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Group

Our Group Insurance team helps you solve any group insurance inquiries!


Product

Group insurance is insurance that covers a group of employees. Health care coverage is one of the most important benefits provided by a company for its employees. A good package of group insurance will not only protect employees’ health and cover their medical expenses, but it will also raise unity and loyalty so that the company will be benefited from a low turnover rate. Talent retention and employee development are crucial for the growth and prosperity of any business. Group insurance can be sub-divided into 4 areas： Medical Insurance、 Dental Insurance、 Vision Insurance、 Life Insurance and Short Term/Long Term Disability Insurance. In many cases, a group insurance plan's benefit is better than an individual's insurance plan. For example, group insurance has more contracted hospitals and physicians. As such, employees need not worry about the “declined to service” situation. Also, the Affordable Care Act currently requires medical plans to cover a set of preventive care services such as free annual checkups, etc. This will help the employees to reduce the risk of developing any chronic condition and stay healthy.

Any Insurance Service carries a variety of products from various carriers to help provide multi-dimensional choices for employers. We also help you to choose a plan that fulfills and satisfies the need of your company to provide a protected healthy life for your employees. Our professional and passionate representatives will assist you on all aspects of services, such as new hire enrollment, employee termination/resignation, billing invoices reconciliation, explanation of your medical claim issue, etc. When it comes to group insurance, we are the best partner and 24/7 personal consultant a client can ask for.
Product Introduction

Small group:

  • New Company
    • Companies need to recruit new talents to help their business grow and lay a solid foundation. As such, the company will only need to provide a minimum of 2-4 weeks of payroll journal to apply for a group medical plan depend on different carriers’ requests.
  • Husband and Wife Company
    • According to insurance underwriting guidelines, a husband-and-wife company needs at least 1 additional full-time employee to be eligible to apply for a group medical plan.
  • Company with Less than 50 Full Time/Full-Time Equivalent (FTE) Employees
    • Company with less than 50 FTE is not mandated to have a group medical plan but most of these companies still choose to buy group medical insurance for their employees.
  • Company with More than 50 Full-Time and/or Full-Time Equivalent Employees
    • As mandated by the Affordable Care Act (ACA), if a company has more than 50 full-time and/or full-time equivalent employees, it is obligated to provide insurance to at least 95% of the employees. And the coverage provided must comply with ACA's minimum essential coverage guideline. Any company that is not in compliance will be subjected to a penalty.
  • When Becoming Small Group from Large Group
    • If your company's number of employees decreased to less than 100, you will need to re-apply for a small group medical plan. This is because premium calculation and benefit for a large group and small groups are different.

Large group:

  • Sole Company
  • Enterprise with Franchise/Branches
  • Common Ownership

Total Full-time headcount calculation:

**Actual full-time employees + Full-time equivalent employees = Total full-time employees

Full-time equivalent employees:The sum of part-time employees' weekly working hours divide by 30

Full-time employee： On average worked at least 30 hours per week and annual working days are over 120 days
Part-time employee: On average worked less than 30 hours per week and annual working days are over 120 days
Suitable for

Q&A

What's the difference between a group dental insurance plan and an individual dental insurance plan?

Compared to individual dental plans, a group dental plan's greatest advantage is “no waiting period”. For an individual dental plan, simple tooth extraction or filling, for example, needs to wait for 6 months to receive treatment and a crown will need to wait for 12 months. In addition, group dental insurance plan can select to have additional feature like orthodontic which individual plan does not and cannot be added.

What are the regulations for new hire's insurance effective date?

Due to Health Care Reform, starting 1-1-2015, the employer needs to enroll an eligible new hire within 90 calendar days. The effective date for new hire's insurance plan can be any of the followings:
  • First of the month following the date of hire
  • First of the month after 30 days from date of hire
  • First of the month after 60 days from date of hire
  • 91st day from date of hire

Is there a way to help my company save taxes and at the same time benefit my employees?

Yes. If a company can set up a Premium Only Plan (POP), medical expenses that the company paid for employees and the employees' insurance premium payments are both tax deductible. Example: Employee A was making $3000 a month (before tax) and he needs to pay $150 for his group medical insurance. If his company had set up POP, his monthly income will be $2850 ($3000 minus $150). As your income decreases, you pay less income tax. For tax-saving purposes, POP is beneficial for both the employer and the employee.

Small group questions

My company was just established, can I apply for group medical insurance？

Yes. Please provide the most recent 6 weeks payroll journal to apply.

We are a husband-and-wife company; can we apply for group medical insurance?

According to insurance companies underwriting guidelines, a company with only a husband and wife cannot apply for group medical insurance. It needs at least one additional full-time employee to qualify.

