Health Insurance and Large Groups — Understand How Your Premiums Are Calculated

Jill GouletAffordable Care Act - ACA, Employee Benefits, Health Insurance, Human Resource Consulting

As an employer, one of the most valuable benefits you can offer to your employees is health insurance. For larger groups of 51 employees or more, you’ll likely have group health insurance coverage. This is a policy you’ll typically purchase from a broker (so you get the best deal) that you can then offer to all of your eligible employees. Around 98% of large employers (businesses with more than 200 employees) provide health coverage to some or all of their people.

These types of health insurance policies are great for your employees

Large group policies have several advantages over small group or individual health insurance plans:

  • The employer typically pays half or more of an employee’s premiums.
  • Premium only plans (POP) mean employees can pay premiums out of their pre-tax incomes.
  • This results in significantly subsidized premiums, meaning happier employees.
  • You get a healthier, better motivated workforce.

The health insurance cost is calculated slightly differently for large groups

The cost of large group policies is typically worked out when the employer decides to purchase, rather than being a fixed rate. The premiums, coverage, deductibles, and benefits are normally based on several factors:

  • The number of employees participating.
  • The type of coverage needed.
  • The amount of payments, deductibles, and benefits desired.
  • An employer’s prior claims history.

Individual employees don’t normally have to fill out health questionnaires, although employers may need to answer general questions on the health of their employees.

Other factors that can impact your health insurance premiums for large groups

Some insurers will also take the following into account:

  • The average age of the workforce.
  • Large claims that have been made by the employer previously.
  • The employer’s location — New York City is going to be more expensive than rural Wisconsin.
  • The gender makeup of the workforce.
  • The sector an employer works in — Premiums for constructions workers are going to be higher than for a retail shoe store.

All of these factors will feed into the calculations, coverage, benefits, and premiums.

Differences in health insurance premiums between small and large groups

If we look at a typical health insurance plan for a family, an employee will generally contribute:

  • In small groups — Around 35% of the premium.
  • In large groups — Around 25% of the premium.

There’s less of a burden on employees in large group health insurance plans.

If you’re a large employer, you must offer health insurance

The Affordable Care Act requires that employers of more than 50 people must offer affordable health plans to their ‘Full Time Equivalent” employees. The penalties for not providing this type of cover are:

  • Mandate Penalty — This comes into effect if an employer does not offer group health coverage. It’s calculated at $2,000 per employee, after the first 30 employees.
  • Qualification Penalty — This applies if an employer does not offer a “qualifying plan.” Qualifying plans must offer a certain minimum standard of coverage, and must be affordable to employees. The penalty is $3,000 per employee that does not get qualifying coverage and purchases a policy through the health insurance Marketplace.

The best way to make sure you get an affordable policy, and your employees get the coverage they need, is to use a specialist health insurance broker. They can help you navigate the complicated areas of health insurance and make sure you get the support you need to make the right choice.

Jill Goulet
Risk Management Consultant
jgoulet@srfm.com

Sinclair 7-22-15-14