Relying on whose knowledge you take a look at, the US is dwelling to tens of millions of small companies. In reality, in line with the Small Enterprise Administration, there are at present 32,540,953 million small companies within the nation and small enterprise medical insurance is a serious concern for them.

And there are over 4 million small companies within the state of California alone.

After all, these numbers might range relying on the standards used to outline a “small enterprise”, such because the variety of workers, annual income, or trade classification.

For instance, below the Inexpensive Care Act (ACA), small companies are outlined as these with 50 or fewer full-time equal (FTE) workers. And a full-time equal worker is an worker who works a median of 30 hours per week or extra.

With so many small companies within the nation, it’s virtually sure that some homeowners should not fully acquainted with the fundamentals of small enterprise medical insurance.




Before everything, it is vital for any small enterprise proprietor to grasp that companies with fewer than 50 full-time equal (FTE) workers should not required to supply medical insurance to their workers below the ACA.

Alternatively, they’re actually in a position to and might derive a number of advantages by doing so. For instance, the ACA presents well being care tax credit to small companies that do select to supply medical insurance plans to their full-time workers.

Small companies could also be eligible for a tax credit score of as much as 50 p.c of the price of the medical insurance premiums they pay for his or her workers. Nevertheless, there are stipulations. To qualify for the tax credit score, the entire following standards should be met:

  • You have got fewer than 25 full-time equal (FTE) workers
  • Your common worker wage is about $56,000 per 12 months or much less
  • You pay no less than 50 p.c of your full-time workers’ premium prices
  • You supply SHOP protection to your entire full-time workers. (Notice: protection does not should be supplied to dependents or workers working fewer than 30 hours per week to qualify for the tax credit score.)

So, it’s possible you’ll be questioning at this level what “SHOP” is. The ACA established Small Enterprise Well being Choices Packages – individually referred to as SHOP –  to assist small companies buy medical insurance for his or her workers.

SHOPs are primarily on-line well being care marketplaces the place small companies can examine and buy medical insurance plans from completely different insurance coverage firms.

The key advantage of going by way of a SHOP is that it may be simpler for you as a small enterprise proprietor to supply medical insurance to your workers and qualify for well being care tax credit. And, by offering entry to medical insurance, you’ll be able to assist your workers keep wholesome and productive, which may profit each your workers and your corporation.



Merely put, small enterprise medical insurance is a sort of medical insurance that gives protection for small companies and their workers. It could possibly additionally embody medical, dental, and imaginative and prescient protection for homeowners and workers.

Small enterprise medical insurance premiums are the quantity you and your staff pay on a month-to-month foundation to buy protection for medical, dental, and imaginative and prescient plans, though some plans make use of quarterly or annual foundation .

Deductibles are the quantity you pay earlier than your insurance coverage begins protecting prices. These are sometimes factored as out-of-pocket maximums that are essentially the most you’ll pay throughout a coverage interval (normally one 12 months) earlier than the medical insurance begins protecting one hundred pc of the price of well being care.

Co-pays are mounted quantities you pay for lined companies on the time of care.

Co-insurance is the share of prices you pay after you’ve met your deductible.

Lifetime limits are the utmost quantity your insurance coverage can pay for lined companies throughout your lifetime.

Drug formulary is an inventory of prescribed drugs lined by your plan.


When looking for small enterprise medical insurance, there are 4 principal parts you need to be conscious of regarding small enterprise medical insurance:

  • Protection
  • Variety of workers
  • Worker premiums
  • Looking for protection

Small enterprise medical insurance plans are designed particularly for small companies.

There are a number of forms of small enterprise medical insurance plans accessible out there. The commonest varieties embody small group medical insurance plans, well being financial savings accounts (HSAs), and well being reimbursement preparations (HRAs).

Small group medical insurance plans are the most typical kind of small enterprise medical insurance.

These plans are designed to cowl a bunch of individuals, resembling workers of a small enterprise, and their dependents. These insurance coverage are sometimes extra inexpensive than particular person medical insurance plans as a result of the danger is unfold throughout a bigger group of individuals. Small group medical insurance additionally presents a wider vary of advantages, together with preventative care, emergency companies, prescription drug protection, and psychological well being companies.

Well being financial savings accounts (HSAs) are a sort of financial savings account that can be utilized to pay for medical bills. HSAs are paired with high-deductible well being plans (HDHPs), that are medical insurance plans with excessive deductibles however supply decrease premiums. HSAs enable workers to save cash on a tax-free foundation to pay for medical bills.

Well being reimbursement preparations (HRAs) are just like HSAs in that they’re used to pay for medical bills. Nevertheless, HRAs are funded fully by the employer and can be utilized to reimburse workers for certified medical bills.



When choosing a small enterprise medical insurance plan, there are a number of components to contemplate. These embody the price of the plan, the advantages supplied, the community of healthcare suppliers, and the extent of customer support supplied by the insurance coverage firm.

The price of small enterprise medical insurance plans will range primarily based on a number of issues, together with the scale of your corporation, its location, and the age and well being of your workers. It is very important examine the prices of various plans to seek out one that matches your funds. Take note, too, that prices contain greater than the month-to-month premium.

The advantages supplied by a selected small enterprise medical insurance plan may range so you will need to take into account the precise healthcare wants of your workers when choosing a plan. For instance, if a number of of your workers have persistent situations, contemplating a plan with complete protection for prescribed drugs and specialist care could also be extra applicable.

Additionally, the geographic protection of a well being plan’s healthcare supplier community is a vital issue to contemplate. Some plans might restrict the variety of healthcare suppliers which can be lined, whereas others supply a wider community of suppliers.

Usually neglected, the extent of customer support supplied by the insurance coverage firm is essential to contemplate. Small enterprise homeowners ought to look for a corporation that gives responsive and high quality customer support to assist workers navigate the healthcare system. Customer support is important for enterprise homeowners and their HR employees, as nicely.



One other “fundamental” truth of medical insurance is that you could cut back prices and lower your expenses by working with an skilled dealer. And dealing with J.C. Lewis means we’re working for you, not the insurance coverage firms. Meaning we’re in a position to examine the protection of assorted insurers in order to seek out you the perfect charges and protection out there.

In different phrases, we will give you unbiased, cost-effective, and best-fit well being protection coverage suggestions.

J.C. Lewis Insurance coverage, a family-owned agency that has been primarily based in Sonoma County since 1979, is made up of knowledgeable brokers who supply small enterprise insurance coverage. For the final 4 many years our mission has been to supply knowledgeable recommendation and help to small enterprise homeowners for group medical insurance and group medical plans.

As well as, our agency solely offers small enterprise medical insurance plans from the main medical insurance carriers licensed to do enterprise within the states the place we function.

We’re licensed and authorized by every insurance coverage provider to supply protection to small-group employers along with Medicare supplemental and prescription drug plans for seniors.

So, once you’re pondering of buying medical insurance for your self and your workers – and probably imaginative and prescient and dental protection – you’ll probably have a number of questions and considerations.

We’re blissful to reply all of your questions on medical insurance protection at J.C. Lewis Insurance coverage Companies, and you may be assured that we’ll provide help to discover the fitting answer.