Virginia Small Business Health Insurance Options
The Complete Virginia Small Business Health Insurance Guide (2025 Edition)
The HSA for America Guide to Virginia Small Business Health Insurance is now available. This guide is aimed at companies in Virginia with fewer than 30 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.
Virginia Small Business Health Insurance Benefits options
There are many options available to small businesses in Virginia when it comes time to provide health benefits for their employees.
The most popular, but also the most costly option is to implement the traditional group health plan.
Prices vary depending on age. However, according to from the Kaiser Family Foundation the average cost of group health insurance sponsored by an employer for a worker’s family was $21,348 in 2021.
Virginian employees contribute an average of $7,037 to their health insurance, or $860 more than the national average.
Virginia businesses have other options that can reduce costs significantly. They include:
- Health Savings Accounts (HSAs)
- Health reimbursement arrangements (HRAs)
- Direct Primary Care (DPC), 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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Virginia Small Business Health Insurance: Geographical Considerations
Virginia’s unique healthcare environment, including the busy cities of Virginia Beach, Richmond, and Roanoke as well as the more rural areas surrounding places like Fredericksburg, Rocky Mount, and other smaller towns, is also important to consider.
Virginia’s business owners must therefore carefully consider how they distribute their workforce throughout the state. Executives in Roanoke who are based at the company’s headquarters may choose to use an HMO which restricts their workers and their family to only seeing doctors in their network, but many of their employees live and work far away from this network.
Virginia Small Business Group Health Insurance
Most Virginia employers choose traditional group health insurance.
The most expensive is also the cheapest.
How it works
Employers contract with third-party insurers – typically a for profit corporation – in order to provide health insurance for employees and, if desired by the employer, their family members.
The Affordable Care Act requires that employers with at least 50 employees offer ACA-qualified insurance to employees who work over 30 hours a week. Otherwise, they will be penalized.
The health insurance policy must include the 10 minimum essential coverages required by the Affordable Care Act. The ten essential coverages (MEC) are:
- Ambulatory Patient Services (outpatient services you receive without being admitted into a hospital)
- Emergency Services.
- Hospitalization (such as surgery and overnight stay)
- Pregnancy and Newborn Care (both before and afterwards)
- Services for mental health and substance abuse disorders, including counseling and psychotherapy
- Prescription drugs
- Rehabilitative and habilitative devices and services (services to help people with disabilities or chronic conditions recover mental and physical abilities)
- Laboratory services
- Services for prevention and wellness and chronic disease management
- Children’s services including dental and vision care are covered (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 for business is expensive, but it has the advantage of guaranteed enrollment.
The insurance company can’t deny coverage or raise the premiums if the worker enrolls in the initial enrollment period, triggered by their first qualifying life event. They can also enroll during the open enrollment period, which begins on November 1st each year.
Small Businesses in Virginia Can Opt Out of Health Insurance
Employers with less than 50 employees are not required by the Affordable Care Act to provide any health insurance.
Virginia law does not have any requirements. You don’t need to provide health insurance if you have less than 50 employees.
You will not be penalized.
Even small businesses should offer health insurance because it is difficult to retain and recruit quality employees without a health plan that is competitive.
In Virginia, the unemployment rate is low and employers are keen to hire talent.
Virginia employers could save money by offering an employee health or medical cost-sharing plan. (See below for more information) You can pay all or part of the costs.
The HRA Alternative
You can also offer your employees a QSEHRA (Qualified Small Employer Health Reimbursement Arrangement) that allows them to pay for their individual health insurance tax-free.
Employers can benefit from QSEHRAs in the following ways:
You can also offer your employees a QSEHRA (Qualified Small Employer Health Reimbursement Arrangement) that allows them to pay for their individual health insurance tax-free.
Employers can benefit from QSEHRAs in the following ways:
1.) Contribution limits are not applicable
You are not required to make a minimum annual contribution, as you would be with a pension plan. You can set your budget for HRAs and adjust it each year based on your cash flow.
With a QSEHRA , you are in charge of your budget for health benefits.
2.) Flexibility
You can offer different amounts to employees depending on their marital status or family situation. 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
Contributions by employers are tax-deductible as compensation expenses. Your employees won’t pay tax on the QSEHRA benefits, unlike those paid in cash.
This is why offering a QSEHRA can be better than offering an employee a health insurance subsidy that they can use to purchase health insurance or pay for other expenses.
