South Dakota Small Business Health Insurance Options
The Complete South Dakota Small Business Health Insurance Guide (2024 Edition)
The HSA for America South Dakota small business health insurance guide is here. It is aimed at companies in South Dakota with 30 or less employees.
This document was created to assist small business owners and freelancers in providing the most cost-effective employee health benefits. You can still be competitive while offering the compensation and benefits you need to keep the best talent on your team.
South Dakota Small Business Health Insurance Benefits Options
South Dakota small businesses have many options for providing health insurance to their employees.
The most popular, but also the most costly option is to implement the traditional group health plan.
The cost of group health insurance sponsored by employers for a worker or family varies depending on age. According to from the Kaiser Family Foundation the average annual cost in 2021 will be $20,922.
South Dakotans typically pay more than $6 699, or $525, above average, towards their health insurance.
There’s several other options that can reduce costs for South Dakota companies:
- Health Savings Accounts (HSAs)
- Health reimbursement arrangements
- Direct primary care memberships
- Health sharing programs
Your small business’s best strategy 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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South Dakota Small Business Health Insurance Geographic Location
South Dakota has a unique healthcare system that includes not only the busy urban areas like Rapid City and Sioux Falls but also more rural places around Aberdeen and Spearfish.
South Dakota’s business owners must therefore carefully consider how they distribute their workforce throughout the state. Executives in Sioux Falls who are based at the company’s headquarters may choose to use an HMO which restricts their workers to only seeing doctors in their network, but many of their employees live in Lennox and have jobs there.
South Dakota Small Business Group Health Insurance
The most popular choice of group health insurance for South Dakota employers is traditional group health coverage.
This is the most expensive.
This is how it works
A third-party provider of insurance, usually a profit-making corporation, is contracted by an employer to provide benefits for its employees. If the employer so desires, they can also include their families.
All employers who have 50 or more workers must provide ACA-qualified insurance to their employees who work for more than 30 hour per week or face a fine.
The insurance plan must provide the ten essential minimum coverages (MECs) that are required by the Affordable Care Act. These are:
- Ambulatory services are outpatient medical care that you can receive without having to be admitted to hospital.
- Emergency Services
- Hospitalization (such a surgery or overnight stay
- Pregnancy care, maternity care, and newborn .
- Services related to mental health, substance abuse disorder and behavioral health (including counseling and psychotherapy).
- Prescription drugs
- Rehabilitative Services and Devices (Services and Devices that help people with disabilities and chronic conditions to regain mental and physical skills)
- Laboratory services
- Chronic disease management and prevention services
- Adult dental and eye care is not covered as an essential health benefit.
The ACA requires that insurance policies cover contraception and breastfeeding.
The traditional health insurance option is the most expensive for companies, but has the advantage that it guarantees enrollment.
In the event that the employee enrolls before the end of the initial enrollment phase, during a period of special enrollment due to a qualifying life-event, or at the beginning of the open enrollment season, starting November 1st, the insurer cannot deny them coverage or charge a premium higher because of the medical history.
Small Businesses in South Dakota Can Choose Not to Offer Health Insurance
The Affordable Care Act does not require employers with fewer that 50 workers to offer any form of health insurance.
South Dakota’s state law also does not require health insurance. If you employ fewer than fifty people, you are not required to provide any health insurance.
You won’t have to pay any penalties.
It’s important for all employers to offer competitive health benefits, even small ones. This is because it can be difficult to attract and retain good employees without them.
South Dakota has a low unemployment rate and fierce competition among employers for talented employees.
South Dakota employers could save a great deal of money if they offer a medical cost-sharing or health-sharing plan. (See below for more information) They can pay all or part of the employee’s costs.
The HRA Alternative
You can also help your employees to pay their own health insurance, tax-free, by offering a QSEHRA.
QSEHRAs offer the following benefits to employers:
1.) No contribution minimum
QSEHRAs don’t require a minimum amount of contributions every year like pension plans. As an employer, it is up to you to decide how much money will be allocated for HRA benefits. This budget can change each year depending on your cash flow.
A QSEHRA allows you to control the budget of your health insurance.
