Question

How many employees do I need to have to receive a quote?

Answer

You must have at least 2 employees in most states but there are some states that we have a higher minimum requirement in. Most carriers will require that the second employee is a W-2 employee that is not the spouse of an owner.

Question

Do small business plans cover pre-existing conditions?

Answer

Yes.

Question

When can I start my health insurance plan for my Small Business?

Answer

You can start a new insurance plan any month of the year and most insurance companies begin coverage on the first of the month. Some carriers will allow coverage to begin on the 15th of the month and every carrier has a deadline on when your submission documents must be received in order secure the effective date you are requesting.

Question

Does the employer have to contribute towards the premium for the employee?

Answer

Yes. Most insurance carriers require a minimum employer contribution of 50% of the employee only premium.

Question

How long are rates guaranteed for?

Answer

The standard rate guarantee period for medical premiums is 12 months. Ancillary coverages such as vision or life insurance can have longer rate guaranteed periods.

Question

What is a waiting period?

Answer

A waiting period is the period of time that must pass before an employee is eligible to enroll in your company-sponsored benefits.

Question

What is the maximum waiting period I can add to my benefit program?

Answer

For plan years beginning on or after January 1, 2014, the Affordable Care Act (ACA) prohibits any group plan and group health insurance issuers from having a waiting period that exceeds 90 days.

Question

What is a deductible?

Answer

A deductible is a set amount you must pay before your insurance company starts to share the cost for some covered medical expenses.

Question

What is a copay?

Answer

A copay is a set amount you’ll pay each time for some covered medical expenses. On some plans these payments start after the deductible is met and on other plans the payments would start immediately. For example, your copay for a routine doctor’s visit might be $50.

Question

What is coinsurance?

Answer

Coinsurance is the percentage you pay for some covered health care services. Your coinsurance will typically start after you’ve reached your deductible. For example, if your coinsurance is 30%, you’ll be responsible for paying 30% of your medical expenses until you reach your out-of-pocket maximum.

Question

What is an out-of-pocket maximum?

Answer

An out-of-pocket maximum is the most you have to pay per year for covered healthcare services. When you have spent this amount in a year on deductibles, copays, and coinsurance for in-network care and services, your health insurer will pay for 100% of your covered in-network health care services for the remainder of the year. Out-of-pocket maximums are typically based on a calendar year, but some plans might base it on a plan year.

Question

When will I receive a copy of my small business renewal?

Answer

Carriers will release a copy of your renewal between 30 and 60 days prior to your renewal date. Your renewal date is typically 12 months from your plan effective date. If you have not received a copy of your renewal, please reach out to your benefit service team using one of the options listed at the bottom of the page.

Question

What is a Qualifying Life Event (QLE)?

Answer

This is an event that will trigger a special enrollment period during the plan year that will allow an employee to make midyear changes to their benefit elections. Examples of a QLE are loss of other credible coverage, gain of other credible coverage, marriage, divorce, birth or adoption, death of a dependent or Medicare/Medicaid entitlement.

Question

How long do employees have to make a midyear enrollment change if they experience a QLE?

Answer

All QLE’s must be reported and processed within 30 days of the QLE Event Date. If the request is submitted after 30 days, the employee will need to wait for the annual open enrollment period to make changes.

Question

How long can my adult child remain covered under my health plan?

Answer

Health plans are required to permit children to stay on family coverage until they turn 26. Note that state law requirements may require offering coverage beyond age 26.

Question

Did the health care reform law eliminate COBRA?

Answer

No. The health care reform law did not eliminate COBRA or change the COBRA rules.

Question

Did the health care reform law extend the time period I can have COBRA beyond 18 months?

Answer

No. The health care reform law did not extend the maximum time periods of continuation coverage provided by COBRA. COBRA establishes required periods of coverage for continuation health benefits. A plan, however, may provide longer periods of coverage beyond those required by COBRA.

COBRA beneficiaries generally are eligible for group coverage during a maximum of 18 months for qualifying events due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. Individuals who become disabled can extend the 18 month period of continuation coverage for a qualifying event that is a termination of employment or reduction of hours.

To qualify for additional months of COBRA continuation coverage, the qualified beneficiary must:

Have a ruling from the Social Security Administration that he or she became disabled within the first 60 days of COBRA continuation coverage (or before); and
Send the plan a copy of the Social Security ruling letter within 60 days of receipt, but prior to expiration of the 18-month period of coverage.
If these requirements are met, the entire family qualifies for an additional 11 months of COBRA continuation coverage.

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