If you know prospects or clients who have been unable to get health coverage for their employees – because of an inability to meet carrier participation or employer contribution requirements – reach out now to get them enrolled during the upcoming annual Special Open Enrollment Window (SOEW).
Employers must enroll between November 15 and December 15, 2021, for coverage effective January 1, 2022.
The SOEW is included in a part of the Affordable Care Act (ACA) called the “guaranteed issuance of coverage in the individual and group market.” Specifically, it states, “each health insurer that offers health insurance coverage in the individual or group market in the state must accept every employer and individual in the state that applies for such coverage.”
Guaranteed coverage can be offered only during special open enrollment periods, and plans can be offered only to applicants who live in, work in, or reside in each health plan’s service area(s).
Participation and Contribution Requirements
In California and Nevada, health insurers can decline to issue group health coverage if fewer than 70% of employees enroll in coverage. Some carriers have even tighter participation requirements.
Furthermore, rules require employers to contribute a certain percentage toward employee premium costs in order to attain group health coverage.
Together, these rules present problems for some small businesses, which limits their ability to offer coverage to employees if they want to offer it. Employers cannot force employees to enroll in health coverage unless the employer pays 100% of the premiums, which many businesses cannot afford to do.
Even if an employer’s contributions are generous, many businesses find their younger and lower-income workers waiving coverage. The annual SOEW helps solve those participation and contribution problems.
A Word About ALEs
It is important to note that Applicable Large Employers (ALEs) – businesses with 50+ full-time or full-time-equivalent employees – are still subject to the ACA Employer Shared Responsibility mandate.
The mandate requires ALEs to offer “affordable” health coverage to full-time employees and their dependents to age 26. For 2022, the affordability threshold is 9.61%, as compared to 9.83% in 2021. If an employer does not offer affordable coverage, the business faces potential non-compliance penalties under IRS Section 4980H.
Don’t let your employer client’s financial challenges stand in the way of employees getting the health coverage they need and want . . . especially with interest up for health insurance due to COVID-19.
Get your eligible groups enrolled between 11/15/2021 and 12/15/2021 – so they have coverage effective in 2022.
You can count on your Word & Brown representative to help you with quoting and enrollment of your SOEW groups.