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Maine.gov > PFR Home > Insurance Regulation > Consumer Information > Brochures > Small Employers Health Insurance
A Guide to.....
Health Insurance for Small Businesses
A Guide for Employers With 50 or Fewer Employees
A Guide for Employers With 50 or Fewer Employees
Small employer health insurance is available in Maine from several insurers, both on and off the federally facilitated Marketplace. This publication will help small employers understand their options.
It is a good idea to contact an independent insurance broker who represents more than one health insurance company to help you
Compare benefits and premiums carefully when considering different plans. In addition to benefits and premiums, service is important to consider; a company providing superior service may be worth some additional cost.
If you need to find a broker, the National Association of Health Underwriters (NAHU) provides a member agent/broker search tool at www.nahu.org/consumer/findagent2.cfm. Another free online tool you can use specifically to find a Marketplace certified broker is
A “small” employer has 50 or fewer eligible employees and at least one employee who is not the employer or spouse. Eligible employees are those who work 30 or more hours per week. Under certain circumstances, the employer may opt to consider employees working as few as 10 hours a week as eligible, as well as retired employees. By law, any insurer in the small employer health insurance market must provide coverage to any small employer who applies, as long as a sufficient percentage of eligible employees and dependents participate. The insurer cannot require partici-pation of more than 75% of eligible employees and dependents (if you choose to cover dependents).
Continued Coverage for Dependent Children up to age 26
If you believe that you are eligible for small group health insurance but have been declined for a small group (or an individual) plan by any of the insurers shown in this brochure, please note the name of the person you spoke to at the insurance company and contact the Consumer Health Care Division of the Maine Bureau of Insurance at (207) 624-8475 or 800-300- 5000 (in Maine only).
Pre-Existing Conditions and Enrollment Periods
Starting January 1, 2014, the Affordable Care Act prohibits pre-existing condition exclusions for new health plans.
An employee or dependent may enroll in the employer’s plan after the employer’s waiting period is met; during the employer’s annual Open Enrollment period; or if and when their existing coverage terminates for one of several reasons specified by law. These reasons include loss of coverage through a spouse’s or parent’s plan (if younger than 26 years) due to death, divorce, termination of employment, or termination of the group plan. Also, when an employee gains a new dependent through marriage, birth or adoption, the employee has a 30 day special enrollment period in which to add the dependent to their plan.
Rates cannot differ based on gender, health status, claims experience, or policy duration. Rates can vary based on tobacco use, age, and geography. Each employee is rated individually, as are his or her dependents. Each dependent under the age of 21 is rated the same, regardless of their age. Costs for dependents younger than 21 are capped at three dependents. (In other words, providing coverage for more than three children under 21 does not cost any more than providing coverage for three.)
Plans of all types generally have an annual deductible that must be met and paid before benefits begin or before they are paid at the highest level. A coinsurance provision generally requires the insured to pay a percentage of the cost until an out-of-pocket limit is reached. Certain services may only require a co-payment at the time of service (such as a visit to the doctor’s office when sick or injured) while some preventative services will not require any payment by the insured, as outlined by the ACA.
To help cover the cost of premiums, deductibles, cost-sharing and copays, IRS Code Section 125 allows employers to offer their employees some pre-tax options.
What Types of Plans are Available?
Most insurers offer a variety of plans. Plans vary as to the level of benefits that are paid, the provider network that is part of the particular plan, and the extent of managed care provisions. The general types of available plans are:
Companies Selling Small Business Health Insurance in Maine
Small business health insurance plans are currently offered in Maine by the companies listed in the table on the following page. You can compare plan types and rates using the Bureau’s comparison charts, found by clicking on the Small Group Health Insurance Options link on the Bureau’s home page at www.maine.gov/insurance.
For plan-specific questions and additional information please use the phone numbers or website addresses provided in the table. You may also want to contact a local independent broker or agent.
NOTE: Anthem and MCHO offer plans both on and off the federally facilitated Health Insurance Marketplace, so you may purchase them directly from the insurance company, from an insurance agent or broker, or through the Marketplace. For more information about buying Marketplace plans through the Small Business Health Options Program (SHOP) see the back page of this publication.
As always, the plans and rates offered by insurance companies in Maine are reviewed and approved by the Bureau of Insurance. You are welcome to call the Bureau at 800-300-5000 (in state only) or 207-624-8475 with any insurance-related questions. For TTY, please use Relay 711.
Last Updated: September 26, 2014
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