Small Businesses have many tasks that are difficult.

Many tasks are quite honestly impossible.


As we’ve covered before, one of those difficult and sometimes impossible tasks is starting (or continuing) a Health Plan as a Small Business.

It’s downright hard to:

  1. Meet Participation Rules
  2. Meet Employer Contribution Rules
  3. Have enough Money to pay the Bills


There are 3 main components which create this road block


 2 of them disappear between November 15th and December 15th


Everyone understands the road block that the High Cost of healthcare creates.

The Participation Rule which requires that you maintain 75% of your Eligible Employees on your Company Health Plan isn’t so easy.

Sure, 75% of Eligible might only mean 60% or 50% of your total employee count after you subtract those with Spousal Coverage, Individual plans or those still covered on their parent’s plan.

But, sometimes even 50% is a stretch—especially if you can’t afford to fund 75%, 80%, 85% of the Employee Cost as an employer.


 Small Group (1-50) Open Enrollment


Well, let’s clear up one item real fast—The Law says it starts November 15th, but think of that as a deadline and not a start-date.    You have to work more proactively to really enjoy this opportunity.


One time per year, Small Group Health Plans (1-50 in Texas) can enjoy the Small Group Open Enrollment window—without any Participation Requirements and without any Employer Contribution Requirements.   Don’t miss the Dec. 15th Deadline.


Who can Benefit from this?

  • Companies with historically low participation (think Small Construction Contractors and Child-Care Centers)
  • Employers who had previously had Individual/Family coverage for themselves and nothing for their employees:
    • This allows Small Groups to have the option to purchase PPO Health plans that aren’t available on the Individual Markets any longer
    • Organizations without the revenue to fund a Health plan can now allow Employees to purchase their coverage and their family’s coverage fully Pre-Tax through Payroll Deductions (big tax break for W2 employees without ownership)
  • Employers who have purposely offered an “Un-Affordable” Health plan to allow some of their employees to get cheaper coverage through the Federal Exchange.
  • Husband/Wife Groups who have the proper company Tax Documentation to swing a Small Group Health plan and want to have greater access to care than the Individual or Marketplace HMOs offer.


When Can You Start the Plan?


January 1st and only January 1st.


But you can price it now, prepare your communication and offer the coverage ASAP.    You don’t want to wait until the Insurance carriers don’t care about you.

This is a get it done now, turn all paperwork and payment in as soon as November 15th and set yourself and your employees up for success for January 1st.

Mike Davis

Mike Davis


 About the author:  Mike has a passion for people. That's why he is at AG Insurance.  Mike has the kind of talent and passion that you want on your team and in your corner. It doesn't hurt that he also has a very strong accounting background as well as having spent time in a CFO & leadership role in his previous company.  With Tax and Accounting practices having a bigger and bigger impact on his clients--so does Mike.  And not to be forgotten,  Mike is also a Baseball Guy and a Rangers Fan--which goes a long way in our culture.

About AG Insurance: AG Insurance ( helps employers and their employees with solutions focused on positive organizational impact and improved employee experiences.

Share This