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Large Group

Group-Plans

A company would fall under the category of large group once they reach 51 or more employees. Due to the number of employees covered under the plan and larger premiums paid, large group plans tend to offer more comprehensive coverage than small group or individual health insurance plans. However, this means that there are more stringent underwriting processes for large groups when they apply for coverage. As compared with small group plans which are guaranteed, large groups can be rejected by carriers based on the claims history of those insured under the large group plan.

Common Requirements:

  • 75% of eligible enrollees must enroll
  • 1099 Employees are not eligible
  • Employer answers simplified medical questions about his employees
  • Employer contribution at least 50% of the lowest cost plan option
  • Medicare is a secondary payer to the insurance carrier for those 65 and older, or enrolled on Medicare due to a disability

Each carrier is able to adjust their requirements slightly for things such as covering part-time employees or the length of waiting periods for new-hires.

The Affordable Care Act brings with it a multitude of requirements and penalties for large group employers should they not offer coverage, or offer coverage not meeting the minimum standards as set forth in the Act . This penalty is called the “shared responsibility” provision, and will target employers when a Full Time employee not eligible for Medicaid or a CHIP plan procures a premium subsidy credit through the health insurance exchange. Many employers may be surprised when they find that this penalty also applies to them even though they have less than 51 employees, as seasonal and part time workers will be calculated against them when levying a fine.

Full Details of Penalty Calculations can be found here:

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Other Penalties may apply if the following occurs:

  • The employee’s contribution for their portion of the premium exceeds 9.5% of their household income
  • The health plan covers less than 60% of health expenses

Let Health Exchange Quote help you establish a large group health plan for your employees. We will work with you to not only find the best medical, dental, vision and life plans to offer, we will make certain you avoid paying any additional penalties.

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