Group Health Insurance

Medical plans (PPO, HMO, EPO), HSA-compatible HDHPs, dental, vision, life/AD&D, disability, accident/critical illness, and extras like EAPs. We can also compare fully-insured vs. level-funded/self-funded solutions and coordinate HSAs/FSAs/HRAs so they play nicely together.

Idaho defines small employer as a business with at least 2 but no more than 50 eligible employees, with most employees working in Idaho. An eligible employee generally works 30+ hours/week (some carriers allow 20–30 hours by agreement).

You’re required to offer coverage only if you’re an Applicable Large Employer (ALE)—on average 50+ full-time (30 hrs/wk) employees including FTEs in the prior year. Employers under that threshold aren’t subject to the ACA employer mandate.

For plan years starting in 2025, coverage is considered affordable if the employee’s cost for employee-only coverage is ≤ 9.02% of household income (safe harbors available). A plan provides minimum value if it covers ≥ 60% of total allowed costs and substantially covers inpatient and physician services.

On Idaho’s SHOP marketplace, carriers require at least 70% employee participation. To qualify for the federal Small Business Health Care Tax Credit, employers must pay at least 50% of the employee-only premium and meet IRS size/wage criteria. (Off-exchange carriers often use similar participation targets.)

Yes—small groups can enroll off-cycle if participation thresholds are met (e.g., 70% on SHOP). We’ll confirm eligibility windows with the carrier and handle the paperwork.

ACA rules cap waiting periods at no more than 90 calendar days after eligibility. A short orientation period (up to one month) may precede that. We’ll design eligibility rules that comply and fit your hiring cadence.

Federal COBRA applies to employers with 20+ employees, giving qualified beneficiaries the right to continue group coverage for limited periods. Idaho does not have a mini-COBRA law, so employers under 20 aren’t subject to state continuation mandates.

Yes. Plans that offer dependent coverage must make it available through age 26, regardless of student status, marital status, residence, or tax dependency.

Yes—pediatric dental and vision are Essential Health Benefits in the individual and small-group markets. Idaho’s EHB benchmark confirms these pediatric benefits for 2025–2027. (Adult dental/vision are optional add-ons.)

We’ll coordinate accounts to maximize tax savings and eligibility:

• HSAs require an HSA-eligible HDHP. 2025 HSA limits: $4,300 (self-only) / $8,550 (family); catch-up $1,000 (55+). HDHP minimum deductibles: $1,650 / $3,300; OOP max: $8,300 / $16,600.

   

• FSAs and HRAs can be layered (e.g., limited-purpose FSA with HSA). We’ll set rules to avoid conflicts and maintain HSA eligibility.

Yes—through a Section 125 cafeteria plan (often a POP), which lets employees pay their share of premiums pre-tax and reduces employer payroll taxes, if the plan is set up properly.

Employees get HIPAA Special Enrollment Rights for life events like marriage, birth/adoption, or loss of other coverage. Generally, there’s a 30-day request window (60 days for Medicaid/CHIP changes). We’ll provide the required notices and handle the adds.

Both routes use Idaho-approved small-group plans. SHOP can unlock the Small Business Health Care Tax Credit for qualifying employers; carriers also apply participation rules (typically 70%). We’ll model both paths and recommend the best fit.