Nursing Home Group Question

jmarkk1

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I'm working on nursing home group with about 400 employees and no insurance.
Question...what are advantages of putting group plan in place now vs. waiting till 2016 for penalty?
 
I'm working on nursing home group with about 400 employees and no insurance.
Question...what are advantages of putting group plan in place now vs. waiting till 2016 for penalty?

Not sure what the advantages are, but I know 2 things.

If they have 400 employees they will need to provide Jan 1 of 2015. Newest extension was only for 50-99 ees.

I would worry more about implementing wellness this year. Get control of the fatties and the smokers and you might be on your way to a more manageable premium in the future.

Also; although I hate doing it (I mean its the last thing I want to tell a biz owner) They need to think about how many people will be on this plan. If its not possible to pay for the coverage for all the full time ees they may need to trim some hours.
 
A couple of things.

I would not use the pro vs con you posited in your original request. There are so many variables that will play into this decision that you will not be able to get the answer from this board. Not saying there is not the expertise to provide it to you, but the process would become paralyzed.

Penalty for not offering is a fixed amount ($2,000) per eligible head. So assuming all 400 are eligible that would be a $800,000 penalty.

I would not necessarily suggest implementing a wellness plan this year. The term “wellness program” can mean a multitude of things, and may contain a variety of programs within it. Keep in mind; a wellness plan without a health plan is almost entirely useless because there is no claim data being provided. Also, there is no way you will “get control ofthe fatties and the smokers” as suggested.

If this were me, I would start the discussion with the employer by saying they will owe the $800k penalty, and then review what other options are available. Off the top of my head I would say they have a few options; 1) reduce the hours of employees as much as possible to reduce the number of heads subject to the penalty, and, 2) reducethe hours of employees as much as possible to reduce the number of heads that will enroll in a medical plan.

Keep in mind this will be an iterative process. You will need to estimate the cost of both the insured and self-funded markets. You will need to make decisions based on benefit design, cost control issues, do you want to offer coverage to spouses, and many other things.

Hope this helps.
 
The reason I posted this is because my group FMO for Anthem told me I might as well wait till 2016. They told me this because they thought delay impacted this size of group...and they are wrong.
Also, I wanted to an idea of advantages of doing something now vs. waiting.
 
The reason I posted this is because my group FMO for Anthem told me I might as well wait till 2016. They told me this because they thought delay impacted this size of group...and they are wrong.
Also, I wanted to an idea of advantages of doing something now vs. waiting.

I hope I did not offend you, it was not my intent. While it is true that they could wait till 2016, there could be reasons why they may want to offer it sooner. For example, are they losing employees to competitors that may be offering benefits? That was all I was trying to say.

Let's assume that the only issue to the group is cost, then I would wait till 2016 to make the plan effective. But the discussion about options needs to start sooner rather than later. A group of this size will have many issues that will need to be addressed and may cause a longer than anticipated process.
 
Leevena, do you have a plan to get these biz ready for this impact? Any idea on how to estimate cost besides just multiplying the current rate (if they have a small group, such as management)? I understand that with no claims info wellness is hard. But can't offering an incentive to employees to quit smoking, or loose weight only help?
 
I wasn't offended at all. In fact, I was thinking the same things. There are many factors to consider. I was more frustrated with my FMO quickly giving up without bringing up solutions.
 
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