What Every Employer Must Know About Their Group Health Plans

What Every Employer Must Know About Their Group Health Plans

Open enrollment for 2017 insurance plans is just around the corner. If you haven’t already started preparing for your employees’ enrollment in the 2017 group health plans, it’s definitely time to get started.

Do you know what you need to know for a successful open enrollment this year?



What Do You Need to Know as an Employer for Open Enrollment?

Do you have a grandfathered plan?

Knowing whether or not you have a grandfathered plan is critical to making sure you are following the right guidelines. It’s also important to know whether your grandfathered plan will maintain its status or need to be changed.


Does your plan meet ACA requirements?

Under the ACA, there are specific requirements that health plans must meet. You want to be sure your plan meets those requirements, such as:

Do your health plan’s out-of-pocket maximums fall within the required limits?

$7,150 for self-only coverage and $14,300 for family coverage

Does your plan include the required preventive health services with no co-pays, deductibles or coinsurance?

You can find a complete list of covered preventive services here.

If your plan includes a Flexible Spending Account (FSA) does it meet the ACA limits?

Does your plan provide a Summary of Benefits and Coverage that meets the new information and template requirements?

Does your plan provide the required notices for patient protections?


Starting in 2017, there are new rules for Health plans that include Wellness programs.

  • Does your plan protect the privacy of my employees?
  • Does your plan provide participating employees with the required disclosures and notices?

There are specific guidelines for the administration of employee wellness programs. Your wellness program should be providing you with the guidelines and helping you ensure you are in compliance.


Are you reimbursing employees for buying individual health insurance instead of providing group health plans?

This is a definite no-no. Employers are prohibited from reimbursing employees who purchase individual health plans. Employers can be fined up to $100/day or $35,500/year per employee.


Did you discontinue group coverage because individual insurance coverage cost less than providing group benefits?

The tables have turned. Individual insurance has become very expensive with reduced options and increased deductibles. Many companies that previously discontinued group coverage for individual plans are finding that group health plans now offer better coverage at much lower rates. For example, small group rates are seeing increases that average six percent or less for 2017.


Have you reviewed your plans with staff or HR to make sure you are providing the benefits your employees need and want?

Roper Insurance offers all of their group clients a convenient customized online survey form so employees can provide anonymous feedback regarding which benefits and features they would most like to have, among other things.


Has your broker made sure you know the answers to all of these questions—and any other questions you may have about your group health and benefits coverage for 2017?

Roper Insurance can help you make sure you are fully prepared for open enrollment. Call us today at 303-721-1145 or email us here for a free benefits review. We’ll not only make sure you have the answers you need to make the right benefit decisions for your employees, but we will also provide you the resources you need for a smooth open enrollment and the assistance you need to keep your benefits programs running smoothly throughout the year.