The "Family Glitch Fix" allows employees with dependent group health coverage to save thousands. Once notified, the fix allows employee dependents denied access to subsidized individual health plans to enroll immediately. Call us, and we can check affordability in seconds, then calculate your monthly savings in any health plan offered in your area. If your employer offers group health insurance and you have dependents, you may be able to lower your premium costs and their out-of-pocket costs for medical care. The so-called "family glitch" stems from a 2013 IRS interpretation. Under Section 36B of the Internal Revenue Code, individuals generally do not qualify for premium tax credits if they are eligible for another source of minimum essential coverage, including employer-sponsored plans. There are two exceptions to this rule under the ACA-when the offer of job-based coverage is not "affordable" or not of "minimum value." If either exception is met, an individual is ineligible for minimum essential coverage, making them eligible for premium tax credits. An employee needs to do this simple test with individual plans less expensive than most group health plans, even without subsidies. With federal and NJ subsidies, the monthly savings are larger than the average car payment.

In 2023, inflation is the central talking point, and health insurance premiums and medical costs are increasing. Small employers must look at benefit costs with salary, and supply costs increasing. If a business offers health insurance, there are three options; Level Funding, Fully Insured, and Individual Health Plans. Level funding is the new option with reduced premiums and more comprehensive provider access for groups with good claims experience. Health questions are asked, and past medical usage is checked for insurance companies to select groups that are likely to have lower claims expenses than the premiums paid. Groups with as few as two employees can enroll, and the final premium rates remain level for the policy year. Level funding is a great place to start if you want to see if your groups can save while still having the option to fall back on guaranteed, fully insured health plans. Fully insured plans are changing and offer savings by reducing provider access, especially to out-of-state providers. Many plan designs are moving away from copays on brand name prescriptions and shifting higher cost sharing to employees. The fully insured plans are favored by employers, paying the lion's share of premiums and wanting to offer benefits with little employee involvement. The small group's health market is yielding to the individual health market that offers rich federal and (NJ State) premium subsidies to employees and cost-sharing reductions on out-of-pocket costs. The Family Glitch law allows dependents for employees covered by group insurance to take advantage of individual subsidies if the employee's cost to insure their dependents is unaffordable. In NJ, the state exploits the small group market by taking premiums and funding individuals not covered by group insurance. The best program depends on the business's unique needs and its employees. All groups should offer health insurance as employees are also crushed by inflation. Employees need expert advice to take advantage of any offer and will be more productive, resulting in lower absenteeism from financial loss.

The Inflation Reduction act guarantees funding to ACA individual insurance market for the next three years with the enhancements implemented by the American Rescue Law of 2021. Premium subsidies are increased for a household earning less than 400% of the Federal Poverty Level (FPL). The "Income Cliff" has been eliminated, limiting costs to homes at any income to 8.5% if not offered group insurance, based on the second lowest silver level plan in their zip code. The "Family Glitch" is removed, limiting a family's cost to 9.12% of household income even when offered group health insurance through work. Many small employers will embrace the change allowing low-income employees to take advantage of subsidies while continuing to fund health premiums for higher-paid employees that do not qualify for subsidies. An ICHRA will enable employers to set up a special enrollment event to transition employees from group to individual plans. A families premium cost as a percentage of the federal poverty level

• 100% to 133%: Zero Premium Plus Cost Sharing Reductions (CSR)
• 133% to 159%: Zero Premium Plus CSR
• 150% to 200%: Zero to 2% Plus CRS
• 200% to 250%: 2% to 4% Plus CRS
• 250% to 300%: 4% to 6%
• 300% to 300%: 6% to 8.5%
• Over 400%: 8.5%

So why will employers continue to pay group health premiums over $500 a month? Most employees do not want to write the check from their paycheck each month. Ask about the One Stop Benefits Bank to keep any contributions out of site from an employee's paycheck. Then compensate employees with Dental, Disability, and Vision. Fill the gaps in out-of-pocket costs using Accident, Critical Illness, Hospital Indemnity, and Tax qualified reimbursement accounts.