Health FAQ


Large Group

What is the different between a Co-Pay plan and an HSA plan?

Co-Pay plans require the insured to pay a flat fee for certain medical expenses and the plan will pay the balance. Plans may include different copay amounts for primary provider office visits, a specialist office visit, for urgent care, emergency care, and prescriptions.

High Deductible Health Plan (HDHP) features a high deductible and a limit on annual out of pocket expenses. This type of plan is usually coupled with a HSA (Health Savings Account). HSA (Health Savings Account) is an account established to save money toward medical expenses on a tax-free basis. In order to have an HSA you must have a High Deductible Health Plan. Final Rates are subject to Underwriting.

 

Do I have to contribute to my employee’s HSA account?

You are not required to make a contribution, however you are able to choose to make contributions as part of your Employee Health Benefits to help your employees pay towards their High Deductible Health Plan deductible.

 

What is ATNE?

AVERAGE TOTAL NUMBER  OF EMPLOYEES: Anyone that was issued a W-2 form in the last 12 months. This number is used to determine your group size of Small (2-50) or Large Group (51+).

 


Small Group

How many employees do I need to have a group health plan?

An employer must have at least 1 eligible non-spouse “common law employee” enrolled in addition to an owner, or 2 non-spouse “common law employee”.

 

What information is needed to get a quote?

The information needed would be: Name, Age, Gender, and Home Zip Code for all employees, spouses and dependents

 

What am I required to pay towards the insurance?

As an Employer, you must pay at least 50% of the employee’s monthly health insurance premium (employee/single coverage only). You must offer coverage to their spouse and children but are not required to pay any portion of their premium.

 

How many hours does an employee have to work to receive benefits?

An “eligible employee” means an employee who works on a permanent basis and has normal work week of 30 or more hours.

 

Do I have to contribute to my employee’s HSA account?

You are not required to make a contribution, however you are able to choose to make contributions as part of your Employee Health Benefits to help your employees pay towards their High Deductible Health Plan deductible.

 

What is a QSE HRA?

QUALIFIED SMALL EMPLOYER HEALTH REIMBURSEMENT ACCOUNT

This plan allows employers to help their employees pay for medical coverage for themselves and their families, tax-free. The employees are able to use the money for insurance premiums, co-pays, deductible, eye care, dental care, or any other qualified healthcare expense. The amount provided is tax-free to the employees and 100% tax deductible to the employer.

 

What is the different between a Co-Pay plan and an HSA plan?

Co-Pay plans require the insured to pay a flat fee for certain medical expenses and the plan will pay the balance. Plans may include different copay amounts for primary provider office visits, a specialist office visit, for urgent care, emergency care, and prescriptions.

High Deductible Health Plan (HDHP) features a high deductible and a limit on annual out of pocket expenses. This type of plan is usually coupled with a HSA (Health Savings Account). HSA (Health Savings Account) is an account established to save money toward medical expenses on a tax-free basis. In order to have an HSA you must have a High Deductible Health Plan. Final Rates are NOT subject to Underwriting per ACA Regulations.

 

What is ATNE?

AVERAGE TOTAL NUMBER  OF EMPLOYEES: Anyone that was issued a W-2 form in the last 12 months. This number is used to determine your group size of Small (2-50) or Large Group (51+).

 

What if either myself or one of my employees have a pre-existing condition? Will that affect my rates?

Small Group ACA plans are Guaranteed Issue which means you can’t be denied due to pre-existing conditions and the carriers are not able to “Rate-Up” due to health conditions.