Spring 2015: Group Plans – New ACA Provisions Coming Your Way

Spring 2015
By Sandra Henderson, Vice President, Insurance


The definition of a “Small Employer” has traditionally been “any group under 50 lives” but when ObamaCare was enacted, the determination has been to increase that number to 100 lives. There have been many discussions on this and though it was supposed to be in effect as of January 1, 2016, it may be delayed.

So, how does small group vs large group affect you as an employer? Small group plans do not use experience rating (traditionally used for large groups), instead they will use a community rating. That can work for you or against you depending on your claims experience and group demographics as a large group. As a small group, you are lumped into a pool of other small group plans so premium increases are not directly related to your group’s claims. Not true for large groups who have rate increases based on their group’s claims in that plan year. So if you are a group with 50-100 lives your status could change from large to small group. No telling which way the rates will go for you, could be more could be less. I just wanted you to have a heads up on the coming changes. Much will be determined as we get to renewal time especially if the small group definition ends up changing in 2016.

Also, as your group plans renew this year and you are required to change into an ACA compliant plan (if you haven’t already done so), your premiums will be based not only on the employee’s age, but of each and every dependent. Sample rating:

Father: 51 – $650

Mother: 48 – $500

Son: 25 – $250

Daughter: 20 – $155

Total $1565

Notice the premium for a 25 year old is more than a 20 year old now. Once a child hits 21 they are priced as an adult child. So, those kids 21-26 will definitely cost a lot more than they used to. Good time to decide if switching them over to an individual plan would work better for you.

Pediatric Dental

Pediatric Dental is another benefit that is now included on all ACA compliant plans. So if you have children under the age of 19 they can have dental cleaning and all kinds of dental work done through your group health plan insurer.


Hope all of you have been receiving ThinkHR Comply updates and that you are finding them helpful in keeping your businesses in compliance to all kinds of rules and regulations in all areas of responsibilities of beig an employer. I am always appreciative of any feedback that you have for any service such as this and whether it has been beneficial to you in running your business.

Turning 65 this year?

Give us a call. You will most likely save by going to a Medicare Supplement plan as well as enjoy much richer benefits by switching to Medicare and filling the gaps with a Supplement plan. If you are currently under a group plan, it’s best to compare the costs and benefits; usually a Medicare plan comes out better.


Just a reminder that open enrollment for individual plans won’t begin until November 15th. At that point you will be able to change your plan to be effective as of January 1st. If you have lost coverage due to no fault of your own, i.e. lost your job and along with it your health insurance, you qualify to apply for individual coverage without waiting. You only have a 60 day window of time from when you lost your coverage to complete the process or you would have to wait for open enrollment.

HSA contribution limits for 2015

Individual: $3,350

Family (2 or more people): $6,650

Over 55? : catch up of $1,000

Consult an accountant or attorney for advice on how insurance strategies apply to your own personal situation. This material contains the current opinions of the author but not necessarily those of Plan Financial and such opinions are subject to change without notice. This material is distributed for informational purposes only. PFI Insurance Services, a licensed insurance agency and division of Plan Financial, provides clients with access to insurance issued by leading insurance companies. Insurance products are underwritten and issued by participating insurance companies. This is not an offer or solicitation in any jurisdiction where the policies are not approved for sale. Any obligations under the policies are the exclusive obligations of the insurance companies and are subject to the financial conditions of the insurance companies. Information contained herein has been obtained from sources believed to be reliable, but not guaranteed. No part of this article may be reproduced in any form, or referred to in any other publication, without express written permission. Plan Financial is a trademark or a registered trademark of Plan Life & Wealth Management, Inc., in the United States.© 2015, Plan Financial.

Print Insurance Insights Spring 2015