Break Off Healthy from Group Plan

ntbktrader

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Question,

I have a company/group plan that I'm trying to help. The business is 2 brothers, each is married with 3 kids. One brothers fam is healthy and one brothers family is not. Could I break off the healthy bros fam from the group plan to help save money?

Anyone try this? Any down side?

Thanks!
 
You're going to have to check with your state's group rules. In MD the group has to be more than 1 employee. So in your case, there are two "employees" but if one peels off it's no longer a legitimate group.

If your state allows a business group of one then you're in. If not it's likely a no-go.
 
You could, but then they would likely not meet participation requirements and have to terminate the group coverage. That would leave the unhealthy family with the potential of paying HIPAA premiums on a guaranteed policy. I guess the answer depends on how much a good HIPAA policy would cost and what they're currently paying.
 
It's in TX, my understanding is a plan has to start with 75% participation but can run below that after a year? Sry I'm a little green with health...
 
I'm not sure but I'd have to check into whether or not voluntary termination of a small group plan entitles someone to an individual conversion plan.
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I think what is being asked here is would it be ok to carve off the family members (dependents) of the one brother since they are healthy but leave the brother on as the second qualifying employee?

Spouses and dependent children never factor into group participation requirements so you could remove the healthy dependents from the group plan and put them on individual coverage. It would be a good idea to compare rates for family on the group versus EE only on the group and family on IFP to make sure that there is actual savings.

Well at least someone is paying attention. It certainly wasn't me because I didn't catch that he only wants to move the healthy brother's family. The short answer is yes.
 
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Well, I was leaving the option open...have the whole fam leave or leave the one bro as EE and take the dependents IFP.
 
I'm not sure but I'd have to check into whether or not voluntary termination of a small group plan entitles someone to an individual conversion plan.

It's not voluntary termination. The business is the entity terminating the program, not the individual, even though they may own the business. Therefore, from the employee's perspective, it was involuntarily terminated.
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Well, I was leaving the option open...have the whole fam leave or leave the one bro as EE and take the dependents IFP.

You could do that, but then you would have separate deductibles for the employee and the rest of the family. Would depend how big a difference in premium there is and what the rules are for removing dependents mid-year, unless they're in an open enrollment period right now.
 
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I have a company/group plan that I'm trying to help. The business is 2 brothers, each is married with 3 kids. One brothers fam is healthy and one brothers family is not. Could I break off the healthy bros fam from the group plan to help save money?

Anyone try this? Any down side?

State laws differ from state to state.
What you are trying to do would not fly in California.
You need two employee's to make a group.
Waiving one employee off the group plan because of obtaining a private health policy is not a valid waiver.
This action would kill partication requirements, and, therefore, kill the group.
 
Easy...the two brothers on the group plan.....the healthy brothers wife and kids individual.....the unhealthy wife and kids on group.....


Question,

I have a company/group plan that I'm trying to help. The business is 2 brothers, each is married with 3 kids. One brothers fam is healthy and one brothers family is not. Could I break off the healthy bros fam from the group plan to help save money?

Anyone try this? Any down side?

Thanks!
 

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