4.) QSEHRAs support employee choice
Many traditional group health plans limit the options available to employees who are in very different situation.
They are usually overpriced, and not suitable for workers. This is because HR and management choose them, and not the workers.
The QSEHRA gives workers and their families a much wider range of choices and allows them to choose the best health plan for themselves.
Taxation of Virginia Small Business Health Insurance
The federal law and the Virginia state laws allow you to deduct as much as possible for business expenses any health insurance premiums that you pay as an employee. The employee is not taxed on these premiums.
Overall, healthsharing plans have lower costs. The employee can also deduct their monthly costs. Employees are taxed on employer-paid health costs.
Virginia Small Business Health Insurance: Disadvantages
Employers and employees alike have some serious disadvantages to the traditional employer-group health insurance.
Health insurance can be tricky.
There’s a lot to keep track of and it’s easy to slip up and miss a deadline, or purchase the wrong plan.
But good news: with a little research and some guidance from a health insurance expert, you can usually prevent these kinds of mistakes before they happen.
A smart move is to talk about what you need and what choices you have with an HSA for America Personal Benefits Manager.
This won’t cost you anything.
And they know a lot about saving you money.
That said, as professional health insurance experts, here are some of the biggest mistakes and misconceptions about health insurance we run into all the time.
- The Cost
The government regulators in Washington, Richmond and other cities 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 of drug and alcohol abuse, mental health, and maternity, which many workers do not need or want. They are therefore much less cost-effective and efficient than they should be.
- Inflexibility
Group health insurance plans often offer a “one-size-fits all” strategy, which may not adequately address the needs and budgets of specific employees. By nature, group health insurance programs 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 plans on 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 affordable and innovative alternatives to health insurance are a great option, especially for those in good health with no pre-existing condition.
Below, we discuss health sharing plans in greater detail.
- Administrative burden
The administrative costs associated with managing a comprehensive health plan are substantial. It involves managing documentation, ensuring compliance, auditing the plans to make sure employees are not enrolling non-qualified individuals into the plan and answering questions from staff. These tasks are vital to ensure that a health insurance program within an organization is run smoothly and efficiently.
They are a burden for very small employers, who may not have enough employees to justify hiring a full-time staff to manage the plan.
Business owners can also use strategies like Health Reimbursement Arrangements or health care stipends.
Alternative approaches can encourage workers to purchase their own insurance through the Affordable Care Act. It may be possible to get subsidies if workers do this. This also removes the employer from the process, reducing administrative and overhead costs.
Health Sharing Plans in Virginia
Small businesses in Virginia can benefit from health sharing plans as an affordable and viable alternative to expensive health insurance.
Medical cost sharing plans are becoming a popular alternative to traditional group health plans for businesses in Virginia. They offer a more affordable option. Companies can save up to half on their premiums by switching from traditional group health insurance plans to medical cost sharing.
This means that Virginia small businesses can potentially save up to $10,000 per employee annually for family coverage and $3,500 for single coverage.
These programs are a new way to fund healthcare. They allow companies to provide employees with high-quality care while keeping costs down. The premise behind health sharing programs is to share resources between a group or organization.
In health sharing programs, participants pay a fixed amount per year instead of paying insurance premiums.
Health Sharing Plans vs. Health Insurance
Health insurance is not the same as health sharing plans.
Healthsharing groups are associations of people who share medical costs. Health sharing ministries, unlike health insurance companies that are typically for-profit corporations are non-profit.
Mandatory Coverages
Health insurance plans do not have such requirements. Federal and state laws require that traditional health insurance policies include coverage for many items, 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 costs of addiction treatment for those who don’t use drugs. They don’t have to pay for injuries caused by drunken driving.
Pre Existing Conditions
Healthsharing plans can impose waiting times before they share costs for treating pre-existing medical conditions.
They also often impose waiting times for surgeries, unless the injury or accident could not be anticipated prior to enrolling.
These waiting periods help eliminate a lot of adverse selection and allow health sharing organizations to provide a fantastic set of benefits for a fraction the cost of a non-subsidized ACA qualified group health insurance plan or one purchased through the Healthcare.gov exchange online in Virginia.
Note that healthsharing plans do not qualify for subsidies as part of the Affordable Care act. The price savings are so large 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 Virginia employers, since small group health plans do not qualify for a subsidy on premiums under the ACA.
