The Affordable Care Act requires that insurers accept all small groups without regard to health conditions; i.e., no medical underwriting. The ACA defines a small group as one with from 2-50 full time (30+ hours/week) eligible employees (FTEs).
That definition however is trumped by Wisconsin insurance regulations that require a different method for counting employees, something called ATNE (average total number of employees). How you calculate ATNE was covered in Tip #142.
The ACME Widget Company covers just 33 people in their group health plan, several of whom have chronic health conditions. Faced with a 73% increase from their insurer, we were asked to help them find relief. But because their ATNE is over 50, no other insurer would accept the risk.
But here’s a new wrinkle. In the course of studying to be ‘certified’ to represent individuals and small businesses on the Marketplace, I learned that eligibility for access to the Small Business Health Options Program (SHOP) is based on FTEs, not ATNE.
The SHOP Open Enrollment Period for 2015 started yesterday. We’re helping ACME enroll. At standard rates!