Kansas Small Business
Health Insurance Plans 2023

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KS Small Business Health Insurance Plans

Kansas Small Business Health Insurance Plans

Kansas Small Business Health Insurance Plans 2023. The following is an overview of the rules that govern small group health insurance plans in the State of Kansas.

The information that is discussed below includes the laws that have been mandated by the Affordable Care Act (ACA or "Obamacare"), as well as the laws that are required by Kansas State government.

If you own and operate a KS small business and you already offer small group health insurance or you're thinking about offering small group health insurance - this guide can help you better understand the regulations, requirements and available Kansas small business health insurance plans available.

Learn how to get Kansas small business health insurance plans for 1 to 50 employees. The best small business health insurance providers in KS offer affordable rates, flexible coverage options and access to a large network of medical providers.

Below are some answers to commonly asked KS small business health insurance plan questions:

How Much Does Kansas Small Business Health Insurance Cost?

The average price of a standard Kansas small business health insurance policy ranges from around $583 to over $1706 per employee per month based on; single or family, location, coverages offered, deductibles and more.

What Are The Small Business Health Insurance Regulations In Kansas?

Kansas Small Business Health Insurance Plans

In the State of Kansas, there are different laws in place for small business health insurance. These laws have been established by the state itself, as well as the United States federal government via the Affordable Care Act.

In Kansas, the law requires health insurance companies that offer small group policies to offer all qualifying small businesses that apply for group health insurance. Additionally, health insurance companies are legally required to offer all eligible Kansas small businesses the same insurance policies.

In order to be eligible for coverage, a small business needs to have a minimum of 2 but no more than 50 employees.

It is important to note, however, that according to Kansas law, health insurance companies can stipulate small business owners meet a minimum participation requirement. Due to this stipulation, a certain percentage of employees or members of the small business have to purchase the health insurance policy that is offered, otherwise the policy that the small business is offered will be rescinded.

The health insurance company can determine that stipulation. Furthermore, health insurance companies in Kansas can also ask employers to contribute a specific amount to their employees' health insurance premiums before the company agrees to offer a policy, and the company can dictate that amount.

The cost of Kansas small business health insurance plans is mildly regulated. The premiums that small business owners pay for their health insurance can be based on specific factors, including the age, health status, and gender of the group; however, those factors and premiums must be within a set limit.

To protect groups that are insured under a small business health insurance policy, Kansas health insurance regulations do not permit the cancellation of policies due to the fact that an individual in the group becomes ill.

According to Kansas Insurance Department, legislation signed by President Obama on March 23, 2010, that made historic changes in the availability and delivery of health insurance, Medicaid and health policy nationwide. Commonly referred to as the health reform law, Patient Protection and Affordable Care Act (PPACA), and Obamacare.

  • Lifetime dollar limits on essential health benefits are not allowed.
  • Insurance plans also cannot put annual dollar limits on essential health benefits.
  • The appeal procedures available to consumers are different.
  • Insurers cannot deny coverage because of a pre-existing condition. They also cannot charge a higher premium due to a person's gender or health condition.
  • Nearly all adult children up to age 26 are eligible to remain on a parent's health insurance policy, regardless of the child's marital status, financial dependency, enrollment in school, or place of residence.
  • There can be no cost-sharing for preventive services provided in-network.
  • Consumers have more access to information about proposed rate changes.
  • Medical loss ratio standards limit how much of premium dollars insurers can spend on administrative expenses.
  • All insurers must use a standardized Summary of Benefits and Coverage (SBC), which makes it easier to compare plans.
  • Small businesses that provide health insurance for employees can apply for a tax credit. It should be noted that since Kansas does not have a SHOP Exchange for small employers they are not eligible for federal tax credits. However, they may be eligible for the small business health insurance tax credit offered by the Kansas Department of Revenue.
  • Persons with Medicare prescription drug coverage receive a rebate to help cover the cost of the "donut hole."
  • Insurers must cover routine medical costs if a person participates in a clinical trial for cancer or other life-threatening diseases.
  • Individuals who can afford it must have basic health insurance coverage, referred to in the ACA as "minimum essential coverage."
  • Beginning in 2019, the individual mandate penalty has been set to zero.
  • Individuals and families who need help affording coverage may have access to financial assistance when they shop in the new health insurance exchanges.

Does Kansas Participate In The Affordable Care Act?

Affordable Care Act Kansas

In 2010, the Affordable Care Act (ACA or "ObamaCare") was passed by the United States Congress and was signed into law by Obama. Following its passage, provisions of the law have continued to be phased in, and as of January 1, 2014, the majority of American citizens and legal residents of the United States are required, by law, to have qualifying health care coverage.

If they fail to have coverage, they are responsible for paying an annual tax penalty for each month they aren't insured, which is known as the "individual mandate".

The cost of the penalty for failure to have qualifying coverage is $95 per adult and $47.50 per child, or 1% of your total taxable income; whichever amount is higher - as much as $285 per family. In 2017, the penalty increased, and has continued to increase thereafter.

Qualifying Exemptions For The Individual Mandate

Individuals who meet one of the following are exempt from the individual mandate and the associated tax penalties in KS:

  • Illegal aliens
  • Jailed individuals
  • Religious objections
  • The cost of health insurance coverage is higher than 8% of your household income
  • Those who aren't covered for less than three months during the calendar year
  • Those who have hardship waivers
  • Your income level is blow the 100% poverty level

What Are The Affordable Care Act Requirements For Kansas Small Businesses?

Kansas Small Business Health Insurance Plans Claim Form

If you're a small business owner in Kansas, you must provide your employees with insurance. This is a requirement that was put into place by the Affordable Care Act.

