Step 2: Consider Coverage Type

If you have fewer than 50 full-time and FTE employees and don't offer health coverage, you are not subject to these reporting requirements. If you are a small employer that offers health coverage, your insurer will report on your behalf, unless you are self-insured.

Here is an overview of each type of plan:

Fully Insured Health Plan - Generally, a type of plan purchased by the employer from an insurance company where the insurance company assumes the health coverage risk. Most employers offer fully insured health plans.

Self-Insured Health Plan - Generally, a type of plan where the employer assumes the risk of paying participants' claims out of its general assets or a trust.

Level-Funded Health Plan - Generally, a type of self-insured plan where rates are based on group experience. They typically have fixed monthly payments that are used to pay claims and maintain stop-loss coverage. For instance, one year rates may be low due to a healthy population of the group but that could change the next year due to illness/injury in the group.

Proceed to Step 3 to determine which forms to file.


Rev. 6/18