Employers play a crucial role in providing health coverage for many Connecticut residents. The Office of the Healthcare Advocate offers resources and assistance to help employers navigate health insurance options and address employee benefit concerns.
Types of Employer Health Plans
Fully Insured Plans:
- The employer pays premiums to an insurance company
- The insurance company assumes the financial risk and pays claims
- Plans must comply with Connecticut state insurance laws and mandates
- Options include HMOs, PPOs, POS plans, and other insurance products
Self-Funded Plans:
The employer directly pays for employees' healthcare claims
Plans are regulated by federal law (ERISA) rather than state law
Employers often hire a third-party administrator to process claims
Self-funded plans offer more flexibility in plan design but involve greater financial risk
Level-Funded Plans:
- A hybrid approach combining aspects of fully insured and self-funded plans
- The employer pays a set monthly amount that covers expected claims plus administrative costs
- At year’s end, if claims are lower than expected, the employer may receive a partial refund
Employer Responsibilities:
COBRA Administration
Employers with 20 or more employees must offer COBRA continuation coverage to qualified beneficiaries who lose group health coverage due to certain qualifying events.
Employers must:
- Provide timely COBRA notices to eligible employees and dependents
- Allow continuation coverage for 18 to 36 months, depending on the qualifying event
- Process COBRA premium paymentsCommunicate with insurance carriers about COBRA enrollees
ACA Compliance
Depending on company size, employers may need to comply with Affordable Care Act requirements:
- Applicable Large Employers (50+ full-time equivalent employees) must offer affordable, minimum value coverage to full-time employees
- Report health coverage information to the IRS and employees
- Adhere to the employer shared responsibility provisions
How OHA Can Help Employers:
The Office of the Healthcare Advocate can assist employers with:Resolving employee health insurance issuesProviding information about insurance laws and regulationsOffering educational resources about health coverage optionsAddressing questions about coordination of benefitsNavigating disputes with insurance carriers