Ohio Small Business Health Insurance Options

Ohio Small Business Health Insurance

Welcome to the HSA For America Guide for Ohio small business health insurance. This guide is aimed at companies with 30 or fewer employees, headquartered anywhere within Ohio.

This guide is designed to help Ohio small businesses, freelancers and independent professionals offer the best, most cost effective set of employee benefits. You can still be competitive while offering the benefits you need to keep the best talent on your team.

Ohio Small Business Health Insurance Benefit Options

Small businesses in Ohio can choose from a variety of options to provide health benefits to their employees.

The most common but also the most expensive option is to implement a group health insurance plan.

Prices vary depending on age. However, according to the Kaiser Family Foundation the average annual cost for employer-sponsored group insurance covering a worker’s family in 2022 will be $21,102.

Ohio employees, on average, contribute more than $5,831 towards their health insurance costs.

Ohio businesses have other options that can reduce their costs significantly. These include:

  • Health Savings Accounts (HSAs)
  • Health reimbursement arrangements (HRAs)
  •  Direct Primary Care (DPC) Memberships
  • Health Sharing Programs

The best strategy to use for your small business depends on a number of factors, including the size of your company, your budget, and your employees’ age and medical needs.

Read on the go, download our Complete Guide To Small Business Healthcare Plans.

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Geographical Considerations for Ohio Small Business Health Insurance

It’s important to also consider the unique healthcare environment in Ohio, which includes both urban areas like Toledo, Columbus, and Cleveland, and more rural areas like Lima and Portsmouth.

Ohio business owners must therefore carefully consider how they distribute their workforce throughout the state. It is not in the best interest of executives at company headquarters in Cleveland to select an HMO which restricts employees and their families from seeing doctors outside of its network when many of their employees live and work in Mansfield.

Ohio Small Business Group Health Insurance

Most Ohio employers choose traditional group health insurance.

It’s also one of the most expensive.

Here’s what it looks like:

Employers contract with a third party insurance provider, usually a for profit corporation, to provide health insurance benefits to their employees and if they wish – also for their family members.

The Affordable Care Act requires that employers with 50 employees or more offer ACA-qualified health coverage to all employees working more than 30 hours a week. Otherwise, they will be penalized.

The health insurance policy must include the ten essential coverages (MECs) required by the Affordable Care Act. These are:

  •  Ambulatory Patient Services (outpatient services you receive without being admitted to hospital)
  • Emergency services
  •  Hospitalization (such as surgery and overnight stays)
  •  Pregnancy and newborn care (both prior to and after birth)
  •  Mental health and substance abuse disorder services, including behavioral healthcare treatment (this includes counseling or psychotherapy)
  • Prescription drugs
  •  Rehabilitative and habilitative devices (services and equipment to help people with disabilities or chronic conditions recover mental and physical abilities)
  • Laboratory services
  •  Preventive and wellness services for chronic disease management
  • Children’s services, including dental and vision care. Adult dental and vision benefits are not essential health benefits

The ACA also requires that health insurance cover birth control and breastfeeding.

Traditional health insurance is the most expensive choice for businesses. However, it has the advantage of a guaranteed enrollment.

The insurance company can’t deny coverage or charge higher premiums if the worker enrolls in the initial enrollment period, during a special period of enrollment triggered by an event that qualifies, or during the open enrollment period, which begins on November 1st each year.

Small businesses in Ohio can opt out of health insurance

Employers with fewer than fifty employees are not required by the Affordable Care Act to offer any health insurance.

Ohio law does not have any requirements. If you have less than 50 employees, then you do not have to provide any health insurance.

You won’t have to pay a fine.

Even small companies should offer health benefits, as it can be difficult to retain and recruit quality employees without a competitive benefit.

Ohio is a great place to work, especially because unemployment is low and employers are fiercely competing for talent.

Ohio employers could save a lot of cash by offering a medical sharing plan or health sharing plan. (More info below) You can pay for some or all costs of your employees.

The HRA Alternative

You can also offer a QSEHRA (Qualified Small Employer Health Reimbursement Arrangement) to help your employees pay their own personal health insurance tax-free.

Employers can benefit from QSEHRAs in the following ways:

1.)No minimum contribution limits

You are not required to make a minimum contribution each year as you would be with a pension plan. As an employer, it is up to you to decide how much money you want to spend on HRA benefits. You can change this budget each year based on your cash flow.

