Group Health Insurance

This health care market has been significantly impacted by health care reform. In the past, one of the biggest benefits of small group insurance was a guaranteed issue. This means that a business could offer a group health plan to their employees and the employee could not be turned down. With the Affordable Care Act, we now have guaranteed issue in the individual market place. This is a game changer for many small companies. At Nefouse & Associates we have pioneered the process of shifting group health coverage to the individual market. This has created a huge saving for most of our micro group clients.

Currently, if you have less than 50 employees you are considered a small group. In 2016, if you have less than 99 employees your company will be considered small group.

The small group market has been forever changed by the Affordable Care Act. We have seen many health insurance companies pull out of Indianapolis, which has created a lack of carrier competition. There has also been an introduction of new plan designs from carriers who are willing to create competition. There is still the traditional fully insured approach. The ACA has impacted the election significantly but it is still an option. There new plan designs are coming in the form of partial and self-funded plans for small groups. These options are giving small groups premium reimbursement or even a check at the end of the year based on utilization. We are even seeing stop loss insurance that could be affordable to most small groups. The industry will continue to create attractive small group insurance vehicles.

This has always been a tough market locally. Do you self fund or do you go fully insured? Every business is different. We have fully insured this market over the years and reduced the majority of liability. We have also self-funded this segment which created immediate savings with large long term savings. There is an emerging private exchange option for these size groups. This is really the old cafeteria approach but with advanced technology behind, this option is still under development but we believe it may be a solution.

Here at Nefouse & Associates, we have a long history of taking care of large employers. We are able to negotiate every aspect of the health insurance package. Our fierce negotiations for clients yield huge savings and at the same time keeping the employees very happy. We have had success in this market because of our industry knowledge and the relationships that have been developed over the years. If your company is in this category and you want to get the deepest network discounts and the lowest administration cost, we can deliver that to you.

With companies that have reporting requirements under the ACA, the benefit admin platform can save hours data collection.  A good system should provide applicable large employer calculator (ALE) which can determine if a group is required to report under the ACA.  Then have the option of generating those reports from the benefit admin system.

Cobra administration integration is now an option for moth benefit admin systems. Multiple third-party administrators (TPA) are contracting with admin system to streamline offering cobra to qualified beneficiaries.  Within the benefit admin system, when an employee is terminated then the communication goes directly to the TPA and they administer the Cobra offer. The goal is to where the employer only must touch the termination one time.