Are you a business owner looking for health insurance but could never enroll because of participation requirements? No worries; your group qualifies for a Special Enrollment Period (SEP)! Yes, you read that, correct!
Open Enrollment is a yearly period when individuals/families and businesses can enroll in a new health insurance plan or make changes to their existing plan. In most states, Open Enrollment runs from November 1st to December 15th, but New Jersey extended the deadline to January 31st, 2021. However, business open enrollment is from November 15th to December 15th for a January 1st, 2021 effective date.
Technically you need 75% of your employees to opt into a group health insurance plan, but during the open enrollment, that requirement is waived, and you can enroll even if only one person is insured. The SEP’s main requirements for your business are that you have at least one W-2 employee on the plan, besides the owner and the spouse of the owner.Â
Business Checklist ComplianceÂ
To prepare for open enrollment, businesses should be aware of the legal changes affecting their plans’ design and administration for plan years beginning on or after January 1st, 2021. Employers should review their plan documents to confirm that they include these required changes.
Confirm that your group health plan’s out-of-pocket maximum complies with the ACA’s limit for 2021. Under the ACA, an ALE’s coverage is considered affordable if the employee’s required contribution to the plan does not exceed a certain percentage of the employee’s household income for the taxable year. Plan years that begin on or after January 1st, 2021, the affordability percentage is 9.83%.
Confirm that the health insurance plan’s deductible and out-of-pocket maximum comply with the 2021 limits. Health plans are subjected to limitations on cost-sharing for essential health benefits. The annual limit on cost-sharing for essential health benefits for plan years beginning on or after January 1st, 2021, is $8,550 for self-only coverage and $17,100 for family coverage. This doesn’t mean you have to choose a plan with this maximum out of pockets
Preventive care services are required to be offered without imposing cost-sharing requirements. Also, the ACA sets a dollar limit on employees’ salary reduction contributions to a health flexible spending account (FSA). Employers may impose their own dollar amount on employees’ salary reduction contributions to a health FSA account, as long as the limit does not exceed the ACA’s maximum limit in effect for the plan year. The IRS has not yet announced the limit for 2021 plan year for FSAs.
Lastly, provide all participates with a summary of their benefits and coverage. The ACA requires employers to provide an SBC to applicants and enrollees to help them understand their coverage and make coverage decisions. Employers must provide the SBC to participants and beneficiaries who enroll or re-enroll during an open enrollment period.Â
The Bottom Line
In any case, don’t just sit back and swallow a premium increase. There may be better plans for you out there today, with benefits that better suit your needs, a better provider network and/or more competitive premium. Â
A little time and effort now can make a great difference throughout the next year, both financially and with the quality of your healthcare. Just give Cosmo Insurance Agency a call. We will simplify the process for you!
Cosmo Insurance Agency is a full-service independent insurance agency based in Hackensack (Bergen County) and Lakewood (Ocean County), New Jersey that offers an all-encompassing range of insurance options for both individuals and businesses. Cosmo keeps its promise to assure an efficient and creative approach to the services we offer. Each of our clients experience a personalized and long-term relationship with us. Our New Jersey based team of health brokers guides our clients in helping them choose the most cost-effective options. By incorporating our knowledge of the insurance guidelines for healthcare, employee benefits, life insurance, self-insurance, dental, disability, and long term care insurance, we keep our clients up-to-date with affordable plans that cover all their specific insurance needs.