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Health Sharing and Network Restriction in Virginia
Health sharing plans offer more choices when it comes time to choose healthcare providers than traditional managed care plans like HMOs or PPOs. These are the most popular group health insurance plans sponsored by employers.
Healthsharing organizations in Virginia don’t restrict their patients to providers in the network in most cases. Health sharing plan members can choose any doctor or provider they want. Choosing the doctor of your choice is a right that people should have.
Does Your Business Need To Offer Health Sharing?
Each business is unique. It takes careful analysis to choose the best plan for your business, whether you’re looking at a healthsharing plan or a more traditional group health plan.
It’s simple for Virginia business owners to receive a complete case analysis with recommendations specific to their organization and employees.
Click here and make an appointment to meet with one of our Personal Benefits Managers in Virginia.
You can help yourself by preparing a staff census.
Most of the time, switching from health insurance to a group plan will save you thousands per employee. Health sharing is not recommended if your employees have pre-existing medical conditions.
Consultation and analysis are always free
Small Businesses in Virginia Can Take Advantage of Health Reimbursement Arrangements
HRAs are tax-free benefits funded by employers that reimburse employees for their individual healthcare expenses.
Small businesses in Virginia often drop group health insurance benefits altogether. They instead establish an HRA and use it to give workers cash to purchase their own health insurance on the individual market with pre-tax dollars.
The company can also benefit from the available subsidies, reducing costs for both the employee and the employer.
After paying for the premiums, employees can use any HRA money left over to cover other costs, such as prescriptions, deductibles, copays and durable medical equipment. HRA benefits remain tax-free for the employee.
By offering an HRA instead of a formal health insurance plan for your group, you empower your employees to select the plans that meet their preferences and needs.
Click on for more information about HRAs in small businesses.
QSEHRAs: The HRA for Virginia Small Business Health Insurance
QSEHRA, or the Qualified small employer health reimbursement arrangement (pronounced “Cue Sarah”) is a type of HRA that can be used by small businesses.
This benefit is for companies that have fewer than fifty full-time workers or the equivalent and do not offer any traditional group health insurance.
Businesses can set their own QSEHRA maximum allowances within certain limits. Virginia employers will be able to contribute as much as $5,850 per employee (upwards of $487.50 per monthly) in 2023. They can also contribute up to $11,800 per family member (upwards of $983.33).
The employees use this money to buy their own health insurance through the online exchange or via a personal benefits manager on the individual and family market. The employee retains the right to a subsidy that they wouldn’t get if their employer paid for group health insurance.
You can choose to reimburse employees’ health insurance premiums only or their premiums and any additional medical costs.
Special Enrollment Periods and QSEHRAs
Your employees are eligible for a Special Registration Period when you replace your health insurance with an HRA. This 60-day period allows your employees to purchase ACA-qualified health insurance plans with guaranteed issue without having to go through medical underwriting.
It will help ensure that your employees are not left without coverage if you decide to replace your existing 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 them.
HRA money is yours until it is actually paid to employees. You can use it as working capital. It is not required to be deposited with a third party.
The HRA benefit can be designed by employers in a way that suits their needs, and includes what expenses they are willing to cover.
The workers’ health insurance is not affected if they change their status to contractors or leave the company. The QSEHRA allows the employee to control and own their insurance policy. Not the employer.
HRA Disadvantages
Some workers may not want to be responsible for researching and choosing their own health plan. Some workers might need additional help to navigate the transition.
Your HSA for America Personal Benefits manager is ready to assist you. No worker will be left behind.
To schedule an appointment, have your workers Click this Link or call 800-913-0172.
Click here for more information about alternative health insurance plans for Virginia small business.
Direct Primary Care Benefit
Direct Primary Care plans are a new alternative health care model that is gaining popularity across the nation and in Virginia.
Membership-based model. Your employees can receive as many visits they need in person or by telehealth for an affordable flat monthly fee.
DPC offers a monthly membership cost of only $80 for those who want to prioritize their health and avoid the hassles of copays and coinsurance.
DPC plans offer members unlimited access to primary, chronic, and preventive care.
Direct primary care services include the following:
Direct Primary Care physicians provide a wide range of medical services.
- Preventive Care. Doctors at DPC emphasize preventive medicine, providing services like routine checkups, vaccinations, and screenings of various conditions.
