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Are Employers Required to Offer Family Health Insurance?

Jeff Griffin

At this point, everyone knows the Affordable Care Act (ACA) requires all employers with 50 or more full-time equivalent (FTE) employees to offer affordable coverage to their workforce. This requirement is called the employer mandate.

What’s less clear for some employers is to whom the coverage must be extended. Do employers have to offer family health insurance coverage? Dependent health insurance? What about coverage for spouses? The answer is pretty straightforward, so let’s dive right in and clear up all that confusion.

ACA Requirements for Employers

The ACA requires that applicable large employers (ALEs) offer affordable coverage to their full-time employees and their dependents up to age 26. However, the law makes no requirement for spousal coverage, nor does it mandate that employers pay for any portion of the premium for dependents.

So in short — employers are not required to offer family health insurance. That being said, many employers choose to offer coverage for spouses and families, regardless of whether dependents are older or younger than 26 years of age. In addition, most choose to subsidize a portion of the premium as well.

One trend picking up steam in the past decade is to only offer spousal coverage if the spouse isn’t able to obtain health insurance through his or her own employer (or if the spouse doesn’t work).

Another common practice is for an employer to levy an additional surcharge for spouses who can obtain insurance through their own employers, but prefer to be on their spouses’ insurance instead. The reasons for doing so are often wide and varied. Nevertheless, the surcharge is often relatively minimal — perhaps around $100.

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Topics: Employee Benefits, Affordable Care Act, Plan Design, employers

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Advice To Give When Employees Need Help Paying Medical Bills

David Rook

When household budgets are already tight, the last thing your employees need is to be overburdened by unplanned and expensive medical bills. Even if they have a persistent cough that won't go away, an injury that just won't heal on its own, or a medical concern they know will eventually land them in the hospital, they may be less likely to see a doctor because they can’t afford to pay another bill.

Unfortunately, health problems often pop up without warning, which may leave some of your employees scrambling to pay the bill — and most likely, at the worst possible time. While most people find this subject embarrassing and would rather keep these matters private, you may have a few employees who confide in you, and seek your advice when it comes to needing help paying medical bills. It goes a long way when you point out to them that they have several outlets to explore before all hope seems to be lost.

Here are some suggestions you can put in your employee benefits guide or send to inquiring employees:

1. Don't Ignore the Bill

This is a really important first step: When you get the bill, don't ignore it. Most companies will bill you again after 30 days, again after 60 days, and then probably once more after 90 days. If you’ve still neglected to pay the bill, you may be sent to collections (the laws can vary, depending on many factors, including the type of medical debt), which will result in agents calling you to demand repayment, negatively impacting your credit history (and therefore, your credit rating).

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Topics: Employee Communications, employee communication, employers

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What Is Reference Based Pricing?

Jeff Griffin

In the never-ending quest to decrease employee benefits spending on healthcare, some employers are turning to a somewhat revolutionary concept called reference based pricing. This switch is most common among large employers (500 employees or more) who are self-funded, and is gaining popularity rather quickly. For those who may be interested in implementing such a program, it’s important to understand how it differs from traditional healthcare plans, as well as how it will affect those enrolled in it.

What Is Reference Based Pricing?

Reference based pricing (RBP) is a system that some employers have started to use for cost containment purposes. This method is different from more traditional pricing options in that the employer caps the amount they’ll agree to cover for certain non-emergent medical procedures that can vary greatly in price yet not in outcome, such as hip or knee replacements.

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Topics: Employee Benefits, Cost Containment, Education, employers

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Are Your Health & Wellness Corporate Communications Missing The Mark?

David Rook

Are you missing the mark with your efforts designed to promote wellness, as well as target other population health issues? Is this inability to effectively target the right employees as well as drive real behavioral change driving up your claim costs, and ultimately your premiums?

If you’re like most small businesses, you’re relying on your employee benefits broker to help out in this area. Unfortunately, most brokers aren’t equipped to help you “unearth” these issues and they certainly aren’t staffed to help guide any effort towards taming your workforce’s true health issues. In fact, when faced with this challenge, most brokers typically hand their clients a set of somewhat generic carrier-generated posters and flyers and call it their “strategic communications plan.”

Here is what you should expect from your employee benefits broker and why customized content is far more effective than cookie-cutter fliers in the break room.

Flying Blind With Generic Marketing Pieces Just Doesn’t Cut It

Setting aside the inability to identify and target true population health risks for a moment, let’s just talk about the efficacy (or inefficacy more likely) of these communication materials. Generic fact-sheets frequently miss the mark because they are written for such a general audience that they fall flat and lack a meaningful call-to-action.

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Topics: Employee Benefits, employee benefits broker, employers

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What Are Required Employee Benefits?

David Rook

When starting a business, most entrepreneurs want to attract employees by offering them a robust benefits package. Then, reality sets in, and they realize that this will have to wait until they establish positive cash flow. Well regardless of if an employer is just starting out or if they’re already well established, employers need to realize that there are certain required employee benefits they MUST offer in order to maintain compliance with the law; failure to do so can trigger large penalties. Here are required employee benefits employers cannot skip — and some that are only applicable as a business grows.

Required Employee Benefits For Employers of Any Size

1. Social Security and Medicare Benefits

Every employer, regardless of size, is subject to the required employee benefit of matching their employees’ social security and Medicare contributions. The current rate for social security is 6.2 percent of the employee’s wage from each party, equalling 12.4 percent in total, up to the first $127,200 in earnings. This amount is also known as the “wage base limit.”

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Topics: Employee Benefits, Affordable Care Act, employers

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Props 205 and 206: 2 Ballot Propositions That Impact Arizona Employers

David Rook


The upcoming election is just days away and includes Propositions 205 and 206 in Arizona, which places company benefits front and center in the minds of employers- accompanied by a collective sigh.

A quick review of what’s at stake in terms of considerations for Arizona employers reveals that questions are more prevalent than answers, especially regarding Proposition 205.

To place employers' questions in their strategic context, here is a framework in which to consider what to do:

  • Consider the role your employees play in giving your enterprise a competitive edge. Benefits plans and policies are key employee attraction and retention tools, as savvy CEOs know.
  • Consider that your benefits plans and policies can work to keep your workforce healthy and productive. It doesn’t end there: when the families of your employees are healthier, your employees remain more productive too.
  • The right benefits policies strategically aligned to your workforce are likely to increase your employees’ engagement with their jobs—which leads to happier, more productive employees who are eager to pitch in outside their job descriptions.
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Topics: Arizona, employers, ballot propositions

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