Small Group Plans

Great employee benefits are one of the keys to attracting and retaining the best employees. Through planning and consulting, we help you design, administer and manage a cost-effective benefits program that is created to reduce costs, improve workforce productivity, educate employees, mitigate risk and help you attract, retain and develop top employees.

ACA (Affordable Care Act) Underwriting Guidelines

Small Group (under 50 FTE)

• Generally, to be an eligible small employer, at least one common law employee must be enrolled at the beginning of the plan and each renewal plan year.
• Benefits must be offered to all eligible employees.
• The employer must pay at least 50% of the employee’ s premium on the lowest cost plan.
• In most cases, must have 70% of benefit eligible employees either sign up for coverage, or have a valid waiver (waiving to other coverage through spouse, Medicare,
• If under 5 enrolled, 3 months of previous payroll history may be required.
• The employer gets to dictate benefit eligibility, 17.5 – 40 hours per week and the waiting period. First of the month following 60 days of hire is most common.

 Plan Year and Renewal

Once enrollments are in, rates are set for 1 year or 12 months based on the effective date, 1st of any month.

Timelines

• You can start a benefit plan any time throughout the year, but they do start on the first of the month.
• To get a new plan off the ground or move carriers, 2 months lead time is encouraged as paperwork needs to be submitted by the 15th of the month prior to the plan start date.

Cost

• In the State of Oregon, Small Group health plan premiums are calculated by demographics and carrier state filings.
• The 2024 Oregon average rate for a Silver level plan, for a 40 year old is approximately $415 Per Employee Per Month.
• CSNW charges a mandatory fee of $350 annually for the creation and maintenance of ERISA Compliance Documents.

Things to Know

• You will need to set up a process for payroll deductions for employee premiums.
• You will need to offer COBRA or State Continuation depending on company size.
• You will manage enrollments and terminations for your company through your carrier portals or by submitting forms to the carriers via email.
• You will need to follow all state and federal compliance guidelines which include testing and reporting.
• To set up premiums to be taken pre-tax, there will be additional plan setup guidelines, and complete non-discrimination testing.
• Employees who are offered coverage through their job that is considered “affordable” are not eligible for financial savings through the Marketplace. But, here’s the catch. If their family is also offered coverage through the employer and the coverage is “affordable” for just the employee to enroll, it is also considered affordable for the family. This means, even if it is costly to add the employee’s family to the plan, they are not able to get financial assistance through the Marketplace.

To gather quotes and present a proposal to you, we will need you to submit a completed census with information on all of your current employees.

• The following information is required for all employees: name, gender, date of birth, date of hire, hours per week and zip codes.
• If you have information on dependents the employees are interested in enrolling, please include their names and dates of birth.
• If you are not sure if the employee will be interested in insurance or not, we will quote with them as if they were enrolling. If you know they would waive, please use the appropriate code on the census key to advise.
• We need a few pieces of group information including: Company name, company address, main contact name, phone number, and email address.
• All mandatory fields are highlighted on the census.
• Note: If you would like us to gather quotes for Life and/or Disability coverage, please also complete the Wage/Salary Info and Job Title columns

Current Insurance

If you have current medical insurance for your group, please send along with the census information you have on your current plan(s). This could include your most recent renewal, current rates, employee cost sheets, benefit summaries etc.

Next Steps

1. Click Here to download a census template.
2. Complete the census – see instructions above.
3. Click Here to return the census to our Small Group service team securely.
4. Our team will reach out to you to confirm receipt within one business day of the census and let you know if there is any additional information they may need and give you a follow up time-frame to go over quotes.

This site is designed to outline general information for setting up a small group health plan. This does not contain all information you will need to know, and is not a guarantee of rates or coverage.