Wednesday, May 31, 2023


Relying on whose information you take a look at, the US is house to tens of millions of small companies. In actual fact, in accordance with the Small Enterprise Administration, there are at present 32,540,953 million small companies within the nation and small enterprise medical insurance is a serious concern for them.

And there are over 4 million small companies within the state of California alone.

After all, these numbers might range relying on the standards used to outline a “small enterprise”, such because the variety of staff, annual income, or trade classification.

For instance, beneath the Reasonably priced Care Act (ACA), small companies are outlined as these with 50 or fewer full-time equal (FTE) staff. And a full-time equal worker is an worker who works a median of 30 hours per week or extra.

With so many small companies within the nation, it’s virtually sure that some house owners are usually not utterly accustomed to the fundamentals of small enterprise medical insurance.




At the start, it is crucial for any small enterprise proprietor to know that companies with fewer than 50 full-time equal (FTE) staff are usually not required to supply medical insurance to their staff beneath the ACA.

However, they’re actually capable of and might derive a number of advantages by doing so. For instance, the ACA presents well being care tax credit to small companies that do select to supply medical insurance plans to their full-time staff.

Small companies could also be eligible for a tax credit score of as much as 50 p.c of the price of the medical insurance premiums they pay for his or her staff. Nevertheless, there are stipulations. To qualify for the tax credit score, the entire following standards have to be met:

  • You’ve fewer than 25 full-time equal (FTE) staff
  • Your common worker wage is about $56,000 per yr or much less
  • You pay a minimum of 50 p.c of your full-time staff’ premium prices
  • You supply SHOP protection to your entire full-time staff. (Notice: protection does not must be supplied to dependents or staff working fewer than 30 hours per week to qualify for the tax credit score.)

So, you might be questioning at this level what “SHOP” is. The ACA established Small Enterprise Well being Choices Applications – individually generally known as SHOP –  to assist small companies buy medical insurance for his or her staff.

SHOPs are basically on-line well being care marketplaces the place small companies can evaluate and buy medical insurance plans from totally different insurance coverage firms.

The foremost good thing about going by means of a SHOP is that it may be simpler for you as a small enterprise proprietor to supply medical insurance to your staff and qualify for well being care tax credit. And, by offering entry to medical insurance, you possibly can assist your staff keep wholesome and productive, which may profit each your staff and your enterprise.



Merely put, small enterprise medical insurance is a sort of medical insurance that gives protection for small companies and their staff. It could possibly additionally embrace medical, dental, and imaginative and prescient protection for house owners and staff.

Small enterprise medical insurance premiums are the quantity you and your employees pay on a month-to-month foundation to buy protection for medical, dental, and imaginative and prescient plans, though some plans make use of quarterly or annual foundation .

Deductibles are the quantity you pay earlier than your insurance coverage begins overlaying prices. These are sometimes factored as out-of-pocket maximums that are probably the most you’ll pay throughout a coverage interval (often one yr) earlier than the medical insurance begins overlaying one hundred pc of the price of well being care.

Co-pays are mounted quantities you pay for coated providers on the time of care.

Co-insurance is the proportion of prices you pay after you’ve met your deductible.

Lifetime limits are the utmost quantity your insurance coverage can pay for coated providers throughout your lifetime.

Drug formulary is an inventory of pharmaceuticals coated by your plan.


When searching for small enterprise medical insurance, there are 4 foremost components you have to be conscious of regarding small enterprise medical insurance:

  • Protection
  • Variety of staff
  • Worker premiums
  • Searching for protection

Small enterprise medical insurance plans are designed particularly for small companies.

There are a number of sorts of small enterprise medical insurance plans accessible out there. The commonest sorts embrace small group medical insurance plans, well being financial savings accounts (HSAs), and well being reimbursement preparations (HRAs).

Small group medical insurance plans are the commonest kind of small enterprise medical insurance.

These plans are designed to cowl a bunch of individuals, reminiscent of staff of a small enterprise, and their dependents. These insurance policy are sometimes extra inexpensive than particular person medical insurance plans as a result of the danger is unfold throughout a bigger group of individuals. Small group medical insurance additionally presents a wider vary of advantages, together with preventative care, emergency providers, prescription drug protection, and psychological well being providers.

Well being financial savings accounts (HSAs) are a sort of financial savings account that can be utilized to pay for medical bills. HSAs are paired with high-deductible well being plans (HDHPs), that are medical insurance plans with excessive deductibles however supply decrease premiums. HSAs enable staff to save cash on a tax-free foundation to pay for medical bills.

Well being reimbursement preparations (HRAs) are much like HSAs in that they’re used to pay for medical bills. Nevertheless, HRAs are funded completely by the employer and can be utilized to reimburse staff for certified medical bills.



When deciding on a small enterprise medical insurance plan, there are a number of elements to contemplate. These embrace the price of the plan, the advantages supplied, the community of healthcare suppliers, and the extent of customer support supplied by the insurance coverage firm.

The price of small enterprise medical insurance plans will range primarily based on a number of issues, together with the dimensions of your enterprise, its location, and the age and well being of your staff. It is very important evaluate the prices of various plans to seek out one that matches your price range. Remember, too, that prices contain greater than the month-to-month premium.

The advantages supplied by a selected small enterprise medical insurance plan also can range so it is very important contemplate the precise healthcare wants of your staff when deciding on a plan. For instance, if a number of of your staff have persistent circumstances, contemplating a plan with complete protection for pharmaceuticals and specialist care could also be extra acceptable.

Additionally, the geographic protection of a well being plan’s healthcare supplier community is a vital issue to contemplate. Some plans might restrict the variety of healthcare suppliers which are coated, whereas others supply a wider community of suppliers.

Typically neglected, the extent of customer support supplied by the insurance coverage firm is vital to contemplate. Small enterprise house owners ought to look for an organization that gives responsive and high quality customer support to assist staff navigate the healthcare system. Customer support is essential for enterprise house owners and their HR workers, as effectively.



One other “fundamental” reality of medical insurance is you can scale back prices and lower your expenses by working with an skilled dealer. And dealing with J.C. Lewis means we’re working for you, not the insurance coverage firms. Which means we’re capable of evaluate the protection of varied insurers in order to seek out you the most effective charges and protection out there.

In different phrases, we are able to offer you unbiased, cost-effective, and best-fit well being protection coverage suggestions.

J.C. Lewis Insurance coverage, a family-owned agency that has been primarily based in Sonoma County since 1979, is made up of knowledgeable brokers who supply small enterprise insurance policy. For the final 4 many years our mission has been to supply knowledgeable recommendation and help to small enterprise house owners for group medical insurance and group medical plans.

As well as, our agency solely supplies small enterprise medical insurance plans from the main medical insurance carriers licensed to do enterprise within the states the place we function.

We’re licensed and authorized by every insurance coverage provider to supply protection to small-group employers along with Medicare supplemental and prescription drug plans for seniors.

So, while you’re pondering of buying medical insurance for your self and your staff – and probably imaginative and prescient and dental protection – you’ll seemingly have a number of questions and issues.

We’re completely happy to reply all of your questions on medical insurance protection at J.C. Lewis Insurance coverage Companies, and you may be assured that we’ll allow you to discover the fitting resolution.
















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