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Employer Group Insurance

Group health insurance is employer-sponsored health coverage for
business owners, employees, and often for dependents. 
A majority of Americans have group health coverage through their own or a family member's employer-sponsored group plan. Employers and employees can share costs and there are special tax incentives available to businesses that provide group health insurance. As an employer, you select a group health insurance plan and then invite your employees to enroll.

 

Typically, employers cover at least 50% of each employee's monthly premium, and can also voluntarily contribute to dependent premiums. The remainder is paid for by the employee.

 

If you want to provide health insurance benefits and you're able to contribute toward employee premiums, group health insurance is the way to go. Offering group health insurance can help you hire and retain the best workers, and the amount you pay toward employee premiums may be tax-deductible. Since no one can be turned down based on medical history, group coverage also protects workers or family members who might otherwise go uninsured. If you really can't absorb the cost of traditional benefits, don't give up. There are a number of other options available in which you can pay whatever you want from zero to 100%.

 

First, tell us about your company and employees. Then we'll show you health insurance quotes from a number of leading companies in your area. Compare plan rates and benefits to find the best match for your needs and talk with one of our licensed insurance agents for personal help. 

  • You pay at least 60% of the premiums which are expected to double
    or triple in the next few years;
  • The employee’s portion can’t exceed 9.5% of their total household
    income so you will need to keep records of your employee’s personal information;
  • You must confirm and report to the IRS your employee’s household
    income
  • Your company meets the minimum employer contribution percentage
    set by the insurance company.

 

Qualified employers may be eligible for the Small Business Health Care Tax Credit if they offer a SHOP plan and have qualified employees enrolled in SHOP coverage, provided certain criteria are met.

Small businesses have three options available when offering SHOP plans to their qualified employees and, iif applicable, their employees’ dependents:

  1. Only health coverage
  2. Only dental coverage
  3. Both health and dental coverage

Coverage Options Available Through the SHOP

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An older man is standing in front of a lumber warehouse smiling and with his hands on his hips.

Small businesses have three options available when offering SHOP plans to their qualified employees and, if applicable, their employees’ dependents:

  1. Only health coverage
  2. Only dental coverage
  3. Both health and dental coverage

The SHOP coverage must be offered to all full-time employees (full-time employees are those employed for an average of 30 hours or more per week). Employers may offer SHOP coverage in Federally-facilitated SHOP states and State-based SHOP Marketplace states, including State-based SHOP Marketplaces not using the federal platform. As noted earlier in this training, the contents of this module are limited to the SHOPs run by the federal government and SHOPs using the federal platform. 

The employer's principal business address or the eligible employee's primary worksite must be located in the SHOP service area or areas (i.e., state or states) where the employer is applying for and offering coverage.

To be eligible for the SHOP, employers generally must be “small employers” and have at least one employee on the first day of the plan year. Estimating employer size can be complex and agents and brokers should refer to official Department of Health & Human Services and Internal Revenue Service (IRS) guidance on this topic before advising employers regarding their size.

Generally, an employer is a “small employer” if it employed one to 50 full-time and FTE employees (one to 100 in some states) on average on business days during the preceding calendar year and employs at least one employee on the first day of the plan year.

A full-time employee is one who is employed for, on average, 30 hours or more per week. An FTE employee is a combination of multiple part-time employees whose combined hours total 120 hours per month.

When counting FTE and full-time employees, do not include the following:

  • Sole proprietors
  • Partners in a partnership
  • 2% S corporation shareholders
  • 5% C corporation shareholders
  • Spouse or family member of the owner

Under this methodology, a full-time employee is one who is employed for, on average, 30 hours or more per week. An FTE employee is a combination of multiple part-time employees whose combined hours total 120 hours per month.

If an employer was not in existence throughout the preceding calendar year, the count of full-time and FTE employees is based on the average number of employees that it is reasonably expected the employer will employ on business days in the current calendar year.

Certain affiliated employers with common ownership or employers that are part of a controlled group are considered part of an aggregated group.

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