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Questions for Large Employers

I am a Large Employer and offer insurance to my employees. Do I have to change plans?

No, it is not necessary to change plans. You can keep the same plan you’ve always had. The following reforms apply to all plans (including grandfathered plans):

  • Lifetime dollar limits cannot be applied to health benefits that are Essential Health Benefits; and
  • Dependent coverage must be extended to adult children until they are 26 years old.

Coverage Changes Effective for Plan Year 2014 in the Large Group Market

Large group health insurance plans are not required to offer Essential Health Benefits. However, any benefits offered by these plans that are Essential Health Benefits cannot have annual or lifetime dollar limits.

Preventive care services must be provided without any cost-sharing to the employee as long as the service is provided by a network provider. This means that a network provider cannot charge copays, deductibles or coinsurance to the covered person. These services include, but are not limited to:

  • Blood pressure, diabetes and cholesterol tests;
  • Many cancer screenings, including mammograms and colonoscopies;
  • Counseling on such topics as quitting smoking, losing weight, eating healthy, treating depression, and reducing alcohol use;
  • Regular well-baby and well-child visits from birth to age 21;
  • Routine vaccinations against diseases such as measles, polio and meningitis;
  • Counseling, screening and vaccines to ensure healthy pregnancies; and
  • Flu and Pneumonia shots.

As a Large Employer how can I purchase insurance?

Your licensed insurance broker, agent or company will still be your best resource for purchasing insurance. Remember to check with the Division of Insurance here to ensure that they are licensed.

Can I offer a different level of coverage, different contribution rate, or different cost-sharing for my management employees (or other selected employees) than what is offered to the rest of the employees?

In the past, an insured group health plan could provide non-taxable benefits to executives and other highly compensated individuals even if the plan discriminated in favor of those individuals with regard to eligibility to participate or the benefits provided. The ACA has now subjected insured group plans to similar rules as those contained with the IRS Code 105(h) if they discriminate in favor of those persons. (Grandfathered plans are not subject to this change as long as the plan retains its “grandfathered” status.) Under the ACA, an employer that sponsors a plan that discriminates in favor of highly compensated individuals is subject to at least a $100 per day penalty multiplied by the number of persons subject to the discrimination.