licensed insurance agent can give you advice about which plan is right for you and can help you see if you qualify for financial help for insurance. It doesn’t cost any more to talk with an agent. You get personal, one-to-one service to help you make the right choice for you and your family.

Yes, the penalty/fee is 2.5% of income or $695 per adult/$347.50 per child, whichever is more.

Open enrollment is each year from November 1 – January 31.

You may qualify for financial assistance through tax credits or subsidies to help lower the cost of your health insurance. Eligibility is based on household income and size for plans sold on the Health Insurance Marketplace or a state exchange.

Subsidy Chart


The percentages are where people fall on the Federal Poverty Level chart. If their income is on that chart they qualify for Medicaid on up a subsidy.

Household Size 100% 133% 150% 200% 300% 400%
1 $11,880 $15,800 $17,820 $23,760 $35,640 $47,520
2 $16,020 $21,307 $24,030 $32,040 $48,060 $64,080
3 $20,160 $26,813 $30,240 $40,320 $60,480 $80,640
4 $24,300 $32,319 $36,450 $48,600 $72,900 $97,200
5 $28,440 $37,825 $42,660 $56,880 $85,320 $113,760
6 $32,580 $43,331 $48,870 $65,160 $97,740 $130,320
For each additional person add $4,160 $5,533 $6,240 $8,320 $12,480 $16,640

For groups give us a call or send us an email.  There are multiple carriers that we can shop at once to find a program that will fit your needs.  Our service is the best in the industry to manage your ongoing questions and changes. 

For individuals and families click on the link here to review the plans and we will contact you to help you pick a carrier and a plan that fit your needs Link to the individual quote