Impact of Health Care Reform on Small Business

In Colorado, a small employer is defined as a business with up to 50 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 group health coverage to your employees, your health plan may change when you renew your group health plan in 2014.

RMHP will offer a variety of new ACA-compliant plans and will assist you in selecting the best option for your needs.

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.

UPDATE - May 2014:  Federal guidance, initially announced in November 2013, then adopted by Colorado in May, 2014, allows small employers to maintain their non-grandfathered plan for the upcoming policy year.

RMHP will offer the extension of non-grandfathered plans starting with September, 2014 renewals.  The reason non-grandfathered plans renewing prior to September are not available for renewal is because RMHP does not have filed, approved renewal rates available to present to groups until mid-late July.  Our renewal rates, filed the week of May 19th, 2014, will follow a 60-day review period by the Colorado Division of Insurance.

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 and will be implemented on your 2014 anniversary.

Your company may not extend the 90-day period to make coverage begin on the first of the month, the start of a payroll period, a regular business day or any other administratively convenient commencement-of-coverage date.

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.

  • Are there any changes in my participation or contribution requirements starting in 2014?

    The new Health Care Reform small business requirements require health plans that decline a small employer application for coverage due to lack of participation or required contribution to allow employers to enroll during a specific Open Enrollment period that begins November 15 and ends December 15 of each year.

  • 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.