Can You Get a Group PPO?
If you’re an Illinois resident buying your own health insurance, you can’t get real major medical PPO coverage health insurance, right? Maybe!
Illinois doesn’t allow individuals to get group health insurance through associations like alumni or professional groups. But since 2016 we’ve helped dozens of self-employed use their business to take advantage of small group (1-50 employees) to get the PPO health insurance coverage they can’t get as individuals.
Benefits of Group Health Insurance
1. Small group insurance, even with only one policy, offers PPO coverage for multiple hospital networks. (Individual/family Affordable Care Act plans do not.)
2. Small group insurance may be less expensive., have higher co-insurance levels and lower Out of Pocket Maximums.
3. Small groups can be formed at any time. No Open or Special Enrollment periods.
4. Small group plans are Affordable Care Act compliant.
How to Qualify for Group Health Insurance
To qualify as a small group, you must create a business that consists of at least two entities:
At least two partners with a formal partnership agreement. Your Federal EIN must state you are partnership and that you will file Form 1065 with your federal income tax. The percentage of partnership is flexible. The group must be based in Illinois and registered with the IL Secretary of State. A group can be created even if only one of the partners takes an individual or family policy.
The two entities are at least one employer/owner (LLC or S or C Corp) PLUS at least one employee working a minimum of 30 hours/week who is paid salary and for whom the owner files an Illinois quarterly wage report (IL340) which you must submit. (There are provisions for new businesses.)
The employee can’t be the spouse of the owner or a child of the owner under 18. A group can be created even if only the owner or one of the employees takes an individual or family policy.
- The business must be registered in Illinois.
- The insurance must be offered to all employees. Some may decline coverage because they have insurance through their spouse, union, Medicare, Military or Medicaid
- The employer/owner must contribute a minimum of 25% to each employee’s health insurance premium except during Special Enrollment Nov.1-Dec.15. During this time the requirements to contribute to employees’ insurance and meet minimum employee participation are waived for the life of the group.
- The entire group health insurance premium is paid by the employer/owner. The business must have a checking account for this purpose.
Who Makes Up the Groups We Help Insure
We have partnerships made up of spouses, siblings, parents and over-18 children, partners in medical, legal. counseling and other practices.
In the case of Owner+Employee qualifying groups, the group can offer health insurance to 1099 employees as well.
A number of the groups we helped create were formed when a person lost employer group health insurance. They formed a business using their skills or used a spouse’s business to benefit from group health insurance.
How To Get Started
Establishing a small group is a multi-step process. Call us to start with a Proposal Request. 847-362-8888. Whether you’re forming your business to get group health insurance or already qualify, we’ll be with you every step of the way. After all, we’ve found the best health insurance for the best price for independent entrepreneurs for nearly two decades.