Health Care Reform for Small Businesses


Are you a small business owner that’s still confused with regards to Health Care Reform, don’t worry you are not alone. At this point the federal government seems to still fine tuning some of the rules and regulations. A few months ago the IRS  provided updates on the rules regarding the individual mandate, Here is the latest news for small businesses regarding their health plans, and what they will be required to provide starting January 1, 2014  The video below provides a very good synopsis of all the credits that are available for small businesses within the Affordable Care Act, and the Heatlh care Reform law.

The Health Care Reform law looks at a small business from two perspectives. The small business that currently provides health care to their employees, and those that don’t.

Small Businesses Currently Providing Health Care.

If you are a small business that is already providing health insurance to your employees, there are some “Grandfathered” benefits and options you will be allowed.  If you had your insurance plan in place prior to the signing of the Health Care Reform bill into law on March 23, 2010 you are allowed to keep that plan as part of the “grandfathered” clause. The grandfathered plans will have less stringent requirement compared to plans that were put in place after March 23, 2010. “Grandfathered” Plan under the Health Care Reform law will not be required to

  • Allow direct access to OB/GYN without the need of referral
  • Provide the ability to have an internal and external process to appeal coverage decisions
  • Provide coverage of the “essential health benefits”
  • Provide coverage of preventative services free of charge to the beneficiary.

Many medium size businesses with less than 100 employees can keep their “grandfathered” plans even if they add new employees onto the plan, or remove old ones. The “Grandfathered” plans are pretty much protected as long as the employer does not change the cost of the premium to the beneficiary, or the level of benefits provided.

Small Businesses purchasing new Health Care Plans

health care reform for small businessesThe Health Care Reform law will provide new requirements for all Health Plans. If you are a small business and currently provide health care, or you have a plan that was put in place after March 23, 2010 you are required to adhere to the rules set in place by The Health Care Reform Bill.

Health Care Reform Premium Cost

  • Starting January 1, 2014 all health insurance plans provided by employers must gaurantee access, regardless of health status, age, sex or pre-existing conditions, adiitionally all plans provided must guarantee access for children up to the age of 26 for all health care plans
  • Starting in January 1, 2014 the premium charged by any health plans (Non-grandfathered) can not vary based on health status. The only factors that can cause a variance in premium will be age, tobacco usage, policy type (Family or Single) and location.
  • Healht Insurance plans can now provide a wellness reward of up to 30% of premium

Health Care Reform Plan Coverage Requirements

  • All plans will now be required to provide “essential benefits”
  • No plans grandfathered or not will be allowed to exclude any pre-existing conditions.

 Health Care Reform Plan Packages Requirements

  • All plans will have to adhere to the Medical Loss Ratio (MLR)
  • All plans will have to be labeled, (Bronze, Silver, Gold, Platinum)
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