Mike Jones
Regional Manager
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NPN #3062257

Option 1
Employer Sponsored Health Plans

Important Update - 7/2/2013

Employer Mandate Delayed until Jan. 1st of 2015


Employer sponsored group health plans will continue for some time to be a part of the way employers attract and keep quality employees.  In order to avoid a penalty, these plans will need to be ACA compatible. Some plans are grandfathered in but eventually even these plans will be forced to comply with the new law’s requirements.

The new plans are feature rich and provide a high level of preventative coverage which should benefit business in keeping absentee rates down but likely will not lower overall health care costs or group health insurance rates. The Congressional Budget Office predicts that health insurance premiums for people under 50 will double at the beginning of 2014. 

Based on that prediction and  the following facts, employer contributions to group health plans will reach a median value in excess of  $6.10 per employee hour ($1050/employee/mo).

           * Historical data published by the Kaiser Family Foundation

           * Increased coverage requirements

           * Higher health costs

           * Federal limitations on premium differences between young and old

           * $563/participant tax on employer sponsored health plans

Health plans between carriers will vary in pricing based on different configurations of benefits and how they go about meeting the essential benefits standards.  Within a given carrier, pricing will vary based on a tiered system of coverage called the metallic plans, platinum, gold, silver, and bronze.  In addition to variations in pricing due to different features and benefits, pricing within those tiers will vary based on these 4 factors.

            * # of people to be insured

            * Geographic location

            * Ages of the insured

            * Tobacco usage 

No underwriting of preexisting conditions or variations due to sex will be allowed.


Small businesses in 2014 will be able to participate in the Small Business Health Options Program which allows their employees to purchase group health insurance through an exchange. No subsidies apply to these plans. Each state until 2016 can define the size of a "small business." Starting in 2016 a small business will be defined national wide as a company with 100 or fewer full time employees. Companies with over 100 full time employees will not have access to the exchanges until 2017 at the earliest.