Frequently Asked Questions

Most group health plans are restricted to full time "employees". The criteria are W-2, tax withholding and working more than 30 hours a week (20-30 hours at the employer’s discretion).

Please complete the census with all eligible employees or all employees currently enrolled.

When the census is complete you can fax back, mail back or call us to pick up it up. We also need the employer survey and a copy of a recent billing statement.
With that information we can use our shopping service, which quotes dozens of companies. We will call you when we have received that printout (usually 4-6 working days).

Our goal is to get you the best value for your money and a plan that your employees appreciate.

If you have any questions, please don't hesitate to call us at 1-800-710-0077.

How to choose an appropriate small group health insurance plan

    1. Any insurance company providing group health insurance in California must offer guaranteed issue for groups of 2-49 lives. You cannot be turned down for any prior medical history. In order to enroll you must: 1. Be a W-2 employee or owner drawing regular compensation.

    2. Work 30+ hours a week (at employers’ discretion 20+).

    3. Satisfy the eligibility waiting period (your choice of 1-6 months). A husband and wife working out of their home more than 20hrs a week each could be eligible. 2. If you are legally required to have workers’ comp. you must obtain it first, in order to apply for group health insurance. 3. A carrier may charge as much as 10% extra for the entire group if there is significant medical history or discount by as much as 10% for larger groups with no medical problems. Some plans do not medically underwrite (do not ask any medical questions) and charge the same rate for everyone. Rates for groups with less than 5 people are usually + 10%.

    4. "1099 employees" are not eligible for coverage under most group health plans.

    5. You must provide the most recent quarterly wage and tax report. Carriers sometimes ask for additional forms and documentation such as articles of incorporation, business licenses and tax returns (for partners/owners).

    6. We are now in a phase of significant inflation for health care. Most carriers will be raising rates 10%+ this year. Most carriers offer a rate guarantee for 12 months.

    7. Employers are usually required to contribute at least 50% of the cost of health insurance for their employees. Employers are not required to contribute to the cost of dependents. Some plans allow employers to contribute 50% of the lowest cost plan. Others require 50% of whatever plan is selected.

    8. Insurance carriers usually require that at least 70/75% of all eligible employees sign up for the plan. Eligible employees include all full time W-2 employees/owners who have satisfied their waiting period and are not covered under a spouse’s group health plan.

    9. An employer can choose to cover employees working 20-30 hours a week. Note however that you must cover all employees in that category. Domestic partners must be offered the opportunity to enroll.

    10. If employees are contributing any portion of the health insurance premium you should implement a premium only section 125 plan. This allows the employees to pay their portion on a pre-tax basis and also saves the employer FICA and in some cases Workers Comp

    11. HMO "Health Maintenance Organizations" have lower out of pocket costs, but limited choice of doctors. These plans work best if the doctor and doctors’ office are adept at working the system and they are not overloaded with patients

    12. PPO "Preferred Provider Organization" is a health plan that offers direct access to a larger network of physicians, including specialists that have contracted with the insurance carrier to provide services at a negotiated rate. Typically, these plans have office visit co-pays, deductibles and coinsurance with calendar year out of pocket maximums. These plans typically allow you to go "out of network" but pay based on limited fee schedules if you do

    13. POS "Point of Service" plans have emerged as a middle ground of managed care. They offer an HMO benefit as well as the ability to opt out either to a PPO network or any physician at will.

    14. Health Savings Account eligible plans are high deductible plans with no co pays and no prescription drug card. All expenses accrue towards your deductible. You may set up a health savings account in conjunction with these plans. This account is sort of like a medical IRA.

    15. If you are debating between group insurance and individual insurance plans weigh the benefits carefully. Individual plans are medically underwritten and you can be turned down. The advantage of group plans is that they are guaranteed issue and enjoy certain tax advantages. Individual plans have a distinct advantage in that they are portable and not dependent on continued employment.

Group benefits add a fixed ongoing monthly cost to your company. You want to get maximum benefit from this cost. Ideally, you want to have a health plan that is perceived by every employee to be a good plan that works for him or her. This helps you attract and retain good employees. You also want a plan that is competitively priced.

The first step is to try and determine what plan(s) your employees are currently on, or what plan(s) they would like to be on. The goal is to allow access to the physicians’ employees are already seeing. I have a survey to use to accumulate this information.

Usually, it makes sense to offer both HMO and PPO or POS plans. Offering the option increases the odds that everyone will be happy. You can structure these plans so that an employee who chooses the PPO or POS plan does so by "buying up" to that plan.

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