 With a QSEHRA , you are in charge of your health benefit budget.

2.) Flexibility

You can offer different amounts to employees depending on their marital status or family status. You can discriminate against employees with dependents by offering a higher benefit to those with families.

3.) Both employers and employees are eligible for tax-free treatment.

Your employer contributions can be deducted as compensation expenses. Your employees will not pay tax on the QSEHRA benefit, unlike cash compensation. This is provided they maintain an insurance plan that includes 10 essential coverages as specified in the Affordable Care Act.

This is why offering a QSEHRA can be better than offering a health insurance stipend to employees that they can use for health insurance or other expenses.

4.) QSEHRAs Support Employee’s Choice

Too many traditional group health plans limit the options available to employees who are in a wide range of situations.

These are often expensive and unsuitable to workers simply because they are chosen by HR and management and not by workers themselves.

The QSEHRA gives workers and their families a much wider range of choices and empowers them with the ability to choose a health plan that is right for them.

Taxation of employer-sponsored health coverage in Ohio

The premiums for health insurance you pay as an employee are fully deductible as a business cost under federal and Ohio law. The employee is not taxed on these premiums.

Healthsharing plans have lower costs overall. The employee can also deduct their monthly costs. Employees are taxed on employer-paid health sharing costs.

Disadvantages to Employer Group Health Insurance in Ohio

Employers and their employees have some serious disadvantages with traditional employer group health insurance.

  • Cost

    As we mentioned above, the cost of health insurance is often crippling.

    The government regulators in Washington and Columbus have crammed health insurance policies full of mandatory coverages and requirements, which make little sense to many workers.

    Traditional health insurance, for example, requires that carriers include coverage for drug and alcohol addictions, mental health, and maternity benefits, which many workers do not need or want.

    This makes them less efficient and more expensive than they should be.

  • Inflexibility

    Group health insurance programs are often a one-size fits all strategy that may not adequately address the needs and budgets of specific employees. By nature, group health insurance plans sponsored by employers tend to provide only one or two options that may not be the best for certain employees.

    Workers may be better off purchasing their own plan through the individual market, and taking advantage of the Affordable Care Act subsidy.

    Below are some alternatives to health insurance that may be less expensive. These innovative and affordable health insurance alternatives can be a great option, especially for workers in good health with no pre-existing condition.

    Below, we discuss health sharing plans in greater detail.

  • Administrative burden
  • Managing full-fledged benefits for health involves significant administrative costs. This includes managing documents and compliance, auditing the plans to ensure that employees do not enroll non-qualified individuals into the plan, as well as responding to staff questions. These duties are vital to ensure that the health insurance program within an organization runs smoothly.

     They are a burden for very small employers, who may not have enough employees to justify a full time HR staff to manage the plan.

     Business owners can also use strategies like Health Reimbursement Arrangements or health care stipends.

    These alternative approaches encourage workers who are not covered by the Affordable Care Act to purchase their own insurance. This could help workers to benefit from available subsidies. This also removes the employer from the process, reducing overhead costs and administrative costs.

Health Sharing Plans in Ohio 

Health sharing plans can be a viable, affordable alternative to expensive health insurance for small businesses.

Medical cost sharing plans are becoming a popular alternative to traditional group health insurance for businesses in Ohio. They are also more affordable. By switching from traditional group health insurance plans to health sharing, businesses can save up to half on premiums.

This means that Ohio small businesses can potentially save more than $10,000 a year per employee on family coverage and more than $3500 per employee a year on single coverage.

These programs are a cutting edge method of funding healthcare. They allow companies to provide employees with high-quality healthcare and control costs. Health sharing programs are based on the idea of sharing resources between a group of individuals or organizations.

Health sharing programs allow participants to pay a fixed amount per year instead of paying premiums for traditional health insurance.

Health Sharing Plans vs. Health Insurance

Health sharing plans and health insurance are not the same.

Healthsharing organizations are voluntary associations that bring together people who share similar interests to help pay for medical expenses. Health sharing ministries are non profit organizations, unlike health insurance companies that are typically for-profit corporations.