- Acute Care:DPC physicians treat acute illnesses such as colds, flus, minor injuries and skin conditions.
- Chronic disease management. DPC doctors can help manage chronic conditions such as diabetes, hypertension and asthma. They offer ongoing monitoring and treatment plan adjustments as necessary.
- Comprehensive physical examinations Doctors at DPC offer comprehensive physical examinations that assess overall health and identify risks. They also provide personalized health advice.
- Urgent Care. Doctors at DPC are usually available to provide same-day or the next-day care.
- Patients can receive immediate attention for non-emergency issues.
- Diagnostic and laboratory services. Doctors of the DPC may coordinate or offer a wide range of lab tests such as X-rays and ultrasounds, electrocardiograms and blood work.
- Management of medication. DPC doctors are able to prescribe medications, monitor the effectiveness of those medications and make necessary adjustments. Also, they provide counseling and education on the proper use of medications.
- Mental Health Services . As part of comprehensive care, many DPC practices offer mental health services. DPC doctors can provide therapy, counseling and referrals to specialists in mental health when needed.
- Minor Procedures
- Referrals and coordination of care. DPC doctors are patient advocates who coordinate care and refer patients to specialists, hospitals and other healthcare providers.
Since there is no insurance company involved in the process, you don’t have to worry about co-pays or co-insurance. Everything is covered by the monthly subscription. The monthly subscription covers everything, so cash-strapped employees can get the help they need immediately. The workers will never have to delay seeing a doctor because they cannot afford the co-pay or deductible.
Patients can select supplemental plans to cover services not covered by DPC, such as high-deductible health plans, accident insurance, or health sharing plans. DPC members can choose to cover routine care with healthsharing plans, which are much cheaper than traditional insurance.
Health Savings Accounts
Health Savings Accounts (HSAs) are powerful tools that can help employees manage their medical expenses and lower premiums for workplace health insurance.
Virginia businesses and residents need all the tax breaks they can get. Employer contributions to Health Savings Accounts for employees are fully deductible from Virginia corporate income taxes as compensation expenses.
HSAs allow individuals to set money aside before taxes in order to pay for future medical expenses. HSAs are open to both employees and employers, subject to a limit set by Congress to reflect the rising cost of living.
The money in an HSA grows tax-deferred, and withdrawals for qualified medical expenses are tax-free.
HSA Eligibility
Employees must be enrolled in a high-deductible health plan to qualify for employer contributions.
The IRS has defined a high-deductible health plan for 2023 as any plan that includes a minimum deductible 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. This limit does not apply to services provided outside of the network.
Can I combine HSAs and health sharing?
Only one major health-sharing plan, the HSA SECURE, is currently available from HSA for America.
HSA SECURE Plan combines the tax advantages and healthcare benefits of a health saving account with cost-saving advantages of healthsharing.
To be eligible for this plan, employees must have income from a small business or self-employment.
HSA SECURE does not apply to W-2 employees. HSA SECURE is a good option for employees or spouses who have a small business or freelance work.
The HSA SECURE plan is also a good option to save money for you as a small-business owner and your partners.
You would need to have your employees enroll themselves in HSA SECURE. Once they have enrolled in and set up an HSA, however, you can contribute pre-tax to their account, up to the limit Congress sets each year.
Virginia Small Business Health Insurance Taxation Rules
Here is a table that explains how these alternative strategies are 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 |
Take Care of All Levels in the Care Pyramid
As shown in the below diagram, a good employee health benefit package should cover all levels of the Employee Healthcare Pyramid, from routine preventive health care to primary care for maintenance, early detection of health issues, and catastrophic incidents.
On the left we list the common insurance-based traditional solutions that cover each level of care pyramid.
On the right we provide a list of alternatives, which are more affordable, to offer meaningful protection to employees at every level of the Pyramid.
A good plan design offers employees affordable solutions for each of these levels. No employee should be forced to delay care or forgo treatment because they cannot afford the premium, coinsurance or copay.
Your Personal Benefits manager can assist you in creating a plan that is tailored to your employees and provides solutions at every level of the Care Pyramid. This plan often costs a fraction of what a traditional group insurance plan would.
Virginia Small Business Health Insurance Tax Credit
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. This program 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.
