NEWSROOM

The annual Affordable Care Act (ACA) Open Enrollment Period begins November 1 annually for individuals and small businesses that want to purchase coverage through the federal marketplace, HealthCare.gov, and the California and Nevada state exchanges, Covered California and the Nevada Health Link, respectively. But the ACA’s lesser-known annual Special Open Enrollment Window for small businesses also opened this month.

The Special Open Enrollment Window gives your clients with 1-99 employees a limited opportunity to get coverage without meeting the standard participation or contribution requirements – so long as they apply during the window of 11/15 through 12/15.

Businesses do have to meet other underwriting requirements, which vary by carrier, and employees must complete waivers if they decline to enroll. Nevertheless, this is a great opportunity for you to capture new business – and for your clients to get the health coverage their employees want, but with fewer requirements.

Reduced employee participation and no required employer contribution

Neither the standard employee participation requirement nor the usual 50% of premium contribution from the employer apply during this special open enrollment window. This is the ideal time for your clients to offer employees the protection they need without increasing costs for their business.

If your clients don’t want to contribute, they can offer all-voluntary coverage. The employer simply collects the premium through payroll deduction and submits it to the carrier or administrator. Employees can pay their premium pre-tax using a Premium Only Plan.

On the other hand, if your clients want to contribute, they can pay any amount toward their employees’ premium; they can choose 5%, 10%, 20%, 25%, or more – it’s their choice.

Because there’s no minimum group participation, if your client has 10 employees and just two want to enroll, that’s okay. If the employer chooses the CaliforniaChoice multi-carrier exchange (available only in California), there’s a minimum of one enrolled employee and a requirement that CaliforniaChoice be the only health plan offered. 

Great options for employees

All of Word & Brown’s carrier partners offer a variety of plans to choose from, including HMOs, PPOs, and Health Savings Account-compatible plans, so each of your clients’ employees is sure to find coverage to match his or her individual or family health care needs. It doesn’t matter how many employees the company may have, or how many employees choose to sign up for coverage during this special open enrollment. This is a once-a-year opportunity to offer health coverage without worrying about participation guidelines or premium contribution requirements.

It is important to note, though, that if your client employs 50 or more full-time and/or full-time equivalent employees, their business is likely an Applicable Large Employer and is required to offer and partially fund “affordable” health coverage to full-time employees. (Click here to read an article from the Society for Human Resource Management on affordability.) As such, they are probably ineligible for the ACA Special Open Enrollment Window.

Continuation of coverage

If your clients sign up during this year’s ACA Special Open Enrollment Window, coverage for their employees will begin January 1 and continue for up to 12 months as long as the premiums are paid. At the end of that time, if they want to keep their coverage, their business will need to meet the usual participation and premium contribution requirements at renewal.

Let your clients know about this limited opportunity

The ACA Special Open Enrollment Window for small business is available for only a limited time: November 15-December 15. If your clients are interested, they must act now to take advantage of this no minimum participation/no premium contribution opportunity.

Feeling overwhelmed? We can help! Word & Brown offers tremendous broker support – during the ACA Open Enrollment, Special Open Enrollment Window, and throughout the year. If you need enrollment assistance, sales support, or have a question about the ACA, contact your Word & Brown representative or your nearest Word & Brown regional office.