Small Group Redefinition

Summary

Small employers must abide by the rules and regulations governing the small group market, including those related to benefit coverage, including essential health benefits, actuarial value, and premium rating restrictions, such as adjusted community rating and no medical underwriting.

The small group rules apply to fully insured plans including those purchased in the Small Business Health Options Program (SHOP) marketplace.

Plans covering groups with 50 or few­er employees will be pooled together for premium rating purposes, otherwise known as Adjusted Community Rating (ACR).

In many markets the state and UnitedHealthcare allow the employer to keep their plan for a while longer by:

  • Changing their plan year to maximize the time the employer can keep their plan in 2016. Employers with a 12/1/15 plan year can renew their current plan and keep it through 11/30/16.
  • Taking advantage of transitional relief, which allows employers to keep their plan through September 30, 2017.

Employers that self-insure are not subject to these requirements.

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