Large Group Quote

[toddoxley]

I have been told by several carrier reps that " total payroll" count is used to determine whether an employer group is issued a ACA metal tiered community rated plan or a non ACA, underwritten, non metal plan.

So, a employer that has 28 full time eligible covered members and another 23 or more part time employees , so a total payroll count of 51 is treated for plan design, underwritten purposes as a large group ie: above 50.

What are other brokers experiencing ?

 

[NWBenefitProvider]

What you are hearing is common among carriers, but NOT how the government is calculating FTE's. Until they are on the same page, this will be a problem.

Carriers are looking at total payroll like they always have.

Government says 30+ hours equals 1 FTE and 2 15 hour a week employees equal 1 FTE. They are going by total number of hours, not total number of bodies on payroll.

Does that make sense? Unless carriers change their definition to go along with the way the government counts full timers, we will be stuck.

It sucks, because I have a few groups with more than 50 on payroll, but only a fraction who are eligible and they have to go on large group plans.

 

[toddoxley]

Are your groups being moved to large group plans at renewal or are you running into this when you get alternate quotes at renewal ?

 

[Ann H]

Carriers are looking at total payroll like they always have...

Government says 30+ hours equals 1 FTE and 2 15 hour a week employees equal 1 FTE...

...I have a few groups with more than 50 on payroll, but only a fraction who are eligible and they have to go on large group plans.

Previously, carriers looked at how many are ELIGIBLE. Has this changed in your cases, NWBP? Are they now looking at body count? If so, that's crazy.

I've heard it said that under the new law there are 15 ways to count to 50!

According to a sales manager at a BCBSAZ seminar I attended, they have a questionnaire with several ways to count, and if any of those results in less than 51, then it's small group.

 

[NWBenefitProvider]

Are your groups being moved to large group plans at renewal or are you running into this when you get alternate quotes at renewal ?

They are going to have to change at renewal with their existing and any other carrier here in WA.

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Previously, carriers looked at how many are ELIGIBLE. Has this changed in your cases, NWBP? Are they now looking at body count? If so, that's crazy.

I've heard it said that under the new law there are 15 ways to count to 50!

According to a sales manager at a BCBSAZ seminar I attended, they have a questionnaire with several ways to count, and if any of those results in less than 51, then it's small group.

Yeah, it's body count on payroll here, which is INSANE! I have a group with about 30 full time employees and another 30 or so per diem employees and even though they only have 30 eligible, they have no choice except large group. It sucks big time.