Mandatory Coverage

Health insurance plans do not have such requirements. Federal and state laws require that traditional health insurance policies include coverage for many things, which many people don’t need or want. Health sharing organizations are not subject to the Ten Minimum Essential Coverage requirements.

For example, medical cost-sharing plans do not have to cover the cost for addiction treatment for those who never use drugs. They don’t have to cover the costs of treating injuries caused by drunk driving.

Pre Existing Conditions

Healthsharing plans can impose waiting periods for sharing the costs of pre-existing conditions.

They also often impose waiting times for surgeries, except in the case of accidents and injuries that were not foreseen before the member enrolled.

These waiting periods eliminate a lot of adverse selection and help health sharing organisations provide a fantastic set of benefits for a fraction of what it would cost to purchase a non-subsidized ACA qualified group health insurance policy, or one purchased through the Healthcare.gov exchange online in Ohio.

Note: Healthsharing plans do not qualify for subsidies under Affordable Care Act. The price savings are so great that even if you qualify for a subsidy depending on your circumstances, many people will still benefit by switching to healthsharing.

Switching to health sharing is often more beneficial for Ohio employers, since small group health insurance doesn’t qualify for a subsidy from the ACA.

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Health Sharing and Network Restrictions are in Ohio 

Health sharing plans offer more choices when it comes time to choose healthcare providers than traditional managed care plans like HMOs and POS, which are the most common group health insurance plans sponsored by employers.

Healthsharing organizations in Ohio don’t restrict patients to providers in their network in most cases. Health sharing plan members can choose their own doctor. Choosing the doctor of your choice is a right that people should have.

Is Health Share Right for Your Business

Every business is unique. It takes careful analysis to choose the best plan, whether you’re looking at a healthsharing plan or a traditional plan for group health insurance.

It’s easy to get a case analysis and recommendations specific to your company and employees in Ohio.

Click here to set up an appointment with one of our experienced Personal benefits managers licensed in Ohio.

You can help yourself by preparing a staff census.

In most cases, switching from health insurance to a group plan will save you thousands of dollars for each employee. Health sharing is not recommended if your employees have pre-existing medical conditions.

Consultation and analysis are always free.

Small Businesses in Ohio can take advantage of health reimbursement arrangements

Health Reimbursement Arrangements are employer-funded benefits which reimburse employees for their individual healthcare costs.

Small businesses in Ohio often drop the group health benefit. Instead, they create an HRA and use it to give workers the money to purchase their own health insurance on the individual market with pre-tax dollars.

This allows employees to take advantage available subsidies, further reducing net costs for both the employee and the company.

If there is any HRA money left after paying the premiums, workers can use it to pay for other costs, such as prescriptions, deductibles, copays, or durable medical equipment. HRA benefits remain tax-free for the employee.

By offering an HRA instead of a formal health insurance plan for your employees, you give them the freedom to choose health insurance plans that meet their needs.

QSEHRAs—The HRA for Small Businesses

Small businesses can use an HRA that is called the Qualified Employer Health Reimbursement Agreement or QSEHRA.

This benefit is for companies that have fewer than 50 employees full-time or equivalent and do not offer a traditional health insurance plan.

Businesses can set their own QSEHRA maximums within certain limits. Ohio employers will be able to contribute up to $5850 per employee (up to $487.50 a month) as of 2023. They can also contribute up to $11,800 per family member (up to $983.33 a month).

Employees can use this money to purchase their own health insurance through an online health insurance exchange or a Personal benefits manager on the individual and family market. This allows them to keep their eligibility for the subsidy they would have received under a group health insurance plan paid by their employer.

You can choose to reimburse your employees’ health insurance premiums only or their premiums and any additional medical expenses

QSEHRAs & Special Enrollment Periods

Your employees will be eligible for a Special Registration Period when you replace your health insurance with an HRA. This is a 60 day window in which your employees can purchase their own ACA qualified insurance plan without having to go through medical underwriting.

This will ensure that your employees are not left without coverage if you decide to replace your group health plan with a QSEHRA.

HRA Advantages

Health Reimbursement Arrangements are a great way to save money.

The money you spend on HRAs for your employees can be deducted from your taxes and is tax-free for your employees.

You retain control over HRA funds until they are actually paid to employees. You can use it as operating capital. You don’t need to deposit it anywhere.

