If you’re considering a group health insurance policy for your employees — or if you want to shop around and compare your current plan with other available alternatives — an employee census is a good first step. It’ll tell you how much your group will pay for employer health insurance, and while brokers and insurers generally offer premade census templates, you can also create your own. No matter which route you choose, here’s what you need to know to get started.
What’s Included on an Employee Census?
Your census will include several key pieces of information about each full-time employee (generally those who work 30 or more hours per week). If you have a small group — meaning you have no more than 100 full-time equivalent employees if you’re in California, Colorado, New York or Vermont, or no more than 50 full-time equivalent employees if you’re anywhere else — the premiums for your group are predetermined, and the insurer has filed them with the state insurance commissioner.
Large group premiums are more flexible and less regulated, but the following factors still come into play. Because your employee census is the basis for the quotes that your broker or insurer will give you, the more detailed and accurate this information is, the better idea you’ll have of what coverage will cost your group before you enroll.
- Name and birthdate of all enrollees. Small group health insurance premiums are linked specifically to each enrollee’s age, including spouses and domestic partners (if your group offers this benefit) and children, so getting detailed age information on each person in the plan is key. For larger groups, though, it may be enough just to indicate how each employee is enrolling — on their own or with a spouse and/or children.
- Residential ZIP code. In most cases, business ZIP codes are used to determine geographically based rates for the whole group, but some insurers need personal ones as well. Include it just in case — better safe than sorry!
- Gender. Small group health insurance premiums can no longer vary based on gender, but that’s not the case in the large group market. Depending on the size of your organization, your premium quote might still depend on the genders of your employees and their spouses.
- Tobacco use within the past six months. Under the Affordable Care Act, small group health plans can charge tobacco users premiums that are up to 50 percent higher than the standard rates, assuming the employee doesn’t participate in the employer’s tobacco cessation program. But tobacco surcharges are prohibited or limited in 12 states and Washington, D.C.
- Whether the employee plans to waive coverage. Insurers have participation requirements for group health plans — usually at least 70 percent. For small groups, there’s a one-month window each fall without participation requirements for new groups, but generally, insurers need to know which employees, if any, are planning to waive coverage. Employees who waive participation in your group’s plan because they already have coverage from another source aren’t counted when determining the percentage of employees who will participate in the group plan, but those who waive coverage and go uninsured will be. Also be sure the census notes any employees who are in a waiting period and aren’t eligible for coverage.
Best Practices for Your Employee Census
Creating your own census? Head to your payroll data first — you may already have census data from the last time you got health insurance quotes for your business, but you’ll want to make sure it’s up to date before you get new quotes. This also gives you a chance to review health plan eligibility for each employee and check on your compliance with the employer mandate if you have 50 or more full-time equivalent employees.
Since your census will need to include things like the birthdates of your employees’ children and whether employees are getting coverage from another source, have each employee fill out their own information. You can provide your staff with paper forms or send them electronic forms they can return to you. After you get all of the applicable information from your employees, compile it and verify that each employee on the census is eligible for coverage.
Once you have a detailed census on file, all there is to do is to keep it updated. Give new hires their own health insurance census form to fill out, and take your annual policy renewal reminder as an opportunity to have employees review their information and make sure it’s still correct. Figuring out your health insurance benefits strategy comes with a lot of question marks. Let your employee census take some of them out of the equation.
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