Referred to as the Employer Shared Responsibility provision, all employers must offer their employees at least one of the ACA-compliant Kansas small business health insurance plans, otherwise then can face fines of up to $2,000 per employee.

Kansas small business owners can purchase coverage for their employees through the state's Small Health Option Program (SHOP) exchange, or from a private insurance agent or broker.

Affordable Care Act Standardized Essential Health Benefits

As per the ACA, all qualifying health insurance plans must offer 10 standardized essential benefits.

Depending on the state, additional benefits may also be required. The 10 ACA standardized essential benefits are as follows:

  1. Ambulatory patient services (medical care that is offered without being admitted to a hospital)
  2. Emergency services
  3. Hospitalizations, such as overnight stays and surgical procedures
  4. Lab services
  5. Mental health and substance abuse disorder services, including behavioral health treatments, such as psychotherapy and counseling
  6. Pediatric health care services, including vision and oral care; however, adult vision and dental coverage aren't essential health benefits under ACA
  7. Pregnancy, maternity, and newborn care, including before and after birth
  8. Prescription pharmaceuticals
  9. Preventative and wellness services, as well as management for chronic diseases
  10. Rehabilitative and habilitative services and devices, including services and devices for injuries, disabilities, and chronic health conditions

Additional Health Benefits Mandated In Kansas

In addition to the 10 essential health benefits, Kansas state government requires health insurance policies to offer benefits that exceed the ACA requirements. These additional requirements include the following:

  • Breast reconstructive surgery
  • Diabetes care management
  • Prescription pharmaceutical medications, coverage for cancer treatments, including anticancer medications that are administered orally

Standardized Kansas Small Business Health Insurance Plans
ACA Metal Levels

In order to make it easier to compare costs and benefits, the Affordable Care Act has designated all qualifying Kansas small business health insurance plans to be one of four metal colors, including Bronze, Silver, Gold, and Platinum.

Each of these designations is based on the average amount of health care costs that the plan will cover, which is illustrates at percentages of how much the insurance company will cover for health care, as well as the amount the insured will have to pay out-of-pocket.

All insurance companies that are participating in the federal or state health care exchange program must offer at least the Silver and Gold Kansas small business health insurance plans.

All four of the metal plans have a shared maximum out-of-pocked amount that the insured can be charged during any calendar year. The following table illustrates this information:

Metal Plan Insurer Pays / Insured Pays
Bronze60% / 40%
Silver70% / 30%
Gold80% / 20%
Platinum90% / 10%

Guaranteed Issue

As per the ACA, individuals cannot be denied coverage or charged higher premiums because of their past health history, or their gender.

Additionally, look-back and waiting periods cannot be imposed. Additionally, policies are effective when they are issued and all coverage is renewable if the individual chooses to renew the policy.

However, plans can be canceled if the individual fails to pay their premiums or commits fraud.

How Are KS Health Insurance Premiums Determined?

A premium is the amount the insured must pay out-of-pocket in order to maintain their health insurance policy. The premiums that are charged for any of the qualifying metal plans can be based on the following:

  • Age of the individual
  • Whether or not the individual uses tobacco
  • Where the individual lives, based on a rating area
  • The number of family members who will be enrolling

What Types Of Health Insurance Plans Are Available For Kansas Small Businesses?

Health Insurance Plan Types

While there are several types of health insurance plans to choose from, the following plans are the most popular among KS small business owners:

Health Maintenance Organization - Simply known as an "HMO", this type of plan offers a variety of health-related services via a network of health care providers and hospitals that exclusively contract with the HMO, or who agree to offer their services to members of the HMO. Employees who participate in this type of plan usually have to choose a primary care physician (PCP), and receive most of their care from this physician. If a specialist is needed, the PCP will recommend one that is affiliated with the HMO.

Preferred Provider Organization - More commonly referred to simply as "PPO", this type of health insurance plan is the most common among Kansas small business owners. The insurance company provides a preferred list of health care providers, and employees must receive their medical care from the doctors and hospitals on that list for their claims to be paid at the highest level possible - but they also have the flexibility to see any other provider anywhere in or out of state.

Point-of-Service Plan - Known as a (POS), this type of health insurance plan provides access to health care services at a lower overall cost, but with fewer choices. Members can access care from in-network or out-of-network providers and facilities, but coverage is better when you stay in-network. POS plans may vary, but generally, plans are considered a blend of HMO and PPO plans - offering more flexibility than HMOs, but less than PPOs.

Health Savings Account - A health savings account (HSA) is a special type of bank account that allows participants in the insurance plan to save money that can be used specifically for the medical care they require in the future. HSA-qualified health insurance plans are usually PPO plans that are specifically designed to be used with an HSA.

Indemnity Health Insurance - This type of health insurance plan allows members to control their own health care and to visit any doctor or hospital they choose. The insurance company would then pay a pre-determined percentage of the total charges for the services that were rendered. Employees may have to pay for some types of services up-front and then they can submit a request for reimbursement with the insurance company.

Kansas Small Business Health Insurance Plans - The Bottom Line

We strongly advise business owners to speak with a CPA and a KS health insurance broker before jumping in and getting any type of the Kansas small business health insurance plans available.

Make sure that you know exactly what each option can do for your company and the potential drawbacks associated with it.

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Learn about Kansas small business insurance requirements for general liability, business property, commercial auto & workers compensation including KS business insurance costs. Call us (620) 205-2115.

Small Business Health Insurance Plans By State

You can find more state specific small business health insurance information including requirments and coverage by clicking on the state below:

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