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Frequently Asked Questions

Is every business required to offer health benefits?

No. The so-called “employer mandate” only impacts companies with 50 FTEs (full time equivalents) or more. Note that this is 50 FTEs, not 50 employees. The law specifies the calculations for converting part-time employees to FTEs. Note also that companies under common control have their employee counts added together for the purposes of qualifying for the employer mandate.

Potential penalties are in effect for companies with more than 50 FTEs who don’t take certain actions with regards to their workforce. Penalties are assessed if an employer either does not offer health coverage to at least 95% of its full-time employees and their child dependents, if the plan is considered unaffordable, or if the plan does not meet a minimum value test

Yes. The tax incentive is available for employers with less than 25 FTEs, average annual wages less than $52,000 (adjusted each year for inflation), and who contribute at least 50% of the cost of the group health premium. For those companies who qualify, the tax credit is available for two consecutive taxable years.

The amount of the credit ranges from 3-50% of the employer contribution (to a max of 50% of premium) and varies according to average wages and number of employees. The maximum credit is available for those with 10 or fewer employees and average wages of $25,000 or less. The credit declines as either of those variables increase. Health insurance must be purchased through the government SHOP (Small Business Health Options Program) exchange in order to qualify for the credit

By working with a HealthMarkets agent, in many cases your employees will receive better health and financial protection with lower out-of-pocket expenses.

Group health insurance plans are categorized as either indemnity plans (also known as “traditional indemnity,” “fee-for-service,” or “FFS” plans) or managed care plans (PPOs, HMOs, and POS plans). The major difference between these categories are in regards to choice of providers, out-of-pocket expenses for covered services, and how bills are paid.

HealthMarkets has access to group health insurance plans from dozens of insurance companies nationwide. Our licensed insurance agents compare multiple options to find a solution that is right for each company’s specific needs.

Combined with health insurance, supplemental insurance (sometimes referred to as voluntary insurance) provides an added layer of financial protection for your employees to cover out-of-pocket expenses. Supplemental insurance can be especially helpful to fill the gap in high deductible health insurance plans since this combination provides lower premium costs while minimizing out-of-pocket expenses.

Employers looking for a way to cut costs while increasing employee satisfaction may find both by offering supplemental insurance as an optional benefit, according to a recent survey of small business owners.



Yes, your employees have the option of looking for health insurance through the individual marketplace.   However, as long as you offer group health insurance that provides the minimum essential coverage and cost sharing in line with a Bronze plan on the marketplace, and has a minimum average cost sharing amount (actuarial value) of 60%, your employees will not be eligible for a government subsidy to help pay for their insurance.  In some cases, the optimal solution for both the employer and employees is to switch from the group to the individual insurance market.  HealthMarkets will perform an analysis to reveal your best option.