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Old 05-01-2018, 12:15 PM
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Default Indemnity plan + company pays for wellness/essential benefits

HEY!

I started working for myself and since then I've had my business purchasing my hospital indemnity coverage. It is very reasonable (about $190 a month). This doesn't include stuff like checkups, annual shots, wellness/essential benefits, etc... But if my company pays for these exclusions, at tax time, can I say I was "fully insured under the ACA rules"?

Also, dental. Can my company also pay for the dental claims and expense it as a business expense?

I am doing a little more research myself (and talking with my accountant) but thought someone here may be doing something similar. Any info will help me into the research a little bit more.
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Old 05-01-2018, 01:21 PM
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Check their teeth during interviews imo

Or, just bring in your dentist.

I've no idea. but you should check just how expensive that can be for you, to see if you have enough in reserve to pay for all that.
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Old 05-02-2018, 05:13 PM
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Not going to work. It has to be a binding guarantee of coverage. ERISA guarantees the coverage to qualifying participants. You can't just say "yeah, if I got sick they'd pay me."

A self-insured plan still has to be formalized and comply with other requirements. A plan document at the very least would show whether the plan could be Qualified and provides minimum essential coverage.
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Old 05-02-2018, 05:17 PM
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Dental is not required under ACA minimum coverage. Pediatric dental is/was an EHB but that doesn't apply, and self-insured plans separate it out anyway.
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Old 05-02-2018, 05:17 PM
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At some point, if you self-fund, you probably want to talk to a reinsurer about stop-loss or something similar.
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Old 05-02-2018, 05:25 PM
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At some point, if you self-fund, you probably want to talk to a reinsurer about stop-loss or something similar.
It doesn't make sense for tiny companies to do anything but fully-insure. You need a TPA (network) anyway. Reinsurance cost will be astronomical. Someone has to report on it and administer eligibility. Too much headache.

You don't want to go uninsured AND pay cash prices for everything. Depending on metro, billed charges are often double or more negotiated rates. A $100,000 claim would not be difficult to reach. And a reinsurer doubtfully would give you coverage on non-negotiated rates anyway.
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Old 05-02-2018, 05:43 PM
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Have you researched if any of these might apply:

https://khn.org/news/4-new-hardship-...lth-insurance/
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Old 05-03-2018, 01:53 PM
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Sounds to me like your in sole proprietor land.
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