Am I eligible to have group health insurance in my state?

You must meet the definition of a small employer, meet participation requirements, and meet employer contribution requirements.

What is a small employer?

Employ at least two eligible employees, but no more than 50 employees. You must also have a majority of eligible employees working in your state.

What is the participation requirement?

At least 75 % of your employees must participate in coverage as a condition of obtaining a small group health benefits plan. Employees waiving for spousal coverage, another group health plan offered by the same employer or another employer, Medicare, or Medicaid are considered to be participating in your plan.

What is the employer contribution requirement?

A small employer must contribute at least 10 % of the total cost of the health benefits plan. This is calculated as the annual premium for the employee and dependents.

What information do I need to provide in order to receive a quote?

Company place of business, a complete list with each employee’s date of birth, gender, and insurance coverage status (single, husband/wife, parent/child, or family). The effective date of when you want the insurance to start, as well as residential zip codes for each employee. You do not need to provide any personal information for employees such as names or social security numbers. You may refer to them on the census provided by their initials or last name.

What paperwork or documentation do I need to start a plan for my business?

Master application for your company that includes a small employer certification form. Check for the first month’s premium on your business checking account made out to the insurance carrier. Each employee must fill out an enrollment form or a waiver depending on if they plan on electing the insurance. A copy of your quarterly wage and tax report (WR-30), any employees not listed on the WR-30 will need to be shown on your monthly payroll. Owners not on the payroll must be on the Schedule C or K1. Newly formed businesses can provide other documentation to prove employee eligibility. If your company has prior health insurance, then you will be required to provide a copy of your last bill. HSA plans will require documents to be filled out by the employer and employee.

What waiting periods can I have for employees?

An employer can have a waiting period of up to 6 months. You may have a different waiting period for current employees and new hires.

When can employees enroll in my group health insurance plan?

As an employee of a company that has a group health insurance plan, you are only allowed to enroll during specified times. An employee is initially allowed to enroll when he or she is first hired. If your company has a waiting period for new hires, then they may have to wait 30 days or more to enroll.

What types of plans are available?

PPO, POS and HMO plans are available. HSA compatible POS and HMO plans are also a popular cost effective way to insure your company.

What are the main differences between plan types?

HMO plans offer in-network benefits only.
PPO and POS plans offer in-network and out-of-network benefits.
Employees receive greater benefits when using in-network providers.
PPO and POS plans are generally more expensive than similar HMO plans. Deductibles and co- insurance for major medical services can be added to lower premiums.
HSA compatible plans have a high deductible that must be satisfied for all services, except for preventive care. The health insurance plan may be used with a savings account that can be obtained from the insurance carrier or from another financial institution.

Will the plans in a quote cover employees outside the state the business is located in?

Yes, provide zip codes of current employees and let the insurance company know if you intend on having employees outside of the state. Only select plans will work in specific states. This varies for each plan type and insurance carrier presented in a quote.

When are referrals required?

Some plans require referrals from your Primary Care Physician before seeing a specialist.
HMO plans require a referral from primary care physician (PCP) whereas PPO’s do not.

Do my employees need to select a primary care physician?

HMO’s and plans that have separate co-pays for your primary care physician (PCP) and specialist visits require you to choose a PCP. If you do not choose a PCP the insurance carrier will charge you the higher specialist co-pay when visit your PCP or they will choose a PCP for you..

How are rates determined for small business health insurance?

Rates in the small business health insurance market are based entirely on your employee demographics or census, zip code of your office, and effective date of your new health insurance plan. Co-pays, deductibles, and plan types all change your insurance premium. Unfortunately negotiating on price is not available in the small group employer market. However this is pretty logical, the more employees to be covered the more negotiating power you have.

Do all insurance brokers and agents have the same rates?

If the exact census and other details are used for two quotes from different brokers or agents, then the quotes will be exactly the same price. Agents and brokers vary heavily on the strategy they use to insure your company, so it is very important to have an in-depth discussion with your broker about your company’s health insurance plan, and to make sure he is constructing a plan and quote that will not only meet your budget but your needs, NO SURPRISES!