Employers can be very flexible when designing their HRA benefits. This includes what expenses they are willing to reimburse.

Workers do not lose their health insurance coverage when they leave a company or become contractors. The QSEHRA allows the worker to control and own his or her health insurance policy. Not the employer.

HRA Disadvantages

Not all workers are willing to take on the responsibility of researching and choosing their own health insurance plans. Some workers may require extra assistance to make the transition.

Your HSA for America Personal Benefits manager is here to assist you. So that no worker is left out.

To schedule an appointment, have your workers Click this link or call 800-913-0172.

Direct Primary Care Benefit

Direct Primary Care plans are a new alternative healthcare model gaining popularity in Ohio and throughout the country.

Membership-based model. Your employees can receive as many visits they need in person or by telehealth for a flat monthly fee.

DPC offers a monthly membership cost of only $80 for those who want to prioritize their health, without the burdens of copays and coinsurance.

DPC plans offer members unlimited access to primary, chronic, and preventive care services.

Direct primary care practices provide a wide range of services, including:

  • Preventive care. Doctors at DPC emphasize preventive medicine, providing services such as routine checks-ups, vaccinations, and screenings of various conditions.
  • Acute care: DPC doctors provide acute care for illnesses and injuries like infections, colds and flu, minor injuries and skin conditions.
  • Chronic disease management. DPC doctors can help patients manage chronic conditions such as diabetes, hypertension and asthma. They provide ongoing monitoring and treatment plan adjustments as needed.
  • Comprehensive physical exams.DPC physicians offer thorough physical exams to assess overall health, identify risks, and provide personalized recommendations for health.
  • Urgent care. DPC Doctors are often available to provide same-day or the next-day urgent care.
  •  Patients can receive prompt attention to non-emergency issues by making appointments. 
  •  Diagnostic and laboratory services. Doctors of the DPC may offer or coordinate various laboratory tests such as blood tests, urine analyses, imaging studies (X rays, ultra-sounds) and electrocardiograms.

  •  Medication management. DPC doctors are able to prescribe medications, monitor the effectiveness of those medications, and make adjustments if necessary. They can also provide counseling and education on medication use.
  •  Mental health services . Many DPC practices offer mental health services in their comprehensive care. DPC doctors can provide counseling, therapy and referrals to mental specialists when needed.

  •  Minor procedures. Some DPC doctors have been trained to perform minor surgeries in their offices, such as suturing wounds, removing skin lesions or moles, and joint injections.

  •  Care coordination and referrals. DPC doctors are patient advocates who coordinate care with specialists, hospitals and other healthcare providers.

Since there is no insurance company involved there are no copays, coinsurance or deductibles. The monthly subscription covers all costs. The monthly subscription covers everything. This allows cash-strapped employees to get the care they need immediately. They don’t have to delay seeing a doctor because they cannot afford the co-pay or deductible.

Patients can choose from supplemental plans like high-deductible health plans, accident insurance, or health sharing plans to cover services that DPC does not offer. DPC members can choose to cover routine care with healthsharing plans, which are much cheaper than traditional health insurance.

Health Savings Accounts

HSAs can be a powerful tool to help workers manage medical costs and to keep premiums for workplace health insurance plans lower.

Residents and businesses in Ohio need every tax break possible. The good news is that employer contributions to employee Health Savings Accounts are fully deductible from Ohio corporate income taxes as compensation expenses.

HSAs allow individuals to set aside money before taxes in order to save for future medical expenses. HSAs are open to both employees and employers, subject to a limit set by Congress to keep pace with the cost-of-living.

The money in an HSA grows tax-deferred, and withdrawals for qualified healthcare expenses are tax-free.

HSA Eligibility 

Employees must enroll in an high-deductible health plan to be eligible to contribute to their HSA or to receive employer contributions before tax.

The IRS defines a high-deductible health plan for 2023 as any plan that has a deductible at least of $1,500 per individual or $3,000 per family.

The total annual out-of pocket expenses for an HDHP (including copayments and coinsurance), cannot exceed $7,500 per individual or $15,000 per family. This limit does not apply to services provided outside of the network. ).

Can I combine HSAs with health sharing?

Currently, there is only one major health-sharing plan that preserves the employee’s eligibility to make pre-tax contributions into a health savings accounts: The HSA Secure Plan, available through HSA For America.