2.) Flexibility
You can offer a different amount to employees based on the marital or familial status. If you want to discriminate, then give a larger benefit to employees that have dependents or are married than to those who are single and without children. This reflects the actual cost of health insurance.
3.) Employers and employees both enjoy tax-free treatment
Your employer contributions can be deducted as a compensation expense. However, unlike cash compensation your employees will not pay any tax on their QSEHRA benefit – provided that they maintain a health plan which includes the 10 essential coverages as specified by the Affordable Care Act.
It is for this reason that a QSEHRA will be more beneficial than simply providing a health care stipend to employees, which they can use towards health insurance and other expenses.
4.) QSEHRAs Support Employee’s Choice
There are too many traditional group insurance plans that force employees with vastly different situations to choose between just one or two options for health insurance.
The HR department and the company management select these items, which are often expensive and unsuitable to workers.
A QSEHRA offers workers and their family members a wide range of options and gives them the power to select a health plan that is right for them.
South Dakota Taxes Employer-Sponsored Health Insurance
Under federal and South Dakota law, the premiums for health insurance you pay are fully deductible as business expenses. These premiums are not taxable for the employee.
The overall cost of healthsharing plans is lower. Employees can deduct the monthly cost of these plans from their taxes. Employer assistance in paying for health sharing costs is taxable.
South Dakota Small Business Health Insurance: Disadvantages
The traditional group health insurance for employers has many disadvantages, both to them and their employees.
- Cost
As we mentioned above, the cost of health insurance is often crippling.
For example, traditional insurance carriers must include mental health benefits, drug and alcohol addictions, and maternity coverage that many workers are not interested in.
The result is that they are much less effective and cost-effective than necessary.
- Inflexibility
Many group health insurance programs are a one size fits all strategy. This may not be able to adequately meet the budget and needs of each employee. Group health insurance plans sponsored by employers are usually limited to one or a few options, which may not suit the needs of specific employees.
Some workers may find it more cost-effective to purchase their own health insurance plan through the individual market. They could also benefit from subsidies under the Affordable Care Act.
A less expensive health-sharing plan may be a better option for them. These innovative, affordable alternatives to insurance can be an excellent solution for employees who are healthy and have no pre-existing medical conditions
The following sections will discuss in detail health sharing plans.
- Administrative burden
.Managing an entire health benefit comes with substantial administrative costs. Managing documentation and compliance is part of this. Auditing plans ensures that employees do not enroll ineligible people and answering staff questions are also included. These duties are crucial to the smooth and effective operation of a health insurance plan within an organization.
However, they are a significant burden for small employers that don’t have enough staff to operate the plan.
Business owners may also choose to use other strategies, such as Health Care Stipends and Health Reimbursement Arrangements.
The Affordable Care Act offers alternative ways to encourage workers. The workers may benefit from the available subsidies. The employer is also removed from the entire process, which reduces overhead and administrative expenses.
South Dakota Health Sharing Plans
South Dakota’s small businesses can find health sharing plans to be a cost-effective and affordable alternative to the expensive health insurance.
South Dakota companies are increasingly using medical cost sharing as an alternative to group health insurance. Switching from health insurance to health-sharing can often save companies up to 50% in premiums when compared with their traditional group health plan.
South Dakota’s small businesses can save more than $10,000 a year per employee on family coverage. They could also save $3,500 a year per employee on single coverage.
These programs represent a cutting edge method of funding healthcare. They enable companies to offer employees high-quality healthcare and control costs. These programs share resources amongst a number of people or organisations.
Health sharing programs allow participants to pay a set amount of money each year as opposed to paying insurance premiums.
Health Sharing Plans vs. Health Insurance
Health insurance and health sharing plans are different.
Instead, healthsharing associations are voluntary associations that bring together like-minded individuals to share medical expenses. Contrary to health insurers, which are often for-profit companies, health sharing ministry is a non-profit organization.
Mandatory Coverage
Health insurance plans don’t have the same requirements. While federal and states laws require traditional insurance policies to cover many things people do not want or need, they don’t. Health sharing organizations don’t have to meet the requirements for minimum essential coverage.
