Health Insurance

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Why should I provide group health insurance to my employees?

You may be a business owner without health insurance coverage for yourself and your family because of the high cost of individual plans. You might be pleasantly surprised to learn that as a business owner, you may be eligible for lower rates for your family insurance than through the individual market, while still receiving the same level of benefits.

Research has demonstrated time and time again that the only thing employees appreciate more than monetary compensation is the health insurance coverage offered to them by their employer. There are numerous reasons to offer group health insurance benefits to your employees, not the least of which is the ability to offer competitive benefit packages that will naturally attract and retain the best workers for your company. Another consideration is the fact that various tax incentives are available to both you and your employees for participation in a group health insurance plan. For example, as a business owner, you can deduct 100% of the premiums you pay annually on qualifying group health plans. Yet another benefit is the reduction of payroll taxes as a direct result of including health insurance as part of comprehensive employee benefits. Finally, your employees will have the opportunity to avoid tax penalties when paying their premium percentage. Consideration of these incentives is imperative to effectively determine the affordability of a specific health insurance plan.

How much of the employees' premium is the employer required to pay?

Usually, an employer is required to split health insurance costs right down the middle, covering 50% of the employee's monthly premium; however, different states and insurance companies have different minimum employer contribution levels. In the case of the 50/50 split, the employee is responsible for the remaining 50% of his or her premium as well as 100% of the premium for any dependents. It is up to the employer to decide whether or not to cover more than the minimum contribution. While completing an application with the insurance company of your choice, you will have the opportunity to specify your level of contribution for your employees and their dependents.

Are there tax benefits that accompany buying group health insurance?

Employers who offer group health insurance are frequently eligible for considerable tax advantages. As a business owner, you can deduct 100% of the premiums you pay annually on qualifying group health plans. Another benefit is the deduction of payroll taxes as a direct result of offering group health insurance as part of a total compensation package. Additionally, your employees will have the opportunity to pay their portion of the monthly premium with no tax penalty. You will want to check with your accountant or tax advisor to confirm the specific tax benefits that are available for your area and business.

Does my company qualify for group health insurance?

There are three criteria when determining eligibility. First, you must have filed tax documents that authenticate that there are at least two owners, officers, partners, and/or employees that work full time. Second, the purpose of your business cannot be to acquire insurance and you must be able to prove via business license, articles of incorporation, or articles of organization that you own a legally recognized company. The final criterion for eligibility rests on simply meeting the insurance company's requirement for ratio of employer contribution. Please note that in addition to the above listed items, each state and insurance company will have its own eligibility criteria.

What are the different kinds of group health insurance?

Indemnity and Managed-Care are the two main types of individual and family health insurance plans. Generally speaking, the most important differences between the two categories are the number of healthcare providers from which to choose, the amount of out-of-pocket expense, and the bill-paying process. Normally, indemnity plans offer more choices of healthcare providers than managed care plans, but it is important to note that indemnity plans pay their share of the costs for covered services only after they receive a bill. This usually results in required payment at the time services are rendered and then subsequent reimbursement by the insurance company.

Healthcare provider networks are the main structures utilized by managed-care plans. Insurance companies and healthcare providers within a network develop predetermined rates for specific services, and the providers agree to perform those services for managed-care plan patients as well as submit the claim to the insurance company. There are three main types of managed-care health insurance plans. These include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and Point of Service (POS) plans.

To summarize the two categories of plans, an indemnity plan offers a wider selection of healthcare providers and utilizes a reimbursement system; a managed care plan provides the options of lower out-of-pocket costs and very little paperwork along with a reduction in healthcare provider choices.

What is an Indemnity plan?

An Indemnity plan is one of the most flexible health insurance plans on the market. It allows you to freely choose any doctor or hospital you wish with no difference in the levels of coverage. Selection of a primary care physician is not required, nor is it necessary to get a referral to see a specialist. However, Indemnity plans are considerably more expensive than managed care plans because a deductible, usually ranging from $500 to $1500, must be met annually before the insurance company begins to absorb any of the cost. When the deductible is met, claims will be paid at a certain percentage of the usual, customary, and reasonable rate (UCR), which is determined by examining the standard costs of healthcare in your area. Additionally, since the insurance company does not have managed care agreements with providers, the responsibility for filing claims for reimbursement is left to you.

What is a Preferred Provider Organization (PPO)?

Although it is not required that you do so, when you use the insurance company's network of preferred doctors and hospitals, a PPO plan will have lower costs. If you choose an out-of-network provider, the cost will be much higher. In-network healthcare providers have predetermined rates, usually nominal, for the provision of each service to the health insurance plan's members. Consider the following example: Let's assume that the out-of-network coverage rate is sixty percent. This means that the insurance company will pay sixty percent of what that service would have cost had you gone to an in-network provider. If you received $1000 worth of services from an out-of-network provider and those same services were available from an in-network provider for $500, the insurance company will only pay sixty percent of $500, which is $300, leaving you responsible for the remaining $700. Another consideration is that not only may up-front payment be required, but the out-of-network provider will not submit your claim for reimbursement.

