Beginning in 2015, businesses with the equivalent of 50 or more full-time employees must provide “affordable” health insurance or pay a tax penalty. Whether you offer group insurance to employees or not, it is absolutely critical that you make your employees aware of their obligation to seek health coverage under the Affordable Care Act. And, you also have to inform your employees they have access to guaranteed coverage in the individual market, and that they may be eligible for government subsidies if the coverage you provide them is not deemed to be affordable under the law.
Keep in mind: Whether you buy a health plan directly from the insurance company or through a licensed agent does not affect your health premium cost since all prices are fixed. However, a licensed agency like Health Plans in Oregon represents multiple insurance companies, therefore, you can compare multiple health insurance plans that best fit your business’ needs and budget.
How much does health insurance cost for a small business?
Your small business has to cover at least 50% of the cost of health insurance for your employees (individual coverage). A nationwide average health care premium suggests that the cost per employee is $6,163 a year. As the employer, that means you’ll have to cover $3,100 a year, per employee.
Group Health Insurance cost depends on:
- Location of business
- Ages of employees under the group plan.
- Your preferred out-of-pocket costs. If you want to spend less in monthly premiums, you can select a plan with higher deductibles and out-of-pocket costs
Your business may qualify for SHOP
SHOP stands for Small Business Health Options Program. Any small business in Oregon with 1 to 50 employees can purchase a certified plan from one of the participating insurers. Click here for a list of 2019 Qualified Health Plans for Small Group in Oregon.
Your business qualifies if you:
- Have an office or employee work site within the SHOP’s service area.
- Have 50 or fewer full-time employees. An owner can count as an employee but needs to have at least one other employee to be eligible.
- Offer coverage to all of your FTE employees (works about 30+ hours/ week for more than 120 days in a year).
- Enroll at least 70 percent of your FTE employees in your SHOP plan.
Now, let’s find out if your business is eligible for tax credit:
Your business can qualify for tax credits if you meet the following criteria:
- Employ fewer than 25 full-time equivalents (FTE) employees (not including family members of owners/partners or seasonal workers who work fewer than 30 hours a week and more than 120 days during the taxable year)
- Pay average annual salaries of $50,000 or less per employee
- Pay at least 50 percent of FTE employees’ premium health care costs
- Purchase a certified medical or dental plan from a participating insurance company in Oregon.
When to enroll in Group Health Insurance?
- You can enroll any time of the year, no need to wait for an open enrollment period.
- At any time of the year, you can add employees or dependents on the group plan.
- At the end of the year, you can renew or change coverage.
Do Oregon employers have to provide health insurance?
For a small business with less than 50 full-time employees, there’s no penalty for not having health insurance. But of course, if you want a productive work environment so you may consider getting health coverage for your employees.
What if you have more than 50 employees? If you have more than 50 FTE, you may face fines if you don’t provide group health coverage. The price of the lowest health insurance plan should not be more than 9.69% of an employee’s annual income.
What if an employee declines the insurance offer?
If an employee decides to not sign up for a health insurance plan, he/she can sign up for a plan thru Health Insurance Marketplace during open enrollment period (Nov. 1 to Dec. 15) but financial help will no longer be available.
The advantage of providing health insurance to your employees:
Investing in health benefits for your team can give your small business a competitive advantage. Policy premiums are deducted from salary schedule, in contrast to individual health plans in which the policy premiums are paid outside of payroll.
Small Business is required to
offer group insurance
If you are purchasing an Individual Health Plan, there may be times when an individual can be denied insurance due to some eligibility restrictions such as immigration or residency. Obtaining health insurance through an employer helps retain and rewards staff, and may help reduce tax obligations as well.
As an employer, your contributions become tax-deductible, payroll taxes are reduced by 7.65 percent and your workers’ compensation premiums are lowered as well.
Difference between Group Health Insurance and Individual Health Insurance:
Buying in bulk often saves money. Therefore, Group Health Insurance plans are traditionally more affordable than Individual Health Insurance plans. It allows employers to offer quality coverage at a discount, and coverage us automatic.
Under a Group Health Insurance plan, employees are only covered as long as they are employed and the employer is paying the premium. On the other hand, with Individual Health Insurance, coverage is consistent at all times — as long as premiums are up to date.
Key Features of Group Health Insurance Plans
Since employees are the most priceless assets of a company, it’s important they be aware of the many benefits group health insurance provides.
Cashless medical services at in-network hospitals
Employees covered in a group health insurance do not have to go thru exhausting tasks of filling out forms when hospitalization occurs. The cashless transactions within in-network facilities are said to be among the most valued feature of group policies.
Also, most group health insurance plans do not have waiting period clause, meaning an employee qualifies for coverage of the group health insurance plan from the first day on the job even for chronic illness.
Pre-and post-hospitalization expenses
A group health insurance policy also provides coverage for pre-and post-hospitalization (lab tests, x-rays, medicine, and consultation) expenses for a specific period as per mentioned in the policy document.
Need free local assistance?
If you need a group insurance quote and side by side comparison of most group insurance carriers in Oregon, please contact us and we can email, mail or call you with a quote right away. We value the money you put into your business and your employees’ healthcare, that is why we aim to provide you with the most affordable and efficient health plans for your small business. We can get you reliable quotes from most of the health insurance carriers in Oregon such as Moda, Kaiser, Regence Bluecross Blueshield, Pacific Source and more!