The HSA SECURE Plan offers a great way to combine tax and healthcare benefits of a health saving account with cost-saving advantages of healthsharing.

To be eligible for this plan, employees must have some form of self-employment or ownership.

HSA SECURE does not apply to W-2 employees. HSA SECURE is a good option for employees or spouses who have a small business, freelance or side hustle, and are in good health without any preexisting conditions.

The HSA SECURE plan is also a great option for you as a small-business owner and your partners to save money.

Your employees would need to enroll themselves in HSA SECURE. Once they’ve established an HSA and enrolled, you can make contributions pre-tax on their behalf up to the annual limit Congress sets each year.

Click here to learn more about HSA SECURE.

How Are Ohio Small Business Health Insurance Benefits Taxed?

Here is a table that explains how each of these benefits is taxed.

Plan TypeEmployerWorkers
Traditional health insurance premiumsTax deductible. May qualify for a tax credit (see below)Non-taxable
HSA contributionsTax deductible
Pre-tax, up to certain limits. No income limitations.
Health sharing costsTax deductible as a compensation expenseTaxable as ordinary W-2 income
Health reimbursement arrangementsTax deductibleBenefits are non-taxable to the employee
HSA withdrawalsN/A
Withdrawals for qualified medical expenses are tax-free. Otherwise taxable as ordinary income.
A 20% penalty for non-qualified withdrawals applies up until age 65.
Direct primary care costs

Tax deductible as a compensation expenseTaxable to the employee

Ohio Small Business Health Insurance Care Pyramid

 As shown below, a good employee health benefits package will address all levels of Employee Healthcare Pyramid, from routine preventive health care to primary care access and early detection of health issues, up to catastrophic incidents.

Care Pyramid for Ohio Small Business Health Insurance

On the left we list the common traditional insurance-based solution that addresses each level of the Care Pyramid.

On the right we list alternative, more affordable ways to provide meaningful protection for employees in each level of the Pyramid.

A good plan design offers employees affordable solutions for each of these levels. So that no employee has to delay or forgo care because they cannot afford a coinsurance or copay.

Your Personal Benefits manager can help you design a plan that is tailored to your employees and provides solutions at each level of Care Pyramid. This is often done at a fraction the cost of a group plan.

The Ohio Small Business Health Insurance Tax Credit

The Small Business Health Care Tax Credit, passed along with ACA, allows certain small businesses to claim a tax credit up to 50% on their employee health insurance expenses.

It is designed for small businesses that have 25 or fewer employees and tend to hire workers at lower wages.

Businesses that are for-profit or non-profit can claim the credit.

* Have less than 25 employees with an average salary of $53,000 or lower (excluding all owners’ salaries). Owners are generally not included in the calculation of the number and average salary of employees for a business. The number of employees is also based on the “full-time equals” (FTEs). Two half-time employees are equal to one full-time employee.

 * Pay at least 50% of the premiums for employees.

* Offer coverage that meets the requirements of the Affordable Care Act on the state exchange. In Ohio, this is healthcare.gov, which is the federal online insurance marketplace.

Once an employer has 25 employees, or if the average wage is $53,000 or more, the tax credit is gone.

How do I claim the credit?

This tax credit can be claimed on your annual income taxes with IRS Form 8941 attached (tax-exempt small business must file a Form990-T tax report to claim even if they are not required to do so).

Contributions to health insurance for your employees are tax-free.

I don’t have to pay taxes for my business this year. Can I still claim my tax credit?

Yes. This tax credit may be carried back to offset income taxes owed in the previous year, or carried forward to offset liabilities incurred in the next 20 years.

If you are a tax-exempt company, the credit will be refundable.

Consult your tax advisor to get the full details on the Small Business Health Care Tax Credit.

Combining Ohio Small Business Health Insurance Plan Strategies

Combining different programs can help you maximize your health insurance coverage.

Combining a variety of healthcare packages allows employers to control costs and provide complete coverage for their employees.

As a cost-effective solution, consider combining a Direct Primary Care plan (DPC) for normal primary care and a low-cost Health Sharing Plan that covers catastrophic events.

This strategy is more affordable than the conventional group health insurance for your company or your employees.

