Group Health Insurance From Massachusetts Specialists

Massachusetts and Federal Requirements

Some businesses are required to offer health insurance benefits to their full-time employees. The Commonwealth passed a sweeping health care reform law in 2006, from which the federal Affordable Care Act (ACA or “Obamacare”) was modeled.

Under the ACA, employers with at least 50 full-time (working more than 30 hours per week) employees must offer health insurance coverage for full-time employees and their dependents. Dependent children must be offered coverage up until age 26. If insurance is not offered, is not affordable, or is substandard, and any employee uses a tax credit to purchase individual insurance via the Health Connector, the employer can be subject to fines. Employers must report subsidized health care costs on the employee’s W-2 form to promote transparency.

Important Criteria

Small businesses with fewer than 100 employees may be able to utilize the Health Connector to purchase group health plans. Small businesses offering health coverage may be eligible for tax credits.

Health care policies must also meet certain criteria including:

• Free preventative services and vaccines
• No lifetime benefit limits
• No denial of coverage for people with pre-existing conditions.
  

In addition to these federal requirements, Massachusetts has a number of insurance mandates covering certain services including:

• Mental health services
• Substance abuse treatments
• Prosthetics
• Hearing aids
• Early Intervention
• Autism spectrum disorder therapies
• Infertility treatments

If you employ workers outside of Massachusetts, mandates from their residential states may also apply. Your agent may be able to help ensure that your policy meets all state and federal requirements.

Group Health Insurance Options

When purchasing group health coverage, you have a variety of options. Most plans fall into one of two categories:

• HMO Plans (Health Maintenance Organization) provide services through contracted providers. Members are only covered for services from these providers.
• PPO Plans (Preferred Provider Organization) contracts with certain providers. Members receive lower-cost treatment from these providers, and pay higher fees with others.

An HMO has more restrictions, but may be more affordable. A PPO may provide your employees more flexibility in choosing their health providers, but may also incur more cost to your company and employees.

The premiums for these plans might vary based on a number of factors including deductibles, co-insurance, and co-pays. These have the ability be tailored to fit your budget and to meet the affordability provisions of the ACA.

Group health plans are an attractive benefit for employees, which might allow them to afford quality medical care for themselves and their families. It is suggested to work closely with your insurance agent to find a health plan that meets all Massachusetts and ACA requirements.