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What is A Group Health Insurance Plan?

Health InsuranceThe type of insurance coverage is practically one of the major elements that employees consider when staying in a certain company. Therefore, it is crucial that one with the best coverage be offered since, not only does it improve retention percentage, but attracts new talents as well.

Insurance companies usually recommend affordable plans. Thus, they opt to offer a group health insurance wherein more than half of the American employee population is covered under. In this type of policy, employers are the ones to acquire and shoulder 50% or more of the required total monthly contribution. And since it is more about getting coverage due to a common cause than a necessity, it would still cost less than purchasing individual plans. This makes it a win-win situation for both parties. This is also why it is currently considered as the most popular benefit a company can offer.

A “POP (Premium Only Plan) allows members to make their share of contribution on a pre-tax basis. This is the type of plan most employees in the U.S is covered under. They are not taxed for company contribution as well which makes this heavily subsidized in terms of taxation.

Are All Policies applicable to all types of companies?

Based on laws that govern in a particular state, health insurance policies may actually vary. Moreover, the comprehensive health care reform law enacted in March 2010 (Affordable Care Act (ACA) also enabled the federal government to lay down several regulations on such insurance plans.

The same applies to those with self-acquired plans or those working in small or minor companies. Hence, there are differences in the laws for the coverage offered and the premium when working in a small company, which is considered to have less than or equal to 50 full-time employees and a large company with larger number of heads mentioned. This leads us to the conclusion that not all policies are the same.

Lost Group Insurance Coverage

Thanks to the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), individuals who have lost access to group insurance due to job loss, incidents, or any other reasons, may still be allowed to keep their group coverage for a certain time. Most are even given the privilege to enjoy unlimited group coverage.

Though proven beneficial, this may not be applicable in some states wherein COBRA does not exist.  However, better options that offer ample benefits are provided.  Consider going through the benefit summary booklet provided by your employer for more information with regard to how this may affect you. La Fayette, CA

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Understanding Requirements and Premium Rates for Small Group Health Insurance

Health InsuranceAny company or business having less than 50 full-time or part-time “equivalent” employees is legally considered a small company or employer. Thus, any business with more than 50 full-time employees would legally be a “large” employer.

The laws governing group health insurance policies for small businesses and large businesses differ quite a bit, and this article will be discussing the ones related to small group health insurance, which is a must have employee benefit.

Understanding the Coverage Requirements

First things first, small businesses aren’t “legally” required to provide group health insurance coverage to their employees. However, many small employers do simply because it’s an important component in enticing new talent and retaining the top workers.

Also, while the federal and state laws may apply to small employers, it depends on various factors, such as the number of employees, the type of business and whether the coverage is being provided through an insurance company.

However, the Affordable Care Act (ACA) requires that the small group health insurance plans meet certain requirements. It has set different benchmarks to ensure that the employees get a certain level of benefit.

The different levels or “metal tiers” of benefits are simply based on what the plan pays of the average total medical expenses.

  • Platinum plans: These are the best ones, but also the most expensive. They usually cover as much as around 90% of medical expenses
  • Gold plans: These plans cover 80% of medical expenses
  • Silver plans: A silver plan would usually cover around 70% of medical expenses
  • Bronze plans: These are the most affordable ones and offer the least benefits, paying just around 60% of medical expenses

You may also want to note that the above mentioned tiers reflect the average medical expenses it may cover. It isn’t the same as coinsurance, which requires the individual to pay a certain percentage of the overall medical expenses.

There are also several other requirements when it comes to group insurance coverage, based on laws that are covered under the ERISA, HIPAA and other similar acts.

Determination of the Premium Rates

After the introduction of the ACA, premium rates are highly determined in a different way than they used to be. Basically, they are based on the modified community rating, which takes limited factors into consideration for coming up with the premium rates.

Such factors include age, geography or demographic profile. For example, the rate would be higher for a 50-year-old male employee who’s a regular smoker and suffers from cancer and a major health condition.

However, the rate would be the same for providing insurance coverage to a 30-year-old healthy male employee and a 30-year-old male employee with diabetes.

Finally, depending on the state, an employer may be able to allow their employees to choose the insurance company. They may also be able to offer them different plan options within a particular metal tier (platinum, gold, silver or bronze), or different plans at different levels. Dublin, CA

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An Overview of Small Group Benefit Administration

5-SmallGroup Walnut CreekGroup insurance offers many benefits to both employer and employees, managing it may be a bit of a hassle. That being said, a small group benefit administration service may be the solution for employers who don’t want to deal with the hassle involved, but still want to offer all the benefits of small group insurance they possibly can their employees.

In other words, the insurance provider will take care of everything associated with small group insurance process for the employer. Let’s go through the things involved that are taken care of by the insurance benefit administration service.

Sharing the Group Details with the Employees

The basic yet important part of small group insurance process. When the employees aren’t aware of the plan details, or were not able understand what they mean, this may cause them to end up making the wrong decision.

The important details to the employees are much better explain by a group of insurance provider that handles the administration of the plan in a way they could understand. These would also allow employees to make changes to their contract easily if they want, which can otherwise be very confusing for them.

Handling Enrollment and Enrollment Changes

In the event of marriage, divorce, death of dependant, new child, etc many insurance benefit administrators would handle the enrollment process as well as the enrollment changes. Submitting the file electronically by the employee, would be considerably more convenient than submitting them manually through an employer.

