California Small Group Definition Will Hurt Business Owners In 2016

When the small group definition of businesses by the Affordable Care Act is reduced to 50 employees or less in 2016, many California business owners are going to be unfairly hurt. In California, the small group definition is going to remain 100 employees or less. As a result, any business with 50 to 99 employees will be damaged by qualifying under the small group definition. Pontrelli, Timour & Associates, Inc. want to help our clients navigate these dangerous waters.

The Sacramento Business Journal reports that Covered California will move forward with an expansion of the definition of small employers under state law. This counteracts the new federal law that halts the change. On October 7, 2015, President Obama signed into law the Protecting Affordable Coverage for Employees (PACE) Act which repeals the Affordable Care Act provision that on January 1, 2016 would have mandated expansion of the definition of “small employer” subject to insurance market reforms from employers with 1 to 50 employees to those with up to 100 employees. Yet, in California, state law defines businesses with 100 or fewer employees as small.

California Small Group Definition Damages

california small group definition

California Small Group Definition Hurts Business Owners

When it comes to being a small group, benefits administration is more costly with less benefits offered to your employees. In addition, small group benefits have higher deductibles for employees and a higher out of pocket expenses. Overall, there was a 26% increase for small group companies in terms of overall healthcare costs in 2015.

Pontrelli, Timour & Associates, Inc. does not believe the California state government is being fair to local business owners. Why should local business owners be penalized because their companies are based in California? Is this a good way to convince businesses to either stay or come to the state? Why would the California definitions be different from the national definitions when the Affordable Care Act has set the bar for benefits administration across the country?

Employment Data & California Small Group Definition

Based on California labor market employment data, roughly 14 percent of all California employment — 2.3 million employees — fall in the 51-100 segment, while roughly 2.4 percent of all California businesses—33,000 employers—fall into the 51-100 market. In California small group definition, an employer has historically been defined as 50 or fewer eligible employees for group health insurance purposes. Unless an employer has a grandfathered large group plan, employers with 51-100 full time equivalent employees who renew or purchase coverage in 2016 will be required to follow all small group regulations.

For large groups, insurance providers commonly use health status or claims experience, industry risk factors, employer size, participation and contribution levels, age/gender factors and composite ratings to determine premiums. With the mandatory migration, those falling under the new small group definition will no longer be allowed those variations. For example, the gender factor will no longer be permitted and age rating will be limited, with a 2016 ratio maximum of 3 to 1.

Age, Family Size & Geography Insurance Factors

Family size, too, will be a determining factor in adjusting premiums under the 2016 provisions with the California small group definition. Up to three children under 21 years of age may be charged a premium within a family, but any additional children can receive coverage at no additional charge. Geographic regions within the state that are currently prescribed may also be changed significantly, as well as premiums for tobacco use, which may be increased up to but not exceeding 50 percent.

Group Benefits Leader Helping Small Group Business Owners

When the ACA small group definition becomes effective in the state of California in 2016, groups sized 51-100 will for the first time fall under the same requirements that currently apply to groups sized 1-50. The California small group definition simply is not fair. As insurance brokers and group benefits leaders, the goal of Pontrelli, Timour & Associates, Inc. is to make sure our present-day clients and our future clients are not hurt by these healthcare problems.

 

Raphy Timour

About 

Co-Founder at Pontrelli, Timour & Associates, Inc.

A California native of Pasadena, Raphy Timour began his career at Automatic Data Processing as an outside sales representative, achieving President Club status each and every year at ADP. Wanting to provide clients with a more customercentric approach, Raphy Timour started Pontrelli, Timour & Associates, Inc. in 2003 with his childhood friend Chris Pontrelli. Raphy Timour has a Health & Insurance License from the California Department of Insurance.

    Find more about me on:
  • facebook
  • googleplus
  • twitter