A practice is harder to insure than its headcount suggests.
One small practice can hold several employment situations at once, and each one changes eligibility, contribution and enrollment.
- Owners, associate providers and contracted clinicians who may not share one eligibility answer
- Per-diem and part-time staff whose hours rise and fall with the schedule
- Pay that runs from front-desk wages to provider compensation
- Staff who want to be seen at your own practice or the hospital you refer to
Two of these come before any quote. First, employment status: a salaried dentist, a per-diem hygienist and a contracted surgeon can each get a different answer, based on the real working relationship and the plan's terms, not the job title. Second, network fit: a hospital system that takes a carrier's cards isn't automatically in every network that carrier sells, and your own clinic can be listed in one plan's directory and missing from the next.
Illustrative: a 24-person family medicine clinic with two locations, three per-diem nurses and a locum physician on contract. Before quoting, we would sort the nurses by hours, have the clinic's advisers confirm the locum's status, look up both locations in every plan's directory, and model a contribution that keeps employee-only coverage within reach for the front desk.
Four levers we pull for practices.
Check the network against your own clinic first.
Then the hospitals, specialists and pharmacies your team uses.
If staff want to be treated by their own colleagues, the plan has to include your practice, and that can differ plan by plan within one carrier. We run the provider check across the carriers we quote, Premera Blue Cross, Regence BlueShield, Asuris Northwest Health, Kaiser Permanente and UnitedHealthcare, and our network and prescription audit shows the method.
Set contributions by class, in dollars.
Pay inside a practice spans a wide range.
A flat percentage of premium can feel light to a provider and heavy to a receptionist. Within the carrier's contribution requirement, model a fixed-dollar amount toward employee-only coverage, a separate decision for dependents and, with two plans, the same dollars toward either. Our one plan or two guide shows the arithmetic.
Protect clinician income, not just health.
A provider's earnings depend on being able to do the work.
For dentists, physicians and hygienists, compare how each disability policy defines their occupation, which earnings it covers, the monthly cap and the exclusions. Office roles may need less; see group life and disability. Accident, critical illness and hospital coverage can sit on top as voluntary benefits, employee-paid through payroll deduction and designed to supplement medical coverage.
Measure per-diem hours with a written method.
Hours, not titles, decide who is full-time.
Under the ACA, full-time means 130 hours of service a month, about 30 a week. If the practice is an applicable large employer, counting commonly owned practices together, new per-diem and variable-hour staff can be measured over an initial 3 to 12 months. Anyone averaging 30 or more hours is then full-time for a stability period of at least six months and no shorter than the measurement period, after an administrative period of up to 90 days. Have payroll or your ACA adviser confirm the method.
Plan the renewal around the appointment book.
90 days out: block the time.
Reserve a staff meeting or blocked lunch for enrollment before appointments fill those hours.
75 days out: census and provider list.
Send roles, hours pattern and home ZIP codes for everyone, plus the clinics, hospitals and specialists staff rely on, through our employee census page.
60 days out: compare with network results in hand.
Premiums, your contribution by class and the provider check go on one page. A plan that drops your own clinic isn't a real option, whatever it costs.
30 to 45 days out: enroll between patients.
One short group session, then individual calls or video for other locations and per-diem staff, with personal health questions kept private. We're in person around Puget Sound and on phone and video statewide.
All year: hires, hours and exits.
We train your office manager to add new hires and terminations in Employee Navigator, and we make the carrier changes. COBRA notices run through a third-party administrator we coordinate, which may charge vendor fees.
What to send, and what to settle first.
What we need from you.
A census with each person's role, hours pattern, home ZIP code and coverage tier. Your current plan summary and renewal, if you have them. Each location's address as it appears in carrier directories.
What your advisers should settle.
Which clinicians are employees and which are contractors. Whether commonly owned practices count as one employer. How any owner's premiums are taxed. Your attorney, CPA or payroll provider makes these calls; we handle the benefits side.
What owners and practice managers ask us.
We own two practices under separate entities. Are they one group?
They may be. Companies under common ownership are combined for the ACA large-employer test, and Washington treats affiliated companies as one employer for small-group purposes. Two practices with 30 full-time employees each could form one applicable large employer. Have your attorney or CPA confirm the ownership analysis, then run the count in our FTE calculator.
Is group dental worth buying when we are a dental office?
It's a design choice, not a rule. Compare the plan with the care you already give staff, and check whether your office is in its network. If staff are mostly seen in-house, the plan may matter more to spouses and children who see other dentists. Our group dental page covers plan types.
Do we have to offer coverage to per-diem staff?
Federal law doesn't require an employer below the 50 full-time-plus-FTE line to offer coverage, and Washington adds no employer mandate, but your plan's eligibility terms still decide who can enroll. Above the line, the measurement rules described earlier apply, and our ACA compliance checklist covers the rest.
Official references.
IRS: determining applicable large employer status and identifying full-time employees. Washington Office of the Insurance Commissioner: small business health plan options. General information, not legal or tax advice.
Send your roster and your referral list.
We'll check every plan against your own clinic first, then quote. You don't need a current plan to start.