Q: We just got our renewal numbers for health insurance for the coming year, and they have us in the small group market. I thought that if you had 51 or more employees, you remained in the large group market. Did I receive the wrong quote?
A: What you are talking about is the Protecting Affordable Coverage for Employees (PACE) Act, signed into law by President Obama on October 7, 2015. This law returned the ability to determine employer size in the small group market to the states, instead of requiring states to use the previous (federally mandated) definition of 50 or fewer as “small group” and 51 or more employees as “large group.”
After the law was signed and took effect, the District of Columbia and six states—California, Colorado, Maryland, New York, Virginia, and Vermont—legislated a state-level change in definition for the small group market to be employers with 100 or fewer Full-Time Equivalent (FTE) employees, as of December 2015.
California, Colorado, New York, Virginia, and Vermont define the large group market as 101 full-time equivalent employees, as of December 2015. If you are in one of those states, then your school is considered to be within the small group market.
If your school has fewer than 51 employees and resides in one of the states that have kept the federal definition of “small group market” at 50 or fewer, insurance rates starting in the second quarter will reflect the small risk pool.
Curious about your school's health care policies and the reform's changes? Ask ISM’s Health Care Reform Expert a question. We respect your privacy. You can also view ISM’s health care solutions.
