Get answers to questions about health care benefit plans

Are you looking into options to provide health care insurance and other benefits to your employees but aren’t quite sure where to start? Our in-house expert has pulled together the most-often-asked questions he hears from restaurant operators who are considering adding health coverage to their suite of employee benefits. 

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How long does my business have to have been in operation to set a plan in place? 
A restaurant needs to be operating for 30 days prior to the effective date of the health care insurance plan.

How many of my employees must enroll/participate?  
This varies by carrier and can range anywhere from 50%–75% of your full-time employees and may or may not exclude employees covered by a valid waiver (i.e., they’re under 26 years old and covered by their parents’ plan or covered on their spouse’s plan, etc.) These participation percentages are one of the more challenging requirements for restaurants to meet.

Not sure you’ll meet this requirement but still want to offer some form of a health care service to your full-time, part-time, 1099 and seasonal employees? Consider telemedicine. It offers your employees the ability to connect to a doctor, dermatologist, or behavioral health provider from wherever you are via phone or video. Please note that telemedicine is an additional benefit and is not and does not replace a group health insurance plan. 

Who is eligible for a traditional group health care insurance plan?
Salaried employees and some hourly staff. For hourly employees, eligibility depends on your state requirements and hours can be anywhere from 25–40 per week. You can take advantage of an Administrative Lookback Period of up to one year to see if employees average the required number of hours. If you are an ACA Large Employer (employing more than 50 employees), then the minimum to be eligible for coverage in a group plan is 30 hours per week.

What is a management carve out?
Some carriers allow employers to offer different benefits to management groups within their organization. Management can be defined as salaried vs. hourly, union vs. non-union and other categorizations. Salaried employees typically are more likely to enroll in a plan you offer and using this carveout approach can help a restaurant meet participation requirements.

How much must I as the employer contribute to a health care benefit plan cost?  
Employers need to contribute a minimum of 50% of the lowest-cost plan for the employee. Contributions to subsidize spouses and dependents are not required.  How much the employee must contribute greatly impacts the number of employees enrolling.

How many plan options should I offer? 
Consider offering more than one plan because employees have different insurance needs. More options can help to get more employees to enroll/participate because the restaurant can offer, for example, a good basic lower-cost/higher-deductible plan that is more affordable for employees and offer more expensive/lower-deductible options for employees who are willing to pay more for a higher level of health care coverage.

Check your doctors and hospitals?  
Some carriers offer plans with access to fewer doctors and hospitals for a substantial savings on premiums. These can be a great option IF your doctor and hospital are in-network. Whenever you change carriers, you should make sure your doctor/network participate with the new carrier because it changes quite often.

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