How the New AHP Could Increase the Risk of Lawsuits Against Your Small Business

DuPage County small business law attorneysSmall businesses have long struggled to provide the same quality healthcare benefits to their employees as larger corporations. As a result, their hiring pool is often smaller, and they sometimes lose good workers, solely because they lack the ability to provide certain benefits. Thanks to the new AHP, that could all change. Franchisors and small businesses need to tread lightly, however, as there are some aspects of the law that could increase their risk of a lawsuit. Learn more in the following sections, including how a seasoned small business lawyer could help to mitigate this risk for your company. 

A Closer Look at the New AHP

At their core, AHPs allow small businesses to band together to purchase healthcare coverage for their employees, but unlike the older version, this new AHP allows companies to band together based on more than just industry or field. Instead, they can be linked by geography, or simply the desire to offer healthcare coverage. Set to start in September, the new AHP will apply to all small businesses, and even self-employed individuals, which were originally excluded. 

Employers who enroll in the program are expected to have the same flexibility as large corporations when choosing a coverage plan, but they may find that there are more exclusions. For example, a provider can choose not to cover prescriptions or drug rehabilitation services. Laws regrind maternity care, pre-existing conditions, and preventative care still apply. 

Avoiding Lawsuits Under the New AHP

In a large corporation, the human resources (HR) department typically works to ensure that all provided benefits are complaint with the law. In a small business or franchise, the task typically falls on the shoulders of the owner, who may already be spread too thin. As a result, they may fail to meet the legal requirements, such as ensuring that:

  • They are providing maternity coverage if they have 15 or more employees;
  • The cost to workers does not exceed more than 9.56 percent of their income (companies with 50 or more employees); and
  • The plan covers at least 60 percent of the cost of covered benefits (companies with 50 or more employees).

If an employer fails to meet these requirements and their employee has to seek other coverage because of that oversight, the small business could be subject to fines, penalties, and lawsuits. 

Franchisors have an even bigger challenge; overcoming joint liability when their franchisees fail to meet the requirements. Extra precautions, like hiring a program administrator and setting up an AHP trust, are highly encouraged for these companies. 

Contact Our Wheaton Small Business Lawyers

At Stock, Carlson, Oldfield & McGrath, LLC, we recognize just how devastating a lawsuit can be to your company’s future, and we strive to protect it. Skilled and experienced, our Wheaton small business lawyers can assist you in taking the appropriate steps before enrolling in an AHP. Call 630-665-2500 and schedule a personalized consultation to get started today. 



Medicare and Medicaid Differences and Planning for the Future

Medicare, Illinois Estate Planning LawyerOne of the most confusing decisions and choices that seniors need to make is about their health care insurance. People may have a hard time understanding the differences between Medicaid and Medicare and how those differences affect their future medical needs, including nursing home or rehabilitation facility placement.

Although both Medicaid and Medicare are federal health care programs, Medicaid is actually overseen by each individual state. Medicaid eligibility is geared more towards people who are low-income; however, Medicare qualification is for everyone, regardless of income.

To qualify for Medicare, a person must be 65 years or older, or a beneficiary of the Social Security Disability Insurance (SSDI) program for a minimum of two years. The program pays for physician visits, lab costs, outpatient care and supplies, prescription medicines, and hospital stays. The program will also pay for short-term nursing home stays (i.e. rehabilitative services) for stays up to 100 days. Hospice services are also covered by Medicare for those who have been given less than six months to live.

The price to enroll in Medicare is based on the plan in which a person enrolls, and all three plans have yearly deductibles. Typically, an enrolled senior is responsible for 20 to 35 percent of their health care costs and is again dependent on the plan in which they are enrolled

In Illinois, the Medicaid program is run by the Illinois Department of Healthcare and Family Services (DHS) and qualification is based on income. Medicaid programs pay basic health care services, such as doctor visits and all of the same coverage that Medicare covers; however, the program will additionally pay for a majority of long-term nursing home costs, assisted living, or at-home health care costs. Also, Medicaid will cover the price of prescription medications that a person's Medicare coverage does not.

Medicaid enrollment costs are often free or of minimal charge and can cover an insured Medicare's deductible, as well as the percentage of medical costs that Medicare does not pay.

One of the greatest expenses facing seniors is the cost of nursing home care and those costs can typically eat up the majority of a person's life savings if the appropriate financial plans have not been put into place beforehand. To make sure that does not happen to you, please contact an experience DuPage County estate planning attorney to help protect your family's financial future.