Each year, there is a Group Special Enrollment period for small businesses. This ACA provision allows businesses to start a group plan in January for their employees at no cost to the business. Since 2017, group medical plans in Illinois are more competitive on price and networks, compared to individual plans. A few years ago, Blue Cross Blue Shield of Illinois eliminated the large PPO network on individual plans, limiting access to the big research hospitals such as Rush, Northwestern, University of Chicago, and Advocate. That PPO network is now only available on the group chassis. United Healthcare eliminated traditional individual health insurance plans and are only available in Illinois for groups.
For similar benefits, premiums are lower on the group side compared to individual/family plans on the marketplace. Small businesses are scrambling to create a group for lower premiums and better plan choices across the board.
Here are a few things to note:
- At least one full-time, non-owner W-2 employee needs to enroll
- Some companies allow 1099 employees to join the group
- Employer contribution to employee premiums is waived
- The effective date must be January 1, 2019
- No participation requirements
- i.e., a group of 10 total employees and only 1 or 2 employees join the group
- Normally this requirement is 50% or higher
- Premium is paid for by the business in advance, and employee premiums are recouped through payroll deductions (or other method that works for you)
Who is this good for?
- Small businesses with employees still on individual plans
- Startup businesses that don’t have financial resources to cover part of the premiums
- Restaurants, hair salons, lawn service companies
- Business owners that want access to the big Chicago-area research hospitals
What other benefits are there?
- Having a group plan allows access to Flexible Spending Accounts
- Can link other benefits like dental and vision (these do have participation and contribution requirements)
- Lays the foundation for employee benefits
- Helps with employee retention
- More choices for care
- Lower out-of-pocket costs
- More robust plan designs
If you’d like to explore this option for your business, contact Tom Manno today at 708.646.9280 or firstname.lastname@example.org.