Small Business Owners: Did You Know You May Qualify for a Blue Cross PPO Group Plan?

As we’re getting closer to Open Enrollment, I want to talk about an option that many small business owners don’t realize is available.

I work with a lot of husband-and-wife businesses—LLCs, S Corps, and C Corps—where there are no additional employees. Many of these business owners don’t qualify for Marketplace tax credits, but they’re looking for something other than an HMO.

The good news? You may qualify for a small group Blue Cross Blue Shield PPO plan.

Why Consider a Small Group PPO Plan?

Many Marketplace plans are HMOs, which often require referrals and have more limited provider networks.

For some families, especially those managing ongoing medical conditions or seeing multiple specialists, having access to a PPO network provides greater flexibility.

While PPO plans generally cost more than HMOs, the additional provider access may be worth it depending on your healthcare needs.

How Pricing Works

Like most health insurance plans, pricing is based on several factors, including:

• Age of each covered member
• Plan selected
• Deductible amount
• Copays and benefit design

Generally speaking, older applicants will have higher premiums than younger applicants, and richer benefit plans typically cost more.

The good news is that there are no medical underwriting questions for these small group plans.

Will Claims Affect Future Premiums?

One important difference with group insurance is that future renewals may take claims experience into account.

While premiums are influenced by many factors, claims history can play a role in future pricing for certain small group plans.

That’s something we discuss during the review process each year.

Do You Have to Be Paid as a W-2 Employee?

This is one of the most common questions I receive.

The answer is:

Not necessarily.

Many people believe both spouses must receive W-2 wages to qualify for a husband-and-wife group plan.

That’s not always the case.

Insurance eligibility rules are different from tax rules.

While your CPA should advise you on how you’re paid for tax purposes, Blue Cross is primarily interested in your relationship to the business.

What Documentation Is Needed?

If both spouses receive W-2 wages, enrollment is usually straightforward.

We’ll typically need:

• Corporate documents
• Wage reports
• Business information

If you don’t pay yourselves through payroll, we can often use your corporate documents instead.

The important part is making sure both spouses are properly reflected in the business records.

If only one spouse appears as an owner or officer, you may need to:

• Add the other spouse as an officer or member of the business, or
• Add them as a W-2 employee

These updates can take time, so if you’re considering this option, it’s smart to review your documents now rather than waiting until Open Enrollment.

One Advantage Many Business Owners Don’t Know About

Unlike Marketplace plans, you don’t have to start your group policy on January 1.

In many cases, you can choose your own effective date.

For example, I recently enrolled a small group with an October 1 effective date.

That means every year we’ll review their renewal in late summer instead of during the busiest Open Enrollment season.

Why That’s Helpful

Choosing an off-cycle renewal offers several advantages:

• More appointment availability
• Faster processing
• Less stress during the holidays
• Quicker turnaround from the insurance carrier
• More time to review your options carefully

Instead of competing with thousands of Marketplace enrollments during November and December, we can focus entirely on your business’s renewal.

Is This a Good Fit for You?

A husband-and-wife small group PPO plan may be worth considering if you:

• Own an LLC, S Corp, or C Corp
• Don’t qualify for Marketplace tax credits
• Want access to a PPO network
• Prefer more provider flexibility
• Are looking for alternatives to Marketplace coverage

Every situation is different, so the best approach is to review your business structure, healthcare needs, and budget together.

If you’d like to see whether a Blue Cross small group PPO plan makes sense for your family, schedule an appointment and we’ll walk through your options.