Group Health Insurance|AnyInsurance

New Company

Companies need to recruit new talents to help their business grow and lay a solid foundation. As such, company will only need to provide a minimum of 4 weeks of payroll journal to apply for group medical plan.

Husband and Wife Company

According to insurance underwriting guideline, husband and wife company needs at least 1 additional full time employee to be eligible to apply for 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 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 has to comply with ACA's minimum essential coverage guideline. Any company that is not in compliance will be subject to 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 small group medical plan. This is because premium calculation and benefit for large group and small group are different.

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	Situation	Penalty Amount	Penalty applies to
All Employers	Company reimburses /pays for employees' individual plan.	$100/day/person; up to $36,500/person	Employer
Small Group Employers(50-100 full time employees)	Company does NOT provide medical insurance at all	$2,000/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”	$2,000/year/person (same as above) ；$3,000/year/person (if full time employee applied through Covered CA and received subsidy), whichever is lower will be the penalty amount.	Employer
Large Group Employers (≥101 full time employees)	Company does NOT provide medical insurance at all	$2,000/year/person (penalty assess from the 31st full time employee, the first 30 full time employees are exempted)	Employer
Large Group Employers (≥101 full time employees)	Company's insurance does NOT meet ACA requirement; or the insurance provided is not “affordable”	$2,000/year/person (same as above) ；$3,000/year/person (if full time employee applied through Covered CA and received subsidy), whichever is lower will be the penalty amount.	Employer

Suitable for

Situation

Penalty Amount

Penalty applies to

All Employers

Company reimburses /pays for employees' individual plan.

$100/day/person; up to $36,500/person

Employer

Small Group Employers(50-100 full time employees)

Company does NOT provide medical insurance at all

$2,000/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”

$2,000/year/person (same as above) ；$3,000/year/person (if full time employee applied through Covered CA and received subsidy), whichever is lower will be the penalty amount.

Employer

Large Group Employers (≥101 full time employees)

Company does NOT provide medical insurance at all

$2,000/year/person (penalty assess from the 31st full time employee, the first 30 full time employees are exempted)

Employer

Large Group Employers (≥101 full time employees)

Company's insurance does NOT meet ACA requirement; or the insurance provided is not “affordable”

$2,000/year/person (same as above) ；$3,000/year/person (if full time employee applied through Covered CA and received subsidy), whichever is lower will be the penalty amount.

Employer

COBRA

COBRA(Consolidated Omnibus Budget Reconciliation Act of 1985) is a federal law that provides employees and their family member(s) continuous insurance coverage benefit after the termination of their group insurance plan. Employees are fully responsibility for the insurance premium.

After the employee resigned or qualified with some other COBRA event, whithin 30 days, the employer shall send a COBRA notice; otherwise, the employee could file a lawsuite 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. Similar to COBRA, resigned employee will receive notice within 30 days and need to decide whether to join within 60 days from termination date or be considered forfeit 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 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
COBRA	20 and more employees	18 or 36 months
CAL-COBRA	2-19 employees	Up 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 visit, inpatient, surgery, prescription, and medical treatment
Dental Insurance - primarily uses for dental care
Vision Insurance- primarily uses for routine eye exam and prescription glasses

Life insurance, short term/long term disability insurance does not fall under「medically necessary」; therefore, after employee resigns, he/she cannot continue his/her term life insurance and disability through COBRA or CAL-COBRA.

Target (individual/ company)	Applicable Form	Issuer
Individual and family Plan with Covered CA (On-Exchange)	1095A	Covered CA(Covered California)
Individual and family plan without Covered CA (Off-Exchange), MediCare, and Medi-CAL	1095B	Insurance Carriers, Medi-care, Medi-CAL offices
Employees with Small Group Medical Plan	1095B	Insurance Carriers

Target (individual/ company)

Applicable Form

Issuer

Individual and family Plan with Covered CA (On-Exchange)

1095A

Covered CA(Covered California)

Individual and family plan without Covered CA (Off-Exchange), MediCare, and Medi-CAL

1095B

Insurance Carriers, Medi-care, Medi-CAL offices

Employees with Small Group Medical Plan

1095B

Insurance Carriers

Group Medical,Dental,Vision,Life,Short/Long Term Eisability Insurance