Small Group Solutions

Classified as less than 50 Full-Time Equivalent employees (FTE)

*****Small employers believe they do not need to be concerned with the Affordable Care Act until January 1st, 2015***** WRONG – there are several items that need your attention now. If you wait until January, you will have missed the opportunity to successfully design your future benefit plan and missed important information regarding model notice distribution required from ALL employers.

We have heard many small employers state they are simply going to walk away and not provide health insurance to their employees, which is an option. However, what are the financial implications of this action? Are you a small company who does not believe there is a financial downside? It is necessary for you to have a conversation with us and examine the true cost of eliminating health insurance on your business.

A small group healthcare financing strategy is more important than ever – it is a known fact that the Affordable Care Act discriminates against the small employer by requiring minimum essential benefits instead of the minimum value plan designs afforded to large employers; a deductible of no more than $2,000 and forced participation in community rating premium pricing. A guarantee issue is a requirement that health plans must permit you to enroll regardless of health status, age, gender, or other factors that might predict an individual’s use and subsequent cost of health services. This applies to small groups (less than 50 full-time employees) on January 1, 2014, but does not apply to self-funded groups. (


In other words, health insurance benefits are dictated to the small business owner, yet large companies are still afforded options. The price is also determined by ‘lumping’ your employees with every other small company offering the same health insurance plan. It no longer matters if your employee is a young/old and healthy/unhealthy person; the price is the same for the small company employee. There are alternatives that can be considered. Please contact us for our consulting services.

The question becomes how do I attract and retain top employees when I cannot offer competitive benefits at an affordable price? The answer is strategy!

Using the newly implemented Affordable Care Act requirements, a long-term strategy can be created around the needs of your business, anticipated future growth and objectives, using benefit designs that will be valued by your employees and financially sustainable to your business.

The Affordable Care Act will completely change the delivery of healthcare. What has always been is no longer viable. To understand and benefit from the potential financial opportunities and plan design flexibility, use an agency known for thinking, that knows the law, is creative and appreciates the many options the Affordable Care Act offers in creating a benefit plan specifically designed to your needs.

Please consider Braden Benefit Strategies, Inc., an agency dedicated to your success.

Full Time Employee (FTE)

A small group is defined as a business with 50 employees or less. Some states define a self-employed business with no employees as a small business, please check with your State Department of Insurance for applicability. In Georgia a small group is defined as 2 to 49 W-2 employees. A large group is defined as a business with 50+ full-time employees. Currently in other states it may be 100+ employees. As of 2016, all states will define a small group as 2-99 employees and a large group as 100+ employees. (

To determine estimated premium and out-of-pocket costs for eligible families and individuals, follow these links to healthcare subsidies calculators

Renewals take on an entirely different strategy as 2014 ushers in small group community rating.

Changes in Insurance Premiums in 2014
Due to the Patient Protection and Affordable Care Act, health insurance costs in the United States will change.

Some of the important factors causing the premium costs to change include the Affordable Care Act to mandate the purchase of insurance, require benefits, and implement premium limitations on the basis of gender, health status, age and group size.

A study by the American Action Forum (AAF) demonstrates how insurance premium costs will be affected by the Affordable Care Act from an individual and small group standpoint. AAF actuarial statistics for Atlanta, GA show, on average, younger and healthier Americans will experience premium increases of 164% while the older and less healthy Americans will experience premium decreases by -21%.

Premium costs will increase significantly for the young and healthy, subsidizing premium costs for the old and less healthy in the individual and small group markets. To read more on this study, please click here.

Common Ownership
We strongly advise consulting an ERISA attorney to determine common ownership should you have questions.

A control group relationship exists if the businesses have one of the following relationships:

  • Parent-subsidiary
  • Brother-sister
  • A combination of the above

All employees of a controlled group under section 414(b) or (c), or an affiliated service group under section 414(m), are taken into account in determining whether the members of the controlled group or affiliated service group together constitute an applicable large employer.

Notice of the “Shared Responsibility for Employers Regarding Health Coverage”

Common Law Standard – Current 1099 Employees
Under the common law standard, an employment relationship exists when the person for whom the services are performed has the right to control and direct the individual who performs the services, not only as to the results to be accomplished by the work but also as to the details and means by which that result is accomplished. Under the common law standard, an employment relationship exists if an employee is subject to the will and control of the employer, not only as to what shall be done but how it shall be done. In this connection, it is not necessary that the employer actually direct or control the manner in which the services are performed; it is sufficient if the employer has the right to do so. See §§31.3121(d)-1(c), 31.3231(b)-1(a)(2), 31.3306(i)-1(b), and 31.3401(c)-1(b).

Before making any changes in employee classifications, please consult your CPA.


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