Impact of Health Care Reform on Small Business

Starting January 1, 2016,  a small employer is defined as a business with up to 100 full-time employees, including full-time equivalents.  This definition determines whether a Colorado-based business will be subject to small group rating and if they can apply for group health coverage through Connect for Health Colorado.

If you offer the same group health coverage that was in place on March 23, 2010, you may be enrolled in a Grandfathered Health Plan (see non-grandfathered plan for specifics). RMHP will continue to offer these plans to you and the group size change for small employers will not affect grandfathered plans.

No matter what plan you have, your company must comply with new waiting period requirements for health insurance eligibility. The waiting period limit can be no more than 90 days for newly eligible full-time employees.

Your company may introduce an orientation period of up to 30 days that can be added on to your waiting period resulting in up to 120-days before coverage is offered. RMHP will allow maximum waiting period of first of the month following 2 months of employment, or first of the month following 3 months of employment when an orientation period is established.

We know this can be complex. If you have questions, call us at 1-800-453-2981, option 1.

  • What does an ACA-Compliant Plan mean?
    The Health Care Reform small business requirements state that all health plans offered in the small group and individual markets to include specific benefits and cost-sharing values.

    The specific benefits to be included in all ACA-compliant plans are called Essential Health Benefits (EHB).

    They include:

    • Ambulatory patient services
    • Emergency Services
    • Hospitalization
    • Maternity/newborn care
    • Mental health/substance abuse
    • Prescription drugs
    • Rehabilitative/habilitative services and devices
    • Laboratory services
    • Preventive and wellness care/chronic disease management
    • Pediatric services, including oral and vision care
    The specific cost-sharing values will have a standardized label to describe how benefits are covered.

    Metal Levels:
    • Bronze  (60% AV)          
    • Silver     (70% AV)
    • Gold     (80% AV)        
    • Platinum (90% AV)
    AV = Actuarial value. This means the percentage the plan will pay on average toward the cost of care.  The amount the plan pays for any individual's care will vary.

    For example, a Silver plan will cover (on average) 70% of the overall costs of the covered benefits.

  • What is a non-grandfathered plan?
    If you have made a plan change (increased your deductible or cost-sharing on benefits, for example), decreased your contribution by more than 5%, or changed insurance carriers to enroll in a different health plan after March 23, 2010, you are most likely enrolled in a non-grandfathered health plan.
  • What is the SHOP Marketplace?

    SHOP stands for Small Business Health Options Plan and is designed as a marketplace where small employers can browse and purchase health insurance for their employees. This option is available for any business with 50 or fewer employees. Employers will select the plan or plans that work best for their business, get a single consolidated bill for all the premiums.  The employer determines what percentage of the premium they will share with their employees.