* Employ fewer than 25 people and pay an average salary of $53,000 or lower (excluding salaries for all owners). Owners are generally not considered when calculating the average salary and number of employees for a business. The number of employees are also based on the “full-time equals” (FTEs). Two half-time employees are equal to one full-time worker.
* Pay half the premiums of employees.
* Make sure that the coverage you offer is Affordable Care Act qualified and available through the state exchange. In Virginia, this means healthcare.gov (the federal online insurance marketplace).
Once an employer has 25 workers or a wage of $53,000 or more, the tax credit is gone
How can I claim my credit?
This tax credit can be claimed on your annual tax return by attaching IRS Form 8941. Tax-exempt small business must also file a Form990-T to claim the tax credit, 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 claim the tax credit still?
Yes.
The credit is refundable if you are a business that’s exempt from taxes.
For more information on the Small Business Health Care Tax Credit, consult your tax advisor.
Combine Virginia Small Business Health Insurance Plan 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 that provides primary care at a lower price with a health-sharing plan that covers catastrophic events.
This strategy is more cost-effective for both your company and your employees.
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 To Do now?
The best way to proceed is to conduct an employee survey and Contact us and receive a complimentary, free business health plan assessment and recommendation.
Your HSA for America Personal Benefits Manager will review your family and work force with you. They will also discuss your budget, needs, employee contributions, and any existing conditions that need to be taken into consideration when creating a new plan.
Many of our PBMs are successful entrepreneurs and business owners in their own right. They understand what you need as a business leader and how to attract and retain top talent.
Can I offer both health insurance and health sharing?
You can provide both plans side-by-side, so that employees can choose the plan that best suits their needs.
If too many employees choose to opt out of the group health plan, your participation rate could drop below the minimum required for a group plan. You can use a HRA to reimburse employees for their individual health insurance. This will cost close to the same.
Virginia Small Business Health Insurance: Frequently Asked Questions
What is the difference between Health Insurance and Healthsharing for Small Businesses ?
Healthsharing is an alternative to traditional health insurance, which is offered by insurance companies. Members contribute to a pool to cover one another’s medical costs.
Can Health Savings Accounts (HSAs) help employees manage their medical costs in Virginia?
HSAs are a way for individuals to save money before taxes to pay future medical expenses. Employees and employers can both contribute to HSAs, allowing for tax benefits and savings on healthcare costs.
How can I claim the Small Business Health Care Tax Credit?
For-profit small businesses can claim the tax credit on their annual income tax returns with IRS Forms 8941, while those that are tax-exempt must file Form 990T.
HSA for America is not a tax advisor. Employers are advised to consult with their tax advisors for complete information about claiming the credit.
Is it possible for a small business to claim the Small Business Health Care Tax Credit even if there are no taxes due in Virginia?
The Small Business Health Care Tax Credit may be used to offset the income tax liability for the previous year. It can also be carried forward up to a maximum of 20 years.
What exactly is an HRA?
HRAs are employer-funded accounts that reimburse employees for medical expenses they incur but which are not covered by insurance. Employers decide what expenses qualify and then contribute money accordingly.
Does health sharing plan have waiting periods for pre-existing condition?
Some healthsharing plans do have waiting periods before they cover pre-existing medical conditions. For more information, it’s best to consult a Personal Benefits manager or review the plan guidelines.
Can employers in Virginia contribute to the HSAs of their employees?
Employers can contribute to HSAs of their employees, but only up to the annual limit set by Congress.
In Virginia, can employer contributions to HSAs be deducted when calculating state income tax?
Yes. In Virginia, employer contributions to employee HSAs can be deducted from state income taxes as compensation expenses.
Is it a good idea for Virginia small businesses to offer a Direct Primary Care plan (DPC) alongside other options?
Combining DPC and low-cost options such as health sharing plans, can provide comprehensive healthcare solutions at a cost-effective price for small businesses and employees.
Are health sharing plans covered in Virginia by maternity benefits?
In Virginia, maternity benefits, including prenatal, labor and postnatal care, are included in many health insurance plans and healthsharing plans. Some healthsharing plans restrict the cost-sharing benefits of children born outside marriage.
Can HRAs used in conjunction with other coverage options such as health sharing plans and individual health insurance plans?
HRAs are compatible with other insurance options. HRAs can be used to reimburse employees for premiums on individual policies. HRA funds cannot be used directly to reimburse employees for the costs of health sharing plans.
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