How much premiums that employers are required to pay for employees and employees’ dependents?

If it's a group medical plan, employers are required to pay at least 50% of the employee's premium. For employees’ dependents, dental and vision plans, such requirement is not mandatory (depending on the employer's benefits package).

Does the insurance premium paid by the employer have any tax benefit?

The premiums that the employer paid can use for tax deduction. Purchased a group medical insurance will be a win-win situation for the employer as can sustain valuable employees and at the same time can have tax benefit.

Our company has more than 50 full-time employees but not exceeding 100, will we be penalized if we do not provide medical insurance?

Yes! Per ACA regulation, a Large Group company must provide to at least 95% of its employees a medical plan that follows the minimum essential coverage plan or will be subject to penalty. How penalty is calculated：
If the company provided a plan that does not meet the guidelines of 「minimum essential coverage」 and is not 「affordable」, the penalty will be assessed on the 31st full-time employee and the amount is $2,750/year per employee (the first 30 full-time employees are exempted). If a full-time employee decided to apply for insurance through Covered CA and received a subsidy, the company will be facing $3,860/per year per each Covered CA applicant. The penalty amount is the lower of the two.
※ What is 「minimum essential coverage」: Company's group medical plan must have an actuarial value or cover at least 60% of the medical cost.
※ What is 「affordable」: Employee's paid premium portion cannot exceed his/her family income's 9.61 % (excluding spouse and/or dependent(s)' premium) 2022; 9.12% (excluding spouse and/or dependent(s) premium ) in 2023.

If an employee left the company, can he or she join COBRA or CAL-COBRA?

Yes. If a company has less than 20 employees, when the employee left the company, he/ she can elect to join CAL-COBRA and can use up to 36 months. If a company has more than 20 employees, he /she can elect to join COBRA for 18 months, and once COBRA lapsed, he/she can continue to elect to join CAL-COBRA for an additional 18 months.

Can we select different tiers of the medical plan when applying for group medical insurance?

Yes. Employers can select different tiers of plans for the employees to meet their needs.

What is 1095B?

1095B is a form provided by the insurance carriers to show an employee's insurance coverage in the past year. Employees should receive the form by March 31st every year.
〈Please note: if your employee does not receive 1095B by March 31, he/she can notify his/her CPA based on his/her actual insurance situation to file taxes.〉

Large group questions

I have multiple companies but most of the employee are part-time workers. Do I need to provide medical insurance?

If your total full-time equivalent employees (FTE) are over 101, then you must provide group medical insurance to your employees. Please refer to “Eligibility Requirement” for part-time employees' working hour calculation formula.

Our company has employees outside of California. Can they use our company's medical plan?

Yes, you can cover everyone's needs by purchase PPO plan only for out-of-state employes and PPO or HMO plan for employees in California.

How much premiums that employers are required to pay for employees and employees’ dependents?

If it's a group medical plan, employers are required to pay at least 50% of the employee's premium. For employees’ dependents, dental and vision plans, such requirement is not mandatory (depending on the employer's benefits package).

Our company has more than 101 full-time employees; will we be penalized if we do not provide medical insurance?

Yes! Per ACA regulation, a Large Group company must provide to at least 95% of its employees a medical plan that follows the minimum essential coverage plan or will be subject to penalty.
(Penalty calculation same as Small group)

What is the 1094C and 1095C Form?

1094C form is filed by the employer to the IRS to report the company's full-time and part-time employees' status in the past year. 1095C form is prepared and provided by the employer to the employees. It shows employees’ insurance coverage information in the past year. The form must be provided to all employees before March 31st every year and the employer must file all 1095C and 1094C to IRS at the same time.

How to file:

Via Mail: For a large company that has 250 or less 1095C
Via the internet for all kinds of a large group
Please note: If a company has more than 250 1095C, it MUST file via Internet

