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small-group health insurance

What is small-group health insurance?

Small-group health insurance is medical insurance geared toward businesses with 50 or fewer full-time equivalent employees. (In four states, they apply to businesses with up to 100 employees).

Small-group plans effective since January 2014 are compliant with the Affordable Care Act’s requirement of health coverage. Insurers can’t use a group’s medical history to set premiums for ACA-compliant small-group plans, and premiums for older employees cannot be more than three times those for younger employees.

ACA-compliant small-group plans also have to fit into one of the four metal levels and cover the ACA’s essential health benefits.

Businesses can buy small-group plans directly from an insurance company, via a broker or private exchange, or from a state’s SHOP exchange. Purchase of a SHOP plan may qualify the buyer for the Small Business Health Care Tax Credit. In states that use, SHOP plans are now purchased directly through the insurance companies, or with the help of a SHOP-certified broker.

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