Health Insurance for Business Owners
Health insurance for Oregon/Washington business owners and employees
Health insurance for employees is one of the top expenses for most business owners. Finding a quality product and a competitive price is one of today's most challenging process. Discover how a Fully Insured or Level Self-Funded plan may work for your organization.
Fully Insured Medical Plans
The insurance company provides fully insured plans, where the employer pays all or at least the required portion of the premium on behalf of your employees. Employers can ask their employees to pay a portion of their healthcare premium as well. The required employer premium percentage may vary between insurance companies. The usual rule is the employer pays 50% of the lowest priced plan offered.
With Fully Insured plans you can also offer to pay some of the premium for your employee’s dependents, but you are not required to. Some employers will offer Employee Only plans. These plans are a good choice when you have a workforce where spouses are getting greater health benefits from individual plans purchased with tax credits in the Federal Marketplace. Federal tax credits to reduce your individual premium are available to spouses of employees on group plans if they meet the income requirements. You can use this link to verify your qualification.
Deductibles, Co-Pays and Co-Insurance
Fully Insured plans will offer a variety of options in deductibles, co-pays and co-insurance levels. Some plans will offer more than one plan design to choose from. The amount of plan designs may depend on the number of enrolling employees.
Out-of-Pocket Maximums
Each plan design will have an out of pocket maximum both at the individual and family level. When that amount has been met the insurance company pays 100% until the plan deductible resets which can be at renewal but is usually January 1.
Level Self-Funded
This plan comes out of the Self-Funded industry. A Level Self-Funded plan has a premium just like a Fully Insured plan. However, in a Level Self-Funded plan there is a possibility to get a return of premium if the group’s claim loss is less than what is predicted.
These plans have lots of algorithms but the key point to remember is that you have the possibility of getting premium dollars back, which is not the case in a Fully Insured plan. A Level Self-Funded plan has a stop-loss feature to protect the employer in case of a large claim. With a stop-loss protection an employer can still be eligible for a return of premium even when a large claim was filed.
In addition, if the employer wants to move back to a Fully Insured plan there is a seamless transition, unlike in years past where some Self-Funded plans were burdened with paying run off claims for months.
This plan structure is not right for every employer but the sophistication of how these plans are priced and operate make them very competitive and worthy of consideration to employers who have a medium sized to large business.
Applying for Employer Group Health Insurance
Different states have different regulations on the specifics of what constitutes a company for a small group plan, but one point is consistent: a company must have at least one employee who is receiving W2 wages. This employee must not be an owner or a spouse of the owner.
Most plans require that at least one W2 employee enrolls in the healthplan in order for the owner or their family are eligible to enroll.
Call our office today to learn more.
Application Process Overview
Information Gathering
The key to employer group enrollment is a detailed census. Depending on the years in business or the size of the company additional documentation may be required such as payroll statements and other documents that establish the business as an active entity.
Application Timing
Most companies require completed applications to be submitted for processing by the 15th of the month for coverage starting on the first of the following month. Some companies will allow you to apply later, but the 15th is optimal to allow the insurance company to process the application, enroll employee members and mail out new member cards prior to the plan effective date.
Complete Application Forms
Enrollment for groups varies greatly based on the insurance company. Most insurance companies have on-line tools to enter the required data. The amount of data can vary.
Renewals
Your insurance company has guaranteed your group rate for the full year of your plan. They will notify you and your insurance agent at least 60 days prior to your renewal of the new rates and any benefits changes for the next plan year. You can choose to accept the new plan rate and benefits or you can work with your agent to get quotes from other insurance companies to make sure you get the product that is right for your business and employees.
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