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 WHAT EVERY EMPLOYER NEEDS TO KNOW

 

 
Why should I use an Independent Insurance Broker? A broker or consultant typically has contracts with the major health providers and has knowledge in the health industry. It is important to work with a Specialist who has your best interest at heart and will shop the best prices and policy.
 
Cost of Broker Services: There is no cost to work with a Health Insurance Broker. The insurance companies pay the broker direct.
 
How much must I contribute to the cost of each employees/ dependents premium?  Employers are required to contribute a minimum of 50% to the employee’s premium. There could also be a minimum contribution e.g. Anthem’s is $125 toward the employee’s premium. There is no contribution requirement towards the dependents premiums.
 
Why should I offer Group Health to my Employees?
Most employers want to provide benefits for their employees because employees expect and or want to have benefits. Benefits optimize employee retention. Offering benefits helps employees that have pre-existing health conditions they could not otherwise have covered under an individual health plan. Also, the younger families want to have Maternity coverage that is covered as any illness compared to very limited coverage on an individual health policy.  
 
Must I enroll all my employees? You may Carve-Out a class of employees and cover only this class of employees. Some employers cover; Owners and Officers of the company; or Salaried Employees or Hourly Employees. Most Health Carriers limit 2 classes in a group. You may have a different waiting period per class.
 
Employer decides who is eligible for the health insurance by determining the number of hours an employee works; the length of employment; or whether the employee is eligible according to class. An employer should think about their philosophy and goal in offering benefits.
 
Minimum # Hours: Eligible employees must work a minimum number of 24 hours a week on a full-time, year round basis, according to the Division of Insurance. Employers may choose to cover employees that work 40 hours a week excluding eligibility of employees under 40 hours.
 
Waiting Period: Employers also need to choose a Waiting Period, which is a length of employment for employees to be eligible. Employers can choose one month, two months, etc… with the effective date the first of the month following the waiting period. Also, there could be NO Waiting Period and the employee would be covered on day one of employment.
 
Participationof employees to enroll in the health plan is required by all group health carriers. It is typically 75% of the eligible employees. If an employee is insured elsewhere, then this employee is not considered eligible. They will be required to complete enrollment and waiver and show copy of ID card for their current health insurance carrier.
 
Pre-Existing Health Conditions will be covered for employees on the new health plan as long as there has been continuous coverage and there has been not lapse of coverage for more than 63 days. For HMO plans, there is no pre-existing coverage exclusion. If a new employee comes to work and has had no prior health coverage, their pre-existing condition will not be covered for a minimum of 6 months on a PPO plan. (Group of 2+)
 
Consumer Driven Health Care is a strategy for actively encouraging consumers of health care to make wise health care decisions, and in the process, lower the overall cost of health care.
 
Small Group Guarantee Issue Plans range from 1-50 employees. A small group will be accepted by the insurance company regardless of the pre-existing health conditions. Currently through 2008 employees are required to complete health questions on enrollment applications. The rates quoted; known as the Community Rates may be reduced up to 25% for every employee based on the information provided on the applications. This law is being phased out at the end of 2008.
 
   
Why does Group Health Insurance Cost so Much?
Group Health in the Small Group Health Market (1-50 employees) can be expensive because of guarantee issue. The healthy pay for the unhealthy!
 
High Deductible Plans
Deciding on which plan to offer the employees has changed over the last 2-3 years. Employers are offering High Deductible Plans (HSA Qualified) in order to reduce premiums. There is one family deductible that all members of the family contribute to and once satisfied, plan can pay 100%.
More Information _______
 
HSA Qualified Plans
HSA stands for Health Savings Account. If you have a High Deductible Plan, you may set up a separate savings account known as an HSA. The concept is to fund the account to provide for your health expenses.
More information ______
 
Employees now have more choice of plans
Insurance carriers are now offering the “Pick a Plan concept where the employees can choose different plans. For example: one employee may choose an HSA plan while another picks a Co-Pay plan.
 
Pre-Tax Benefits
Employers payroll deduct group health premiums after tax unless they have a plan document called a POP (Premium Only Plan) in place. Having a POP plan allows an employer to payroll deduct the employee/dependent portion of the health premium on a pre-tax basis. This is a win-win for the employer as the employer will not match any FICA/WC for every dollar that is deducted pre-tax. The employee’s net cost of the health insurance is reduced due to the tax savings.
 
How do I apply for Group Health? Your consultant will help you with the enrollment process. The Broker will complete an Employer/Master Application. Each employee is required to complete a Colorado Uniform Employee Application. You will also be required to provide financial documentation to prove you are a bonafied-business, showing employees on the payroll.  
 
 
As a Business Group of 1 with no employees, you must show financial documentation of income for one year. Click here for more information.  
 
As a Business Group of 2 + employees. Group must provide prior 3 month State Unemployment Income Wage Reporting Form, (UITR). Start up
Business with no prior UITR requires at least 2 -6 weeks of payroll, depending upon the insurance carrier. In addition other financial documentation may be required. 
 
 
Educating the employees is important and can be done during an employee meeting or through other means of communication via on-line or through hand-outs. Our agency believes in helping the employees understand their plan and learn the on-line tools the insurance company provides. Educating the employees to be “wise health consumers will eventually reduce your employee benefits bottom-line.
 
Insurance Companies have Cut-Off dates to submit enrollment applications.  Some company’s cut-off is on the 15th while some will allow you to turn in the enrollment on the last day of the month. When you submit your group late, the approval will go into the month applied for and can be very discouraging for the employer and employees expecting ID cards.
 
Can I insure 1099 employees on the group health plan?  Some companies allow groups to add 1099 employees. It is limited to a small % of the W2 employees. If you have 1099 employees you want to insure, advise your Broker.
 
Flexible Spending Accounts
The FSA is an authorized administrative plan under Section 125 of the IRS code. The plan allows the employee to pay certain expenses from pre-tax income rather than after tax income.
Medical Reimbursement Account (Medical/Dental Vision Expenses)
Dependent Care Assistance Account
The plan allows you to allocate the annual dollar amount you wish to direct to employee accounts. This amount will be taken from pre-tax earnings in equal increments from your paychecks throughout the year and placed into the accounts you select. As the employee incurs expenses throughout the year, they can use the FSA money to pay for medical expenses and dependent care tax free. There is a Use-It or Loose-It provision, so it is important to use all the money in the accounts so it is not lost. 
 


 

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