Did you know that open enrollment for group medical insurance plans may help you improve your health insurance coverage?

There is a lot of discussion nationally about health insurance open enrollment these days.  The one thing that we can all agree on is that it seems to get more expensive each year to provide quality health insurance to our families and employees.

Factors that Impact Group Medical Plans

The best benefits/pricing combination for health insurance is often found in group policies.  These are employer-sponsored plans that provide benefits to eligible employees.

In New Jersey, there are several important provisions in qualifying for a small group plan (under 50 full-time equivalent employees).

• The employer must contribute to the cost of the plan for each employee. The minimum contribution is 10%.
• 75% of eligible employees must participate in the plan or be covered by another plan (such as one from their spouse’s employer, or under a parent’s policy).  So, if you have 10 employees (and the owner does not count), you must have at least 8 of those employees enroll in the plan or provide a waiver that shows that they have coverage through a spouse or parent group policy.
• To qualify as a “group” you must have at least one eligible employee and the business owner does not count in that calculation nor does the business owner’s spouse.

However, and this is an important exception, January 1st is open enrollment for small group plans.  This may be the only time of year small employers are not subject to the participation/contribution requirements.

Client Example

For example, we have a client who has over 20 full-time employees.

Most of those employees are laborers who make close to minimum wage, and many of them are covered by low cost or subsidized health insurance or not covered at all.

It is difficult for these employees to afford any premium contribution.  The employer certainly cannot afford to pay most or all the premium, so for years, they had no group plan.

We were able to set them up on a group plan with an effective date of January 1st, with only one employee enrolled in the plan.  This employee happened to be a relative of the owner who works in the company in a management capacity.

Since the participation requirement is waived, this group is eligible, and the owner can participate as well.

This open enrollment exception allowed the company to provide excellent health insurance to the owner and his family and a trusted, high-level employee, while all the other employees chose to opt-out of the coverage.

This could not be done at any other time of the year.

We’re Here to Help

If you are a business owner without an employer-sponsored group benefits plan, contact us to see if a January 1st date opens opportunities for you to access better, and less expensive health insurance.

Please note, these plans must be submitted to the carrier between November 15 and December 15.

We can help you with a full range of retirement and employee benefit plans including qualified and non-qualified retirement plans, group medical, group dental, group life, group disability, voluntary benefits, payroll, human resource consulting and outsourcing and more.