It is generally not required to pick a primary care physician which allows plan members to seek medical services from any doctor or specialist within the network. While one of the most popular qualities of PPO plans is the flexibility in choosing providers, it is essential to confirm that your preferred doctor or neighborhood hospital belongs to the network. Additionally, if you will be including children in your plan, preventive and well-child care benefits will be of special importance to you. An annual deductible typically must be met before the insurance company starts covering your medical bills. A co-payment may be required for certain services or it may be necessary for the plan member to cover a certain percentage, or coinsurance, of the total charges.

What is a Health Maintenance Organization (HMO)?

The biggest benefits of a standard HMO plan are the lower out-of-pocket healthcare expenses, the strong focus on preventative medicine, and nominal co pays that are independent of a deductible. However, more often than not, these features are paired with more limited options as far as freedom to choose specific physicians or hospitals. Unlike a PPO, the selection of a primary care physician (PCP), who will handle the majority of your healthcare needs, is required. With an HMO plan, your insurance claims are submitted for you by the provider. It is important to note that should you decide to receive services out-of-network, an HMO will most likely cover none of the cost. In addition, even in-network providers are not covered for services rendered without being referred by your PCP. In order for the insurance company to cover specialist visits, it is up to the discretion of the PCP to make a referral.

What is a Point of Service (POS) plan?

A POS plan is a cross between an HMO plan and a PPO plan. Similar to an HMO, it is required to select a primary care physician (PCP) whose services will usually be provided independently of a deductible. POS plans also share the HMO's concentration on preventive medicine. The highest percentage of coverage will almost always be for services rendered or referred by your PCP. As with PPOs, visits to out-of-network providers generally require payment of the deductible and less of the costs will be absorbed by the insurance company. Another consideration is that not only may up-front payment be required, but the out-of-network provider will not submit your claim for reimbursement.

What is a Health Savings Account (HSA)?

The freedoms offered by HSAs have been available since the January 1, 2004 legislation. An HSA is the most progressive alternative to traditional health insurance, allowing you to set aside money specifically for healthcare in an investment savings account without any tax penalties whatsoever. HSAs facilitate the payment of current health expenses while simultaneously saving for future medical and retiree health expenses. Not only is the money in your account solely controlled by you independently of any third party or health insurer, but only you have the authority to determine what types of investments will be made to grow your funds. In order to be eligible for an HSA, you must first be covered by a High Deductible Health Plan (HDHP). Standard HDHP costs are usually lower than those of traditional health care, so the money saved on insurance expenses can be put directly into the Health Savings Account. Please see our HSA examples of significant savings with HSAs.

Similar in function to IRAs, the popularity of HSAs and HSA-eligible health insurance plans is rapidly spreading. This is why:

• When used in combination with an HSA-eligible high deductible health insurance plan, HSAs allow you save for retirement while paying for current medical expenses.
• The standard annual premium on an HSA-eligible high deductible plan is much less expensive, usually around $1000 less, than the annual premium for a lower-deductible health insurance plan.
• Not only are contributions to an HSA 100% deductible, but they may also be made with no income tax penalties, up to set limits per year.
• You control and invest the funds in your HSA with the option of simply allowing unused funds to remain in the account and accrue interest year-to-year, tax-free.
• Money in your HSA can be withdrawn to pay for qualified medical expenses with no tax penalties and funds can also conveniently be used for purposes other than healthcare, although there are taxes and fees associated with non-medical withdrawals.
• Similar to IRA guidelines, sole ownership and control of the money in an HSA account belongs to the employee. However, one of the main areas in which the two accounts differ is that an employer does have the option of contributing to the funds in an HSA.

Before choosing an HDHP for use with an HSA, it is important to be sure that your selected high-deductible plan is HSA-eligible. Read more information about HSAs.

What is a multi-plan?

A multi-plan is a popular option with employees because it enables them to access group coverage from an employer while still having a certain amount of freedom in which plan they choose. Usually, an employer will offer several different plans either from one insurance company or more than one and allow employees to opt for the plan that best meets their medical needs and financial circumstances. Since there is more than one plan, benefits and coverage levels will vary based on each selected plan.

Is dental coverage automatically included?

No. Dental coverage is not one of the features usually included in a standard health insurance plan; it is often available as a benefit rider with a group health insurance plan. After you have determined which plan will best suit your needs, you will then have the option of adding other types of insurance plans, such as dental, vision, and chiropractic care.

What is the process for obtaining small business coverage?