It is not necessary for medical cost-sharing to cover addiction treatment costs for people that never use drugs. Also, they do not need to cover any injuries that are caused by the drunk driving of members.
Pre-existing conditions
Unlike traditional insurance plans, some healthsharing plans impose waiting period before they’ll share costs to treat pre-existing health conditions.
The waiting period for surgeries is often longer, unless the accident or injury was not anticipated at the time of enrollment.
These waiting times eliminate a significant amount of adverse choice, and they help health-sharing organizations offer a set of great benefits at a fractional cost of a policy purchased on the Healthcare.gov South Dakota exchange or an unsubsidized ACA group health insurance.
Note: Under the Affordable Care Act, healthsharing plans do NOT qualify for subsidies. Even if they are eligible for a government subsidy, switching to a healthsharing plan can be a great deal cheaper.
South Dakota employers may find that switching to a health sharing plan makes more sense because small group plans are not eligible for a premium credit under the ACA.
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South Dakota Health Sharing and Network Restrictions
Health sharing plans can offer greater choice in healthcare providers compared to traditional managed-care plans like HMOs and POS, which are by the far most common group health plans offered by employers.
Healthsharing organizations South Dakota in general do not restrict patients in South Dakota to network providers. Health sharing plan participants can pick their own doctor. Giving people the choice of doctors
Is health-sharing right for you?
Each business has its own unique characteristics. Choosing the right plan requires careful consideration, regardless of whether it is a healthsharing program or a traditional health insurance group plan.
To begin the process, simply click on this in order to book an appointment with our experienced Personal Benefits Management licensed in South Dakota.
If you’ve prepared a census of your employees, it will be useful.
In many cases, switching employees to health coverage will result in savings of thousands of dollars. If you have employees who already have health conditions, it may not make sense to share the cost of their coverage.
Consultations and analyses are always provided free of charge.
South Dakota Small Businesses can take advantage of Health Reimbursement Arrangements
Health Reimbursement Arrangements, or HRAs, are benefits provided by employers to reimburse employees tax-free for healthcare expenses.
Many South Dakota small business owners simply do away with the group health benefit. Instead, they create an HRA. The HRA is used to give workers cash to buy individual health insurance with pretax dollars.
It allows employees to benefit from available subsidies and reduces the cost of the employee as well as the employer.
Workers can use their HRA benefits to cover out-of pocket costs like prescriptions, copays, durable medical equipment, and deductibles. HRA benefits, once again, are tax-free.
Your employees can choose their own health insurance plans with an HRA, instead of having to sign up for a formal group insurance plan.
Read more about Health Reimbursement Accounts (HRAs) for Small Businesses.
QSEHRAs is the HRA for Small Businesses
QSEHRA is a specific type of HRA for small businesses.
This benefit is available to companies with less than 50 full-time or equivalent employees, who do not have any group health plan.
Businesses are allowed to set their QSEHRA allowances maximums. However, there are certain limitations. South Dakota employers may contribute up to $5.850 for an individual employee (up to $487.50 monthly) and up $11,800 for a family of employees.
Employees can use the money to buy insurance on their own via an online health insurance exchange website or via a personal benefits manager, in the market for individual and family health coverage. It preserves their eligibility to receive a subsidy. They would not have received one under a group insurance plan that was paid for by the employer.
Employers can reimburse their employees either for the premiums alone or for both premiums and additional medical expenses.
QSEHRAs & Special Enrollment Periods
If you decide to replace your existing health insurance plan with an HRA and cancel the old one, then your employees qualify for Special Enrollment. This is a window of 60 days during which employees can buy their own ACA-qualified health insurance plan, with guaranteed issue rights and without medical underwriting.
This will ensure that your employees’ coverage is not interrupted when you switch from a group health insurance plan to a QSEHRA.
HRA Advantages
Health Reimbursement Arrangements have many benefits.
You can deduct the money spent on HRA benefits, and your employees will not pay any tax.
HRA funds are yours to keep until they’re actually paid out. It is available as operating capital. It’s not necessary to have it deposited.
You have great flexibility when it comes to designing your own HRA benefits. This includes the expenses that you will reimburse.
