Sutter Health Plus News & Trends

A news blog for brokers, employers, reporters and the community.

Upcoming Change to Small Group Employer Definition

Posted by on Jul 13, 2015 in Access

S--Nolte-WebToday, California defines employers with 50 or fewer employees as small groups and those with more than 50 as large groups. Beginning January 1, 2016, the small group definition expands to any employer with up to 100 employees. Why does this matter?

Nothing changes too much for small group employers with 50 or fewer employees. However, employers with 51 to 100 employees will move to the small group market next year. As small group employers, they’ll now have to follow a more stringent set of medical coverage rules and regulations. Small group health plans must include essential health benefits such as habilitative services, and pediatric dental and vision.

The new rules may result in premium rate changes that could be positive or negative for businesses and employees—depending on the specific circumstances and the impact of rating factors. This includes such characteristics as firm size, geography, as well employee and dependent age and family demographics.

What should groups do if they prefer to wait another year before they make the change? Many carriers are offering clients the opportunity to renew early for a December 1 effective date. In fact, we’re offering this to our current 51-100 group clients. And for those ready to make the change to an ACA-compliant plan, we have a portfolio of small group health plans.

Learn more about health care reform and small groups by downloading our free tip sheet.