Employees can be given more flexibility by allowing them to choose between a health sharing plan and an individual health insurance plan. They can also fund a Health Savings Account for those who select a HDHP plan that qualifies for an HSA.

What to Do Now

The best way to proceed is to conduct an employee survey and contact us in order to receive a complimentary, complimentary business health plan analysis.

You will be connected with a Persona Benefits Manager from HSA for America who will discuss with you your work force, families, budget, needs, employee contribution ability, and any preexisting health conditions that need to be taken into consideration when designing a plan.

Many of our PBMs are successful business owners or entrepreneurs themselves. They understand what it takes to attract and retain the best talent for your business.

Can I offer both health insurance and health sharing at the same?

You can offer both plans side-by-side, allowing your employees to select the plan that best suits their needs.

If too many employees opt-out of a health insurance group plan, you may fall below the minimum required participation rate to maintain a plan. You can use an HRA as a reimbursement for the employee’s individual health insurance. This will cost close to the same.

The Frequently Asked Questions for Ohio Small Business Health Insurance Plans

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What’s the difference between health sharing and traditional health insurance plans?

In the traditional insurance industry, health insurance covers medical costs. Health sharing is when members pool their money to help cover one another’s expenses.

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Health Savings Accounts – How do they help Indiana’s employees to manage their medical costs?

HSAs provide individuals with the opportunity to invest pre-tax dollars to help pay for future healthcare expenses. The contributions of both employees and employers could provide significant tax benefits as well savings on medical expenses.

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Are employer contributions toward HSAs deductible from Indiana income tax?

Yes. Indiana tax law allows for the deduction of employer contributions made to HSAs.

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What are the requirements for claiming the Small Business Health Care Tax Credit?

 Tax credit claims can be made on Form 8941 of the IRS for businesses that make a profit, while small tax-exempt businesses are required to file Form 990-T.

HSA for America doesn’t provide tax advice. To get the full details on how to claim this credit, employers are advised to consult with their tax advisor.

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What is an HRA (Health Reimbursement Arrangement) and how does it work?

An HRA is an employer-funded account that reimburses employees for qualified medical expenses not covered by their insurance plan. Employers determine what expenses are eligible and contribute funds accordingly.

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Does Indiana have a limit on the size of small business eligible to receive these programs?

Only employers with fewer than fifty employees are eligible for the Qualified Small Employee Health Reimbursement Arrangement. If you employ more than fifty employees or your business grows, you may be eligible for other HRAs. 

A requirement of the ACA is that you must provide a health plan to your employees. If not, then you will be subject to a fine. Speak to your Personal Benefits manager if you plan on hiring your 50th employee or the equivalent soon. This could have an impact on your plans.

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Do health-sharing plans have waiting periods if you already had a pre-existing condition?

Some health sharing plans do have waiting periods before they cover pre-existing medical conditions. For more details on a specific plan, it’s best to consult the guidelines of that plan or speak with your Personal Benefits Manager.


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Do employers in Indiana contribute to employee HSAs?

Yes, employers are allowed to make contributions to their employees’ HSAs, subject to annual limits set by Congress.

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Does offering a Direct Primary Care (DPC) plan along with other options for coverage make sense to small business in Indiana?

You can carry the Small Business Health Care Tax Credit backwards to offset your income tax liabilities from previous years or forwards for a maximum of 20 years.

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In Indiana, are maternity benefits included in health sharing plans?

Indiana health plans that offer health insurance and provide health sharing benefits often include maternity coverage, which includes prenatal care, labor and postnatal health care. However, certain health sharing plans have limitations on the costs-sharing benefits that are available for children born out of wedlock.

Ohio Small Business Health Insurance faq Icon

Can HRAs be used alongside other coverage options like health sharing plans or individual health insurance plans?

Yes, HRAs can be used alongside other coverage options. Some small businesses choose to cancel group health insurance altogether and use HRAs to reimburse employees’ premiums for individual policies. However, HRA money cannot be used to reimburse employees directly for health sharing plan costs.

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How can I determine which combination of health insurance and cost-sharing options is best for my small business in Indiana?

 This is not something you should do alone. Call a Benefits Coordinator You can get a free consultation and analysis based on any specific requirements, such as budgets, employee numbers, or pre-existing problems. It is possible to create a customized plan which maximizes value while minimizing costs.


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