If workers leave their company or become contractors, they do not lose their health insurance coverage. In the QSEHRA, workers own and control their own insurance policies. Not the employee.
HRA Disadvantages
Not all workers are willing to take on the task of researching and selecting their own insurance plan. Some workers will need additional help navigating through the transition.
You can get help from your HSA for America personal benefits manager if this happens. So that no worker is left out.
You can also call 800-913-0172 to schedule an appointment.
Click Here to Learn More About Alternatives to Employer-sponsored Health Insurance for South Dakota Small Businesses
Direct Primary Health Care Benefit
Direct Primary Care plans, or DPCs, are an alternative healthcare system that has gained popularity in South Dakota as well as across the United States.
This is a membership model. In exchange for a monthly flat fee that’s affordable, just like a gym, your employees get as many visits as needed, in person or through telehealth.
DPC’s monthly membership fees start at just $80 and are a viable option for people to prioritize their health, without having to pay copays or insurance co-payments.
DPC Plans provide unlimited access to routine primary care, chronic and preventive services.
Some of the services that are commonly provided by direct primary health care practices include
Direct Primary care doctors provide a wide range of medical services.
- Preventive care. DPC doctors are committed to preventive medicine. They offer services such as routine checks, immunizations and screenings.
- DPC doctors offer acute care to patients with minor injuries, minor illnesses, infections and colds
- Chronic disease management. DPC doctors assist patients in managing chronic conditions, such as diabetes and hypertension. They also help with asthma, arthritis, and other diseases. They provide ongoing treatment, monitoring, and any necessary adjustments to the treatment plan.
- Comprehensive physical exams. DPC doctors perform thorough physical exams to evaluate overall health, identify risks and offer personalized recommendations.
- Urgent care. DPC doctors often offer same-day and next-day urgent treatment.
Appointments allow patients to receive prompt medical attention for issues that are not emergencies.
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Diagnostic and Laboratory Services DPC doctors offer or coordinate various laboratory tests including blood work, urine analyses, imaging studies such as X-rays and ultrasounds, and electrocardiograms.
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Medication management. DPC doctors prescribe medications. They can monitor their effectiveness and make adjustments if necessary. The doctors also offer education and counseling regarding medication use.
- Mental health services Mental health services are often included in DPC practice’s comprehensive care. DPC doctors provide counseling, therapy and referrals when needed to mental health specialists.
- Minor procedures. DPCs are equipped to carry out minor surgeries in their own offices.
- Care coordination and referrals. DPC doctors serve as patient advocates, coordinating care with hospitals, specialists and other healthcare professionals when necessary.
There are no copays, coinsurance or deductibles because there’s not an insurance company involved. Monthly subscriptions cover everything. It allows cash-strapped people to get the immediate care they require. Patients no longer need to postpone their doctor’s appointments because they are unable to pay the co-pays or deductibles.
In order to cover additional services, patients may choose from supplementary plans like high-deductible health plans or accident insurance. DPC’s membership already includes routine care, so patients can choose more cost-effective options such as healthsharing instead of traditional health insurance.
Health Savings Accounts
HSAs are great tools for helping workers to manage their medical bills and also to lower the premiums of workplace health insurance plans.
South Dakota businesses and residents are desperate for any tax break. The good news: employer contributions to employee Health Savings Accounts can be fully deducted from South Dakota Corporate Income Tax as a compensation expense.
HSAs enable individuals to put money aside for future medical needs before they pay taxes. HSAs allow both employees and their employers to contribute, up to a certain annual limit. This is updated by Congress each year to keep up to date with the cost-of-living.
HSAs allow for tax-deferred investment growth and withdrawals that are used to pay qualified healthcare costs.
HSA Eligibility
Employees can contribute to their HSA and receive pretax employer contributions if they enroll in an High Deductible Health Plan (HDHP).
In 2023, an IRS-defined high deductible plan is any plan that has a deductible greater than $1,500, for an individual plan, or $3,000, for a plan for a whole family.
A HDHP can only have a maximum of $7,500 in annual out-ofpocket expenses. This includes deductibles, copayments and cotinsurance. This limitation does not apply for services rendered outside of network. ).
Can I Combine HSAs and Health Sharing?
