Understanding Health Insurance Guidelines for Small Businesses
Following the enactment of the Affordable Care Act (ACA), the government established certain guidelines for small businesses that wish to offer health insurance to their employees. The goal was to offer quality healthcare at an affordable cost and to standardize plan designs. It required insurers to cover Preventive Care at 100% and prevented them from charging more or denying coverage for members with pre-existing conditions. They also developed “member level pricing” or “age banded rates”. This means all plans offered to small businesses would have a different, individual premium for everyone based on their age. The rating tables range from ages 0 to 65 so each employee, along with their dependents can have different premiums.
This system receives mixed reviews across the industry but has no doubt been an equitable way to establish a pricing structure for small businesses.
What Health Insurance Options are Available in D.C. for Small Businesses?
In 2011, following the ACA, D.C. decided to try something that no other state in the country was doing at the time. D.C. established an online exchange, where small businesses could offer a variety of health insurance options from different national/regional carriers. The idea was to simplify the process and give employers a one-stop shop for health insurance.
To participate in the exchange the employer must be:
- headquartered or have employees’ primary worksite in DC
- have at least 1 non-owner employee
- cover at least 50% of the employees’ premium cost.
If you meet the criteria, employers then have access to over 100 plans from the ‘big 4’ health insurance carriers: CareFirst, UnitedHealthcare, Aetna and Kaiser Permanente.
Typically, small businesses are limited to offering up to 3 plans from 1 health insurance carrier, but a unique aspect of DC Health Link is that employers can have more flexibility with what they offer. Employers can offer ALL plans from a carrier, all plans for a specific Metal Level (Platinum, Gold, Silver or Bronze) which includes plans from ALL 4 carriers or offer 1 single plan.
By doing this DC Health Link allows for more control, customization and most importantly more options for employers.
Dental coverage is also available on DC Health Link. Other benefits like Vision, Life Insurance, Disability and more can be purchased outside of the exchange with the help of your trusted advisor
Navigating the Washington, D.C. Health Insurance Exchange
With so many options, specific rules and timelines to keep in mind, employers generally need help understanding their options and deciding what to offer. That is why DC Health Link has partnered with independent insurance advisors to assist employers with the process. Insurance advisors or brokers are available to employers at no cost and can be changed at any time within the DC Health Link employer portal.
Advisors must complete the following requirements to be credentialed with DC Health Link:
- Completed the necessary DC Health Link Policy & Systems Training
- Obtained carrier appointments in the intended market
- Possesses a D.C. Resident or Non-Resident health insurance producer license that is in good standing.
Beyond being well-versed on the platform, it’s important your advisors take the time to understand your needs and how they grow with your business. This is true for employers who are establishing a plan for the first time or those who want & need a higher level of support.
As a credentialed advisor, we are proud to say that we have been working with DC Health Link since its inception. Our CEO, Ed Bonifant, was an active participant in the DC Health Benefit Exchange Authority, and we have expanded our team to include a designated in-house DC Health Link Coordinator. Since then, HWP has partnered with well over 100 small businesses throughout the District to provide health insurance for their employees.
If you are unsure what benefits are right for you, reach out to one of our advisors today.
About the Author
In his role at HWP, Marty acts as an employee benefits advisor focusing on helping employers of all sizes and industries implement and enhance their benefits programs. He also is well versed in Individual Life insurance and Disability products.
Marty holds a Business Marketing & Management Degree from Fairmont State University. He is also a Registered Employee Benefits Consultant (REBC) and is currently working to attain his Chartered Life Underwriter (CLU) designation from the American College of Financial Services.
Email: mbonifant@hwphillips.com
Phone: 202-351-0269
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