Health Law

When applying for a group medical plan, employers are required to cover at least 50% of the employee's premium. Dental and vision plans for employee-dependent (s) are optional (depending on the employer's benefits package).
Company Contribution Ratio
Both the company and the employees benefit from being in compliance with the ACA regulations. Not only will the employees receive qualifying health care coverage, the company will have tax deduction benefit for the group medical plan:
Target Situation Penalty Amount Penalty Target
Small Group Employers (50-100 full time employees)Company does NOT provide medical insurance at all$2,750/year/person (penalty assess from the 31st full time employee, the first 30 full time employees are exempted)Employer
Small Group Employers (50-100 full time employees)Company's insurance does NOT meet ACA requirement; or the insurance provided is not “affordable”$2,750/year/person (same as above) ；$3,860/year/person (if full time employee applied through Covered CA and received subsidy), whichever is lower will be the penalty amountEmployer
Large Group Employers (more than 101 full time employees)Company does NOT provide medical insurance at all$2,750/year/person, first 30 employees are exemptedEmployer
Large Group Employers (more than 101 full time employees)Company's insurance does NOT meet ACA requirement; or the insurance provided is not “affordable”$2,750/year/person (same as above )$3,860/year/person(if full-time employee applied through Covered CA and received subsidy), whichever is lower will be the penalty amountEmployer
※ Please note: Per ACA regulation, group medical plans need to be「affordable」and in compliance with the 「minimum essential coverage」provision.
※ Affordable: Employee's paid premium portion cannot exceed his/her family income's 9.61% (excluding spouse and/or dependent(s)' premium) 2022, 9.12% (excluding spouse and/or dependent(s) premium) in 2023.
※ Minimum essential coverage: Company's group medical plan must have an actuarial value or cover at least 60% of the medical cost.
How Penalty is Calculated
Both the company and the employees benefit from following the ACA regulations. Not only will the employees receive qualifying health care coverage, but the company will also have tax benefits benefit for the group medical plan.
Section 125: Section 125's Premium Only Plan, employees' insurance premium responsibility can be deducted before tax, enabling employees to lower their taxable income. At the same time, the company will pay less FICA/payroll tax.
If a company has less than 25 employees and a full-time employee's average income is less than $50,000/year, Company can apply via Covered CA for SHOP (Small Business Health Options Program) to receive an additional tax credit.
Tax Advantage and Deduction

COBRA

COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) is a federal law that provides employees, and their family member(s) continuous insurance coverage benefits after the termination of their group insurance plan. Employees are fully responsible for the insurance premium.
  • After the employee resigned or qualified with some other COBRA event, within 30 days, the employer shall send a COBRA notice; otherwise, the employee could file a lawsuit against the employer at any time.
  • The resigned employee can decide whether to join COBRA or forfeit within 60 days of his/her termination date. After 60 days, it will automatically be considered forfeit the right.

CAL-COBRA

CAL-COBRA (California Continuation Benefits Replacement Act of 1997) is an extension from Fed-COBRA and only applies to companies in California. Like COBRA, resigned employees will receive notice within 30 days and need to decide whether to join within 60 days from the termination date or be considered forfeiting the right.
※ Please note: Cal-COBRA and COBRA's biggest difference is that CAL-COBRA's notices are issued by insurance carriers to its members. COBRA, on the other hand, is issued by the employer or third-party administrator.
  • Continuation Coverage Period：
    A company's COBRA and CAL-COBRA's maximum continuation coverage period varies depending on its total number of full-time employees.
    • Type/Number of Full Time Employees Suitable For Duration
    COBRA20 and more employees18 or 36 months
    CAL-COBRA2-19 employeesUp to 36 months
  • Eligible Insurance Products：
    Not all insurance plans are available under COBRA and CAL-COBRA. Only「Medically Necessary」type plans are eligible, and it includes the following:
    • Medical Insurance - primarily uses for doctor visits, inpatient, surgery, prescription, and medical treatment
    • Dental Insurance - primarily uses for dental care
    • Vision Insurance- is primarily used for routine eye exams and prescription glasses
Life insurance and short-term/long-term disability insurance do not fall under「medically necessary」; therefore, after an employee resigns, he/she cannot continue his/her term life insurance and disability through COBRA or CAL-COBRA.
COBRA and CAL-COBRA
Health Care Reform Act requires all legal residents to have health/medical insurance or will be subject to a penalty. 1095 form series are used to indicate the insured's health care coverage for the past year. The forms include 1095A, 1095B and 1095C.
Based on the type of insurance plan, different forms apply.
Target (individual/ company) Applicable Form Issuer
Individual and family Plan with Covered CA (On-Exchange)1095ACovered CA (Covered California)
Individual and family plans without Covered CA (Off-Exchange), Medicare, and Medi-CAL1095BInsurance Carriers, Medi-care, Medi-CAL offices
Employees with Small Group Medical Plan1095BInsurance Carriers
1095C form is prepared and provided by the employer to the employees. It shows employees’ insurance coverage information in the past year. The 1095C form must be provided to all employees before March 31st every year and the employer must file all 1095C and 1094C to IRS at the same time.

How to file form 1095C & 1094C

  • Via mail: For large group that has 250 or less 1095C
  • Via Internet: For more than 250 1095C

Deadline:

  • If the employer filed via mail, the deadline is May 31.
  • If the employer filed via the internet, the deadline is June 30.
※ Note: Above deadlines are based on IRS' annual announcement.
1095 and 1094 forms