There is only one major health plan that allows employees to contribute pre-tax money into their health savings accounts: the HSA Secure Plan. It’s available through HSA America.
HSA SECURE Plan allows you to combine the tax-savings and healthcare advantages that come with a Health Savings Account (HSA) with the cost savings benefits of healthsharing.
In order to be eligible, however, your employees must be self-employed or own a small company.
HSA SECURE cannot be used by employees who are W-2. HSA SECURE could be an excellent option if you or your employee have a side business, freelance or other work and are in good physical health.
As a small business, you may find that the HSA-SECURE Plan is a fantastic way to save money.
Your employees must enroll in HSA SECURE by themselves. If they’ve already enrolled and created an HSA you can make contributions pre-tax on their behalf up to the annual limits Congress establishes every year.
HSA SECURE is available by clicking on the link below.
How Do South Dakota Small Business Health Insurance Benefits Get Taxed ?
You now know about the different strategies that small businesses can use to supplement traditional health insurance. Here’s a quick table that shows how each benefit is taxed.
| Plan Type | Employer | Workers |
|---|---|---|
| Traditional health insurance premiums | Tax deductible. May qualify for a tax credit (see below) | Non-taxable |
| HSA contributions | Tax deductible | Pre-tax, up to certain limits. No income limitations. |
| Health sharing costs | Tax deductible as a compensation expense | Taxable as ordinary W-2 income |
| Health reimbursement arrangements | Tax deductible | Benefits are non-taxable to the employee |
| HSA withdrawals | N/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 expense | Taxable to the employee |
All levels of the care pyramid Should be Addressed
Employee Health Benefits should be designed to cover the entire Employee Healthcare Pyramid. From routine preventive healthcare, primary care access, early detection and maintenance of health problems through to catastrophic incidents.
On the left you can find common solutions based on traditional insurance that are aimed at each level of care pyramid.
On the right side, we offer a few alternative and more affordable ways to protect employees at each level.
Plan design that is good will provide employees with solutions that are affordable at each level. So no employee has to delay or avoid care because of an inability to pay a premium.
Your Personal benefits manager can help create a custom-designed plan for you and your team that will address each of the levels of the Care Pyramid. Often, this plan is a fraction as expensive as a standard group plan.
South Dakota Small Business Health Insurance Tax Credit
Small Business Health Care Tax Credit enacted along with ACA allows for some small businesses claim a federal income tax credit of 50% or more of the employee health care costs.
It’s designed for small companies with fewer than 25 workers who hire employees at lower salaries.
For-profit and not-for-profit businesses alike can claim credit for the following:
* Have less than 25 employees, and an average salary that is around $53,000. (excluding the salaries for owners). In general, owners’ salaries are not taken into account when determining how many employees the business has. The number employed is based also on “fulltime equivalents”(FTEs). The two half-time staff would be equivalent to one full-time employees
* Pay at the least half of all premiums to employees.
* Offer coverage eligible under the Affordable Health Care Act on the state exchange.
The tax credits are eliminated after 25 employees and/or a median wage of about $53,000.
How Can I Claim a Credit?
You can claim this credit by attaching IRS Forms 8941 to your annual income tax returns. (Tax exempt small businesses will need to file a tax return Form 990T, even though they are not otherwise required to).
The contribution you make towards their health coverage is not subject to tax.
My business has not paid taxes for this year. Can I claim my tax credits?
Yes. This tax credit may be carried back in order to offset any income tax liability that was incurred during the previous tax year, or it can be carried forward and offset any liability that is incurred within the next 20 tax years.
If you are an exempted business, then the credit will be refundable.
Consult your tax adviser for complete information about the Small Business Health Care Tax Credit.
Combine South Dakota Small Business Health Insurance Strategies
When it comes to maximizing your health insurance coverage, combining different programs is a wise move.
Combining a variety of healthcare packages allows employers to reduce healthcare costs and provide complete coverage for their employees.
As a cost-effective option, consider combining Direct Primary Care (DPC), a plan for primary care that is low-cost and covers all catastrophic events with a health-sharing plan.
This strategy is more cost-effective for both your employees and your company.
