There is a special one-month open enrollment period for small group health insurance plan sponsors that might not otherwise meet minimum participation or contribution requirements.  The special enrollment period is a little-known window of time that can help dental practice owners secure better, lower-cost health care coverage for themselves, their employees, and families

What are the benefits to Small Group plans versus Individual Market plans?

There are many advantages of enrolling in the Virginia small group health plan market versus the Virginia individual medical insurance market including the following:

• Lower Premiums – In almost all areas of VA, small group market premiums are lower than individual market premiums. Premium savings can be as much as 40% depending on the area and whether subsidies are available. In Roanoke and Richmond, for example, individual market premiums average 70% higher than group rates.
• Larger Plan and Carrier Selection – The number and quality of plans in the VA Small Group market far exceeds those available in the VA Individual market. For example, in 2020, Anthem is offering 5-6 plans in the Individual market as opposed to 60+ in the Small Group market. Anthem only offers HMO plans in the Individual market, but they offer PPO and POS plans in the Small Group market. Furthermore, the lowest deductible available in the Individual market is currently $1000 whereas there are plans in the Small Group market with no deductible at all. There are also areas in VA where only 1 carrier is available in the Individual market whereas most areas in Small Group Market VA have 2-4 carriers available.
• Tax Advantages – Group health insurance premiums and/or contributions may be 100% tax deductible as a business expense for employers. Consult with your CPA for additional information.
• Employee Retention - Offering a comprehensive health insurance plan shows that you care about your employees’ overall well-being and can be used to attract and retain valuable employees. With regular access to preventive care, group coverage is an easy way to keep your employees happy, healthy and productive at work.
• Greater Market Stability – Since the advent of the Affordable Care Act, there have been fewer changes to small group rates and plans than in the individual market. Subsequently, group plan sponsors have encountered significantly less volatility and greater ease of health plan renewals relative to individual health insurance consumers

Who is Eligible to Enroll in a Small Group Plan?

Business owners with at least one full-time W2 employee (in addition to the owner) may be eligible for group plans. In addition, Sole Proprietorships may be eligible for coverage thanks to new Virginia legislation passed on July 1, 2018.

What are the Advantages to Enrolling During the Special Annual Open Enrollment Time?

Eligible small groups can start a group plan at any time during the year, but there are participation and contribution requirements that must be met. Most carriers require that 75% of full-time eligible employees must participate in small group plans, minus qualified waivers. In addition, every carrier requires that employers pay at least 50% of the premium for their employees. These requirements may be difficult for a small employer to meet due to employees not wanting to enroll and the cost of paying for the employee premiums.

During this special time once a year, employers can enroll in a group plan regardless of who chooses to enroll and pay nothing towards the employee’s premiums. In other words, if only one person chooses to enroll in the plan, you can still reap the benefits of enrolling in the small group market.

The special enrollment period is effective January 1 only and all adoption and enrollment paperwork must be submitted between November 15 and December 15.

Contact VDA Services Endorsed Partner RK Tongue to discuss your insurance needs.  

Caroline Cole is Director of Employee Benefits at R.K. Tongue Co., Inc. Since 2007, she has dedicated her professional life to offering clients unprecedented knowledge and expertise as well as superior service. With the cost of medical insurance at all-time highs, she realizes that offering a quality benefits program at an affordable price is a challenge for employers. She is committed to addressing that challenge by staying informed of all available products/plans in addition to thinking “outside the box” to find creative solutions that make sense for her clients. Caroline also attends regular training on healthcare reform to ensure that she is up to date on all the latest changes and how they affect her clients. She is an active member of the National Association of Health Underwriters. Caroline can be reached at ckendrick@rktongue.com