Top Group Health Insurance Questions
We have compiled a list of the Top 6 Group Health Insurance questions we receive to help you better understand small business health insurance.
HOW DOES GROUP HEALTH INSURANCE WORK?
With group health insurance, the employer selects the plan (or plans) to offer to employees. The premium cost is usually split between the employer and employee as a percent of the premium, or as a fixed monthly contribution by employer. Employer Groups with under 50 employees are not required to pay towards the premium, although most do.
WHAT IS A GROUP HEALTH INSURANCE PLAN?
A group health insurance plan is an insurance plan that provides healthcare coverage to a select group of people. Group health insurance plans are one of the major benefits offered by many employers. These plans are generally uniform in nature, offering the same benefits to all employees or members of the group, or a limited choice of 2 or 3 options of plans.
WHO WILL BE COVERED UNDER A GROUP HEALTH INSURANCE PLAN?
As a small business owner, the first thing you need to know is who will be covered under your new group health insurance plan. You probably intend to cover yourself and your family. You probably also intend to cover your employees – but which ones? If you have full-time as well as part-time workers, you can only offer coverage to those working 20 hours per week or more. You can also carve out a group of eligible full-time employees, such as management or salaried, and if you do this you generally must offer it to all employees within that same category. You can also extend coverage to your employees’ dependents, but you should have a policy whether you would pay for a portion of their coverage as well.
You may also wish to consider the likely health needs of your employees. Are they likely to need generous prescription drug coverage or maternity coverage? Are they likely or unlikely to visit the doctor often? For legal and privacy reasons, you may not be able to ask them specifically about their personal health, but you can usually ask them in general terms what kinds of health coverage are most important to them.
WHAT ARE THE BENEFITS OF GROUP HEALTH INSURANCE?
Group Health insurance provides piece of mind to better ensure the physical, mental and financial health of insured members and their families. Some of the additional benefits found in group health insurance plans that are not usually available in individual market plans are Telemedicine, Employee wellness benefits, and dedicated nurse helplines to name a few. Most also include enrollment counseling and advice from licensed brokers during initial and renewal enrollment times, which are not available in the individual market. This benefit helps assure employees and employers are getting the most out of their healthcare dollars.
HOW MANY HOURS DOES AN EMPLOYEE HAVE TO WORK TO BE ELIGIBLE FOR HEALTH INSURANCE?
This depends on the size of the group. The Affordable Care Act (ACA) requires employers with 50 or more full time equivalent (FTE) employees to provide ‘affordable’ coverage to all FT employees who work at least 30 or more hours per week to avoid penalties. Employers with under 50 FTE employees can allow for anywhere from 20-40 hours per week as full time, and it is up to the employer to decide those hours.
HOW MANY EMPLOYEES DO YOU NEED TO QUALIFY FOR GROUP HEALTH INSURANCE?
A small group is 1-100 employees consisting of an owner and at least one common law employee working at least minimum wage, 20 hours per week or more. Common law employee is a NON spouse employee.