Compare-Health-Quotes.com strives to ensure your complete satisfaction as you seek coverage for your small business. Our process differs from other companies in that instead of viewing impersonal, and often less than accurate quotes online, Compare-Health-Quotes.com provides a free one-on-one consultation to determine your exact needs. This is because we want to ensure that we personally select the best options for your company and not rely on an automated program. Your company and its needs are unique. To honor that distinctiveness, Compare-Health-Quotes.com offers the personalized attention of our health insurance advisors to guarantee that you receive the best plan for your needs and budget. Here are the steps to finding the right small business coverage for you through Compare-Health-Quotes.com:

1. You should begin by completing the small group form, which will provide us with critical information about your small business.
2. You will then be invited to participate in a conference call with your personal health insurance advisor to discuss your needs, budget and concerns.
3. It will be necessary for you to provide to Compare-Health-Quotes.com your census and current coverage information.
4. Your health insurance advisor will then go to all of the carriers in the marketplace to obtain personalized quotes for your business.
5. After analyzing the quotes to determine the best fit, your health insurance advisor will prepare a summary and recommendation for your review.
6. You and your health insurance advisor will work together to finalize your small group insurance program.
7. Compare-Health-Quotes.com will prepare individualized enrollment kits and will assist you in communicating the enrollment plan and process to your employees.

Before your annual renewal, your health insurance advisor will review your current plan with you to determine if it still meets your individualized needs. Of course, your advisor will be available at any time to help you with any questions you have or issues you encounter.

How do I choose the best plan for my company?

At Compare-Health-Quotes.com, we know that finding the best health insurance plan for your business can be complicated since there is no such thing as a one-size-fits-all plan. Frequently, health insurance terminology can be overwhelming and intimidating, resulting in confusion about available options. Compare-Health-Quotes.com is here to dispel any myths about health insurance and simply help you find the best health insurance for you, catered specifically to your needs and circumstances. We understand that the best plan for you and your company will be different than what might work for another company. Important pieces of information such as varied health care needs and financial constraints must all be considered. It is because we appreciate the diversity of our customers that we have created the following list of questions to help you and your employees find the perfect plan for your business.

• How frequently will medical services be utilized?
• Will coverage for items such as chiropractic care, dental, vision, maternity, or prescription drugs be a necessity for you or your employees?
• Is your main concern coverage in case of a major injury or illness or is coverage for preventive medicine more of a priority?
• How much of a monthly premium are you able to pay?
• Are you willing to pay an annual deductible before coverage begins in exchange for lower monthly premiums?
• How important is it to be able to see any doctor at your discretion?
• Are you willing to have all of your medial care coordinated through a primary care physician?

Will my final group health insurance costs be the same as the rates on my initial quote?

Probably not. Insurance companies utilize factors such as age, location, and health of the employees for whom you are applying for coverage to determine your final rates. Using criteria such as number of enrollees and preexisting condition, the insurance company will assess your group as a whole to arrive at a final monthly premium.

What is a benefit rider?

A benefit rider is an additional or stand alone policy such as dental, vision, chiropractic, or life insurance that are not usually included in a standard health insurance plan. Benefit riders are usually only available in conjunction with a group health insurance plan. Your personal health insurance advisor can assist you in purchasing dental, vision, life insurance, or chiropractic coverage as a separate plan.

Why do you need to know my zip code?

Each geographical area has its own "usual, customary, and reasonable" (UCR) rate that is based on the area's availability of certain services, the average cost of those services, and the number of providers in the area. As a result, health insurance rates also vary from area to area, frequently following the geographical boundaries of zip codes. Usually, the rates for each specific small group plan are based on the zip code where the employer's main address is located.

Who do I contact if I need help?

Your personal health insurance advisor is able to walk you through this process from beginning to end. At Compare-Health-Quotes.com, we believe in providing you with stellar customer service to address all of your health insurance needs.

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      Just call 888-423-6437 anytime to speak to a health insurance advisor.

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      Send us an email atinfo@benepath.com and we will get back to you as soon as possible.

The only two employees in our company are my spouse and me. How should this information be entered?

In order to be eligible for a small business group health plan, it is necessary to provide tax documentation that you and your spouse are separately compensated as full-time owners, officers, partners, and/or employees of your company. The following forms are acceptable verifiable state tax documentation: (WR30) (MDES-1) (UC-018) (UI-3S) (UI-340) (TWC 3-C) (UC-2A). On the application, enter your information on separate rows leaving the Spouse column marked "No" for both of you. You may list any eligible dependent children under either spouse, but be sure not to duplicate dependent information.

Should I only include employees who want insurance?

All of your employees should be included even if they don't plan to utilize the insurance you offer because the total group size is often a factor in determining your eligibility for certain plans. A general rule of thumb is that a higher number of eligible employees almost always partners with a wider selection and more flexibility in your choice of plans.

Am I eligible to enroll under a small business health insurance plan?

There are three criteria when determining eligibility. First, you must have filed tax documents that authenticate that there are at least two owners, officers, partners, and/or employees that work full time. Second, the purpose of your business cannot be to acquire insurance and you must be able to prove via business license, articles of incorporation, or articles of organization that you own a legally recognized company. The final criterion for eligibility rests on simply meeting the insurance company's requirement for ratio of employer contribution. Please note that in addition to the above listed items, each state and insurance company will have its own eligibility criteria.