Employees can be given more options and lower costs by allowing them to choose between a health-sharing plan or an individual health plan. They can also fund their Health Savings Accounts (HSAs) if they select a HDHP plan that qualifies for an HSA.
What Should You Do Now?
The best way to proceed is to conduct an employee survey and call us and receive a complimentary business health plan evaluation and recommendation.
You will be connected to an experienced HSA for America persona benefits manager who will discuss with you your workforce and families, your budget needs, the ability of your employees to contribute and any pre-existing conditions.
Many of the PBMs we work with are also successful entrepreneurs. They are business owners themselves and know what it takes for you to be competitive.
Can I provide both Health Insurance and Health Sharing at the same?
Yes, both options can be offered side-by side. This allows employees to select the best plan for their needs.
You may not be able to maintain your group plan if you have too few employees participating in the plan. HRAs can be used to reimburse employees for their individual health insurance. The cost will be similar.
South Dakota Small Business Health Insurance Frequently Asked Questions
What is the Difference Between Health Insurance and Shared Cost Health Insurance for Small Businesses
Healthsharing involves members contributing money to a fund to cover medical expenses.
What can Health Savings Accounts (HSAs) do to help employees in South Dakota manage their medical expenses?
HSAs enable individuals to set money aside before tax to save for future medical bills. Employers and employees both can contribute, which provides tax advantages and possible savings on healthcare expenses.
Can South Dakota employers deduct contributions to HSAs from their state income taxes?
Yes. South Dakota allows employers to deduct their contributions for employee HSAs as compensation from the state’s income tax.
In South Dakota, are maternity benefits covered under health sharing plans?
South Dakota health insurance policies, healthsharing plans, and labor and delivery benefits often include maternity care. This includes prenatal, postnatal, and labor care. Some health sharing plans may restrict cost-sharing for children born out of wedlock.
Can a South Dakota-based business claim the Small Business Health Care Tax Credit, even if there are no taxes due?
Even if the business does not owe any taxes for a given year, it can still carry back the Small Business Health Care Tax Credit to offset tax liabilities from the prior year.
What is a Health Reimbursement Agreement (HRA) and how does this work?
HRAs reimburse employees’ qualified medical costs not covered by their health insurance. Employers determine which expenses are eligible for reimbursement and allocate funds accordingly.
What are the options for health insurance and cost sharing that I can choose from in South Dakota as a small-business owner?
Don’t do it alone. Speak to a Personal Benefits manager. They can provide a free analysis based upon your needs, budget and employee count. They can help you design an optimal plan to maximize the value of your employees’ benefits while controlling costs, and helping you stay competitive.
What are the waiting periods on pre-existing conditions for health sharing plans?
Yes, there may be a waiting period for certain healthsharing plans before coverage is provided. You should review the guidelines of your plan or speak to a Personal benefits manager for more details.
Can employers in South Dakota contribute to employees’ HSAs?
Employers are permitted to contribute to HSAs for their employees. However, there are annual limits set forth by Congress.
Do small businesses in South Dakota make sense to offer Direct Primary Care plans alongside other coverage options?
Combining DPC coverage with low-cost plans like health sharing can provide cost-effective and comprehensive healthcare solutions for small business and their employees.
How do I claim my 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 businesses who are not tax exempt need to file a Form990-T.
HSA for America doesn’t provide tax advice. Employers can consult their tax advisor to get the full details on how to claim the credit.
Can HRAs used in conjunction with other insurance options such as individual health plans or health sharing plans?
HRAs may be used in conjunction with other options of coverage. HRAs are used by some small businesses to reimburse employees premiums for individual policies and cancel their group health insurance. HRA money can’t be used to reimburse an employee directly for costs associated with a health sharing plan.
Does South Dakota have a limit on the size of the small businesses that can apply for these programs?
QSEHRA is only for employers with fewer 50 employees. There are also other HRAs that you can use if your company has more than fifty employees.
You must also comply with the ACA’s requirement that you provide a qualified plan of health insurance for your employees or face a penalty. Talk to your Personal Benefits Coordinator if you’re about to hire 50 full-time workers or the equivalent, as this could impact your plan design.
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