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Guest Blog: The Affordable Care Act Part 1 – What’s Ahead for Large Businesses?

Posted by Louis Balbirer on Fri, Aug 29, 2014

Louis BalbirerLouis Balbirer of Kaufman Rossin writes a guest blog post for NetMinder about changes related to healthcare reform. This is the first post in a two-part series discussing opportunities and challenges of the Affordable Care Act for small and large businesses. Material shared here was presented at the C-Suite Breakfast Series event, co-sponsored by Kaufman Rossin and Vistage.

By January 1, 2015, large businesses will need to decide if they are going to extend coverage to their employees or pay the annual fee for declining to “play.” For businesses, understanding their obligations under the Affordable Care Act (ACA) now and in the coming months is more important than ever.

The ACA was the topic of the most recent C-Suite Breakfast Series. A panel of experts discussed the impact of the Affordable Care Act on small and large business.

Panelists included:

What are some opportunities for large businesses?

Companies with more than 50 full-time equivalent employees are considered large businesses under the healthcare law. Large businesses are subject to many rules under the ACA that do not apply to small businesses.

The Affordable Care Act presents several opportunities for large businesses related to the insurance coverage options they provide to their employees.

  • The opening of the Small Business Health Options Program (SHOP) marketplace to businesses with 50-100 full-time employees in 2015 will offer employers additional insurance plan options.
  • According to the panel discussion, quality of insurance coverage and healthcare is expected to increase for employees at large businesses.
  • The delay of the Employer Shared Responsibilities Provisions until January 1, 2015, for businesses with more than 100 full time equivalent employees, allows employers more time to strategically position themselves to provide insurance in order to avoid associated penalties. Qualifying businesses with 50-100 full time equivalent employees have until January 1, 2016, to comply with the provisions.
  • Businesses that choose to participate in health insurance plans can use benefits as a recruiting tool to potentially attract higher-quality candidates than those who choose to pay the fees associated with not providing coverage.

What has the Affordable Care Act made more challenging for large businesses?

Large businesses have a greater responsibility than small businesses under the Affordable Care Act. A number of deadline changes have made the roll-out of the healthcare law even more confusing for large employers. Added expenses, additional reporting and mandatory coverage for all full-time employees are further complicating the process for large employers.

The following challenges face large businesses under the healthcare law:

  • Reporting responsibilities for large businesses mean added infrastructure is needed. In 2015, large businesses must start reporting on whether insurance was provided to employees, what type of coverage was offered, and some companies may be required to report on the value of the insurance provided to each employee on his or her W-2.
  • Guidance and regulations continue to evolve, making it challenging to plan and comply with the law.
  • Cost of insurance has increased (in most cases) due to plan design limitations and fees or taxes imposed by the Affordable Care Act.
  • Insurance rates may increase for employers if plan participation is low.
  • Employees may not be able to keep their current insurance plans due to ACA mandates.
  • Large companies that do not offer affordable coverage may be subject to penalties of up to $3,000 per subsidized employee.

What’s ahead for business owners?

Large businesses need to decide if they are going to pay or play by the January 1, 2015, deadline.

“When we talk about next steps, I recommend that companies prepare for the compliance and reporting requirements,” said panelist Alexis DeLuca. “Inevitably, whether a large business chooses to pay or play, they’re likely going to end up with a larger reporting burden than they planned for.”

According to DeLuca, businesses should take steps to ensure they are ready to comply with the changes as they roll out. Investing in the infrastructure needed to accurately report, capturing the required data and planning ahead for annual assessments of health insurance options by contacting an insurance broker or a tax advisor will help large businesses manage the impact of Affordable Care Act.

Louis Balbirer, CPA, is a director of tax services with Kaufman Rossin, one of the top CPA firms in the U.S. He has 20 years of experience providing tax and accounting services to clients and can be reached at

Tags: NetMinder, health insurance, Affordable Care Act, insurance broker, healthcare reform, ACA, healthcare exchanges, Health plan

3 Steps to Using Competitive Network Advantage to Win More Business

Posted by Aaron Groffman on Thu, Apr 11, 2013

Helpful Tips

I’m often asked how to use a competitive provider network advantage to win more business.  As I talk to NetMinder users, one of the best and easiest ways I hear is to leverage your network advantage to negotiate for better rates for prospects in your sales pipeline.  Try these three steps:

  1. For key prospects, assess your network compared to competitors.  Do you have more providers in areas with significant concentrations of your prospects’ employees?  Are you the market leader?
  2. Provide this data to your underwriting team.  Stress the expected higher in-network utilization and lower claim costs that will result.
  3. Demonstrate to your prospect how your network advantage will save them money.

As I wrote in Chapter 7 of Dental Benefits: A Guide to Managed Plans, the network is the product.  A competitive provider network strengthens your sales pitch! Try this approach and let me know if you see results.

Tags: network providers, dental insurance, insurance broker, Ancillary benefits, Vision insurance

Heard About Your Customers May Already Be Using It.

Posted by Aaron Groffman on Wed, Jan 02, 2013

describe the imageIf you haven’t already been to, I suggest you visit. The U.S. Department of Health and Human Services (HHS) introduced the website as a way for consumers to shop for health insurance, and businesses are also using it to research group plan options for their employees. includes information from hundreds of insurers about thousands of coverage plans in all 50 states. This tool can be especially useful for small businesses looking for cost and coverage estimates for small groups and options for in-network versus out-of-network benefits, deductibles and co-pays.

HHS launched the site about a year ago under the requirements of the Affordable Care Act. Users can submit basic information about the type of insurance coverage they need (for an individual or group of up to 50 employees) to generate a list of results with estimated costs and advanced filtering options.

What does this mean for brokers and payers? Consumers and business owners are hungry for information and they have the tools to start the research phase of the buying process on their own. However, as they move further down the sales funnel, they would benefit from the guidance of an experienced insurance professional who is knowledgeable about the available benefit options and able to provide more accurate pricing as well as a competitive network adequacy assessment.

So, have you been to How do you think consumers and businesses will use it?

Tags: health insurance, Affordable Care Act, Healthcare, insurance broker, healthcare reform, health reform, Obamacare, employee benefits, benefits advisor

Affordable Care Act Makes Strategic Benefits Advisors More Important Than Ever

Posted by Aaron Groffman on Wed, Dec 12, 2012

I recently attended a presentation by Beverly Beattie, president and CEO of Selden Beattie Benefit Advisors, Inc. Beverly addressed an audience of entrepreneurs and small business owners and explained the impact of the Patient Protection and Affordable Care Act on the increasingly complex and competitive employee benefits marketplace.  While many in the industry assume that brokers will become marginalized as a result of healthcare reform, I came away from the presentation believing that a strategic benefits advisor is more important than ever.

Businesses have many decisions to make over the next 12-24 months as the healthcare reform law is implemented. For example, businesses with 50 or more employees have to decide if they will “pay or play.”  Will they opt out and pay penalties or offer employee health insurance when the new rules go into effect in 2014? Many employers who do not currently offer health insurance may decide to do so after performing a cost-benefit analysis – which, of course, is good news for insurers.

It’s important for health care companies to identify those brokers and advisors in their distribution channel who are truly strategic (versus transactional), because I believe these will be the best sources for the new business opportunities that are certain to result from the complexities and changes of healthcare reform.

Tags: Affordable Care Act, Healthcare, insurance broker, healthcare reform, health reform, Obamacare, benefits advisor





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