West Virginia Small Business Health Insurance Options

The Complete West Virginia Small Business Health Insurance Guide (2024 Edition)

Welcome to HSA for America’s Complete West Virginia Small Business Health Insurance guide. This guide is aimed at companies in West 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.

Small Businesses in West Virginia Have a Wide Range of Health Benefits Options

There are many options available to small businesses in West 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 or family in 2021 will be $21,348, which is $3 higher than the average.

West Virginian employees contribute an average of $6,813, or $640 more than the national average, towards their health insurance.

West Virginia companies also have other options that can reduce costs. They include:

Health Savings accounts (HSAs)
Health reimbursement plans (HRAs)
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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West Virginia Small Businesses: Geographical Considerations

West Virginia has a unique healthcare environment that includes not only the busy cities of Morgantown, Charleston, and Huntington but also more rural areas like Ravenswood and Petersburg.
West Virginia employers should consider carefully how they distribute their workforce throughout the state. Executives in Morgantown who are responsible for company headquarters may choose an HMO which restricts employees and their families from seeing doctors outside the network. However, many of their employees live and work in Fairmont and are far away from this plan’s provider network.

West Virginia Small Business Group Health Insurance

Most West Virginia employers choose traditional group health insurance.

The most expensive is also the cheapest.

How It Work?

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 a health insurance plan approved by the ACA to employees who work over 30 hours per 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 maternity care, as well as newborn care (both prior to and after delivery)
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, which is when the employee first qualifies for coverage.

Small businesses in West 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.

West 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.

West Virginia is a good example, as unemployment rates are low and employers compete fiercely for the best talent.

West 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:

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.

You can control your budget for health care benefits with a QSEHRA.

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 a wide range of situations.

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 employer-provided health coverage in West Virginia

The federal law and West Virginia’s state law allow you to deduct the premiums for health insurance 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.

West Virginia Employer Group Health Coverage: Disadvantages

Employers and employees alike have some serious disadvantages to the traditional employer-group health insurance.

Cost
The government regulators in Washington, Charleston and other states 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.Health sharing plans are discussed in more detail below.

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

Administrative costs are high when managing a comprehensive health plan. It involves managing documents and 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 the organization’s health insurance program runs smoothly.

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 West Virginia

Small businesses in West Virginia can benefit from health sharing plans as an affordable and viable alternative to expensive health insurance.

West Virginia businesses are using medical cost-sharing plans to replace traditional group health plans. These plans offer a more affordable alternative. Companies can save up to half on their premiums by switching from traditional group health insurance plans to medical cost sharing.

This means that West Virginia small business could 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 do not want or need. 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.

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 West Virginia online exchange.

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.

West Virginia employers are often more inclined to switch to health sharing because 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 West 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 West Virginia don’t restrict patients to providers in their 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.

Is Health Sharing Right for Your Business?

HRAs are tax-free benefits funded by employers that reimburse employees for their individual healthcare expenses.

West Virginia’s small businesses often drop group health insurance benefits altogether. They instead establish a HRA and provide the money to their employees to purchase individual health insurance on the 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 here for more information about HRAs in small businesses.

QSEHRAs – The HRA for Small Businesses

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 maximums within certain limits. West Virginia employers will be able to contribute up to $5.850 per employee (upto $487.50 monthly) as of 2023. They can also contribute upto $11,800 per family.

The employees use this money to buy their own health insurance through the online exchange or 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.

QSEHRAs and Special Enrollment Periods

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 their own ACA qualified insurance plan without having to go through medical underwriting.

It will help ensure that your employees are not left without coverage when you 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 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 contractor 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 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 options for West Virginia’s small businesses.

The Direct Primary Care Advantage

Direct Primary Care plans are a new alternative health care model gaining popularity in West Virginia as well as across the nation.
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 prioritise their health and avoid the copays or 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. DPC doctors focus on preventive medicine, offering services like routine checkups, vaccinations and screenings.
Acute care: DPC doctors provide acute care for minor injuries and illnesses such as colds, flu and infections.
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.
Urgent care. DPC doctors can often provide same-day or the next-day emergency care. Patients can receive immediate attention for non-emergency issues.
Comprehensive physical exams.DPC doctors provide comprehensive physical exams to assess overall health and identify potential risks. They also offer personalized health recommendations.
Diagnostic and laboratory services. DPC doctors can offer or coordinate laboratory tests such as bloodwork, urine analysis and imaging studies (X rays, ultra-sounds) and electrocardiograms
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. 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.

To cover services beyond what DPC offers, patients can choose supplemental plans such as high deductible health plans, health sharing plans, or accident insurance. Since routine care is already included in the DPC membership, patients can opt for much more cost-effective coverage options, such as healthsharing rather than traditional health 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.

West Virginia businesses and residents need all the tax breaks they can get. Employer contributions to Health Savings Accounts for employees are fully deductible from West 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 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 with 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.

Click here to learn more about HSA SECURE.

Taxation of West Virginia Small Business Health Insurance Benefits?

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

Edit
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

West Virginia Small Business Health Insurance Care Pyramid

Employee health benefits packages should include all the levels of the Employee Healthcare Pyramid. This includes routine preventive care and primary care access to maintain health, detect health problems early, and deal with catastrophic incidents.

Care Pyramid for West Virginia Small Business Health Insurance

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’ needs. This plan will provide solutions at every level of the Care Pyramid, and often for a fraction the cost of traditional group plans.

The West Virginia 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.

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 West 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 do I claim the 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 do not owe any 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 Small Business Health Plan Strategies

When it comes to maximising 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?

Contact Us and we will provide you with a complementary, complimentary business health plan and analysis.
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 business owners. They are business owners themselves and know what you’re going through. They also understand how to find and keep the best talent for your company.

Can I provide both Health Insurance and Health Sharing at the same?

You can present both plans, and let employees choose the one that suits them best.

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 your employees for the cost of individual health insurance.

West Virginia Small Business Health Insurance Plans: FAQs

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..

What are the benefits of Health Savings Accounts for West Virginia employees?

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.

In West Virginia, can employer contributions to HSAs be deducted when calculating state income tax?

Yes. In West Virginia, employer contributions to employee HSAs can be deducted from state income taxes as compensation expenses

How can I claim the Small Business Health Care Tax Credit (SBHCTC)?

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 credi

What is a Health Reimbursement Agreement (HRA) and how does this work?

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.

What is the best combination of health insurance options and cost-sharing for a small business in West Virginia to choose?

Do not go it alone. Contact an Employee Benefits Manager to conduct a free assessment and make recommendations based on the specific needs of your company, your budget, employee count, and any existing conditions. They can design a plan that maximizes value for employees, while controlling costs and ensuring you remain competitive.

Do health sharing plans have waiting periods for pre-existing diseases?

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.

Employers in West Virginia can 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.

Is it a good idea for West 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.

Can a small business claim the Small Business Health Care Tax Credit even if it does not owe any taxes to West 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 20-years.

Do health sharing plans cover maternity benefits in West Virginia?

In West 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.

What is the maximum size of a small business eligible for this program in West Virginia?

Only employers with fewer than fifty employees are eligible for the Qualified Small Employee Health Reimbursement Arrangement. If you have over 50 employees or if your company expands to more than 50 people, you can choose from other HRAs.

You’ll also be required by the ACA to offer a qualified health plan to your employees or pay a fine. Speak to your Personal Benefits manager if you plan on hiring your 50th full time worker in the near term. This could have an impact on your plan.

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