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Employer FAQ

Frequently Asked Questions And Answers

Can independent contractors be insured under a group health plan?

Usually not, although some group health insurers offer some limited flexibility on this issue.

Can any group of people organize to purchase group health insurance?

No. There must be a legitimate “employer-employee” relationship to qualify.

How much of the premium does the employer have to pay?

As a general rule, most carriers require that the employer contribute at least 50% of the employee health insurance premium. The employer is not required to contribute to the cost of dependent coverage.

When does COBRA continuation apply?

COBRA applies to employer groups that averaged 20 or more full-time employees during the previous calendar year. COBRA compliance regulations apply to the employer, not to the insurance company. Potential civil and regulatory penalties for COBRA noncompliance can be considerable. We suggest employers to consider the services of a professional COBRA administration company, which is provided as a complimentary service through Benefit Pro.

Can part-time employees enroll?

If the employer chooses to offer coverage for part-time employees, employees who work as few as 20 hours per week may qualify. There are additional underwriting restrictions which may apply.

What can one do to minimize group health insurance rate increases?

As market dynamics are always changing, we continually monitor the carriers, available programs and coverages to ensure that you’re consistently getting the best value available in the market.

Can a group health insurance application be declined?

Group coverage is “guarantee issue” and cannot be declined due to medical history. However, if the business does not meet the insurer’s participation and employer contribution requirements, the group application can be declined.

Are Pre-Existing Conditions Excluded From Coverage?

Since the passage of the Affordable Care Act, all pre-existing conditions are now covered.

What is the definition of eligible “full-time” employee?

Employees who work an average of 30+ hours per week are considered “full-time” for benefits eligibility purposes.

For how long am I committed to keep a policy?

Most group health insurance policies are purchased as a month-to-month contract. Should you discontinue your current plan, be sure to notify your insurer in writing.

What are Health Savings Account (HSA) plans?

Health Savings Accounts (HSAs) are savings accounts that allow funds to be contributed to (and eligible medical expenses withdrawn from) the HSA account on a pre-tax basis. The account requires an underlying qualified High-Deductible Health Plans (HDHPs) for contributions to be allowable.

How many employees have to enroll?

As a general rule, most carriers require at least 50% of eligible full-time employees to enroll under their plan. The number of eligible employees can be reduced by those who have other “group coverage”, such as coverage through a spouse, parent, Medicare, VA, Champus, Medi-Cal or second employer. In some cases, employees covered under an individual or Exchange policy may also qualify as an exemption.

Can we offer employees a choice of different health insurance plans?

Yes, most insurers allow a choice of multiple plans to be offered to employees. Also, exchanges such as Cal Choice and Covered California SHOP, also offer a choice of multiple carriers, as well as multiple plans.

What documentation is required to qualify?

If you have employees, you will typically need to provide a copy of your most recent quarterly wage and tax report (DE-9 in California). Some health insurance companies will consider payroll records to be sufficient documentation of employment. For partnerships or corporations, in which owners may not be drawing wages, you may need to provide a business license, articles of incorporation or other documents to verify their employment or ownership status.

Is any one insurance carrier really better than another?

YES. There are big differences in rate competitiveness, benefit choices, network access, administrative services and financial stability. We can assist with making the right choices.

Can I save money by working directly with the insurance company?

No. The rates are the same for small group plans (99 or fewer employees), regardless of which broker you have or even if you have the services of a broker at all. Group insurers prefer that you work with a qualified professional agency, such as Benefit Pro, so that the employers have direct assistance in selecting the right plans, meet underwriting guidelines, are provided enrollment support and can educate employees on their new benefits and proper use of their plans.

Does my company need Worker’s Compensation Insurance to qualify?

Yes. In most cases, 100% of the eligible employees must be covered by Worker’s Compensation Insurance, except for those people that are exempt under Federal or state laws.

How many employees are required to qualify for group health coverage?

You need at least two full-time “eligible” employees or owners. The two “eligible” can be an owner and an employee, two partners of a partnership, or two officers of a corporation (but not husband and wife).

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