Large employers and health insurance

Many large employers (more than 50 employees) offer health insurance to their employees. Large group rules and benefits are different depending on if you have a health plan that’s grandfathered or non-grandfathered. If you’re not sure, ask your insurance company or your human resource department.

Large employer health insurance and health reform

Starting in 2015, large employers must offer affordable insurance to their employees and their dependent children. A plan's considered unaffordable if the employee’s share is more than 9.5 percent of their household income or if the plan pays for less than 60 percent of covered health care expenses.

In the meantime, if your employer offers health insurance, and it's not affordable, you might qualify for a premium subsidy, if you buy a health plan through Washington state’s health insurance exchange (www.wahealthplanfinder.org).

Health reform does not require large employer plans to include the essential health benefits (EHB). However, if the plan does include an EHB, then that benefit has no annual or lifetime dollar limit.

Large employer health plan requirements under health reform Non-grandfathered group plans Grandfathered group plans
Provide you with plan documents so the “Summary of Benefits and Coverage” (SBC) is easy to understand Yes Yes
Cannot retroactively cancel your coverage if you made a mistake on your initial application, unless the plan finds fraud or intentional misrepresentation Yes Yes
Provide health coverage for dependent children until they turn age 26 Yes Yes
Provide coverage for pre-existing conditions for enrollees under age 19 Yes Yes
Provide coverage for pre-existing conditions for all enrollees (2014) Yes Yes
Allow discounts and rewards on wellness programs of up to 30 percent on premiums (in 2014) Yes Yes
Renew your policy even if you become sick (in 2014) Yes Yes
Guarantee your right to appeal Yes No
Cover certain recommended preventive care for free Yes No
Provide you the right to choose your doctor and access to out-of-network emergency room services Yes Fully funded plan = Yes
Self-funded plan = No

Updated 03/27/2014

See also

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