Similarly, small group insurance administration would take care of the terminating enrollments, special provisions, as well as answer all the inquiries the employees may have about the plan, benefits or eligibility criteria.

Handling Claims

When it comes to POP the administrator handle the claims directly for your employees. However, if the employee seeks the services of a professional that’s not a part of their network they may not handle it.

Managing Billing

Managing billing and payments is a lot easier as well, with the administrator taking care of most of the work.

The insurance provider handling the administration may generate invoices both online and  hard copies, and would make them available at different intervals, depending on the plan. Also, if any of the enrollees require special billing arrangements, the provider may help them make it a part of their contract.

Finally, they would also handle the payments by allowing the enrollees to pay using different payment methods as well as setting up automatic payments.

A Final Word

While there’s more to what we discussed above, we wanted to give you an overview of what small group insurance administration means and how it can help you as an employer.

Good benefits administrator would help achieve a higher level of efficiency and a smoother integration between claims management and administration.Walnut Creek 6-Things You


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Things You Need to Know About Health Insurance Brokers and Agents

8-Understanding La FayetteDepending on the broker or agent you choose, they can be helpful when it comes to choosing the right health insurance plan for your family or your employees (if you’re in business). A good broker can also help save a bit of time and money, which you would probably spend trying to figure out the right product for your needs.

For instance, an experienced group Health Net health insurance broker may help businesses understand the different types of plans they can go for even those that are offered by another provider they work with as a broker.

More importantly, while buying a health insurance plan a broker or agent may be the best way to not end up choosing a wrong plan, which can often be disastrous.

Help you understand your insurance needs

Licensed brokers or agents are now officially known as insurance “producers”. As for why you may need one, the American health care system can be very confusing and complex. A good and knowledgeable insurance producer can explain the things you need to know about in a simple and easy-to-understand way.

Furthermore, they may even give you an insight of your insurance needs, which, in turn, will help you choose the right plan.

Types of insurance producers

“Captive” producers are typically those that work for a particular insurance provider as their employee. On the other hand, independent insurance producers don’t work for any particular provider, but with many of them, and a percent of the plan amount or a flat fee as a commission.

Should you go with a broker or agent?

Well, this choice could be really subjective and depends on a few different factors. An agent who works for a particular company as an employee may help you get better rates, better support, make it easier to change plans and connect you better with your provider.

A broker can help you find a better fit by searching through the market for different plans and finding one that fits the bill perfectly for you.

While the decision may depend on your needs, it’s better to meet a few agents and brokers. Also remember that working with multiple agents may not be a good idea, as it would be pretty much the same as working with a broker, but with limited advantages.

Why health insurance is different?

Unlike other types of insurance, health insurance is very different. This is because buying the plan is only a small part of the process.

In fact, it’s also not very uncommon to switch plans a few years down the line, as the health insurance needs of your employees or family are constantly changing.

Hence, you would want to find an insurance producer who would not only help you choose the right health insurance plan, but also the right carrier, as it can be crucial as well when it comes to getting the support you need after purchasing the plan.

La Fayette 8-Understanding



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How to Become a Successful Group Kaiser Health Insurance Broker

San Jose Insurance BrokerHow to Become a Successful Group Kaiser Health Insurance Broker?

Kaiser Permanente is one of the reputed insurance providers out there that offers different types of insurance plans. Similarly, it also has a wide range of plans that are designed to meet the specific needs of a small business.

It also offers many resources to help new brokers get started with doing business with them. Finally, the application process is fairly simple as well, and if you’re qualified to become an insurance broker, you may get approved in less than 10 days.

However, despite these things, you may still need to educate yourself about many different things if you want to become a successful group Kaiser health insurance broker, or a successful insurance broker of any company for that matter.

So without further ado, let’s take a look at those things, which can make or break a new insurance broker.

Being Patient

One of the common mistakes many new group health insurance brokers make is trying to rush the selling process. This is especially a big mistake while selling to businesses, as there may be many formalities involved and it may require the suggestions or approval of many different officials of the company.

That being said, while you need to be patient with the selling process, you should also understand when to move it along. You need to provide the information the business is looking for, or may help it take the right decision. You would also want to build a relationship with the client at the same time, in order to turn them into a long-term one.

Identifying the “Quality” of Leads

It can be very frustrating for a new insurance broker to lose leads that they put in a lot of time and efforts to get. That being said, it’s an important skill to learn for an insurance broker to be able to get an idea of the quality of leads.

So basically, you would want to focus on the most qualified leads and avoid the ones that may waste your time (and still may not result in a sale).

Back Your Claims with “Logic”

Exaggerating the facts and talking only about the rates are considered old-school tactics and don’t work effectively anymore. Instead, you may want to back your claims with logic, so that they make perfect sense to the potential client.

You should be more focused on understanding the business’ goals and offering a solution accordingly, instead of doing the same sales talk every time you meet a potential client. You can use the resources Kaiser Permanente offers to its brokers, and it may definitely help you find better plan choices for your potential clients.

Building a Relationship

Perhaps the only thing that used to work a decade back, and still works, and may also work for the next few decades or so in the insurance industry is building a relationship with your clients. It’s the best way to connect to your clients and get to know their requirements better.

And when the requirements are clear, you can come up with an effective solution and convincing explanation. San Jose City