Group Health Specialists

Lynne Brilliant
617.733.9890
lynneb@eakaplan.com
www.eakaplan.com
 Agenda
• MA State Law
• Plan Designs
• Trends
• ER Contributions
• Build a Benefits Program
• Federal Mandates
• Questions?
 MA STATE LAW
• Mandatory
• Guarantee Issue
• No Pre-Ex
• 11+ FTE ( 38.5 hrs)
• Eligibility
• Equal Contribution
• Non Discrimination
• Min Creditable Coverage (MCC)
• Penalty
 PLAN DESIGNS

HMO
• Managed Care
• One network
• Usually lower premiums
• PCP is your gate-keeper
• No out of state coverage except medical
emergency
 PPO

• Flexibility
• In and Out of Network
• In / Out of state coverage
• See any Dr. or go to any Hospital
• Usually more expensive
 TRENDS

• Growing number of companies going to

High deductible plans
• Typically Ov & Rx not subject to deductible
• Often ER helps fund all or part of deductible
thru HRA or HSA
• Small business offering health ins to attract
good employees (about 90%)
 EMPLOYER CONTRIBUTIONS

• Insurance Carriers require a minimum

contribution of 50% single & 33% family
• Should set up a pre-tax plan for Ee
(section 125)…required if 11+ fte
• Insurance Partnership Program-www.4ip.org
State run to help small business owners and
employees with their medical premiums and is
based on income.
 BUILD YOU OWN GROUP PROGRAM
• Medical, Dental, STD, LTD, LIFE, LTC,

• 1st step is to provide a snapshot of your group

and the information is captured on a census.
• Rates are determined by Industry code, zip
code, age demographics and mix of the group
• Rates -brokers can not negotiate..
 FEDERAL MANDATES
Now:
• small business tax credits
• Age 26 benefits
• $0 co-pay for routine exams
• Being phased in thru 2018 if they aren’t
repealed. This will add another level of
complexity.
• WE CAN KEEP IT SIMPLE FOR YOU.
 QUESTIONS?

• Please feel free to contact me if you have

questions, any time.