Eva No Comments

Understanding Requirements and Premium Rates for Small Group Health Insurance

Requirements April 2018 (1)Understanding Requirements and Premium Rates for Small Group Health Insurance

A businesses having less than 50 employees are being considered as a small companies while the companies with 50 full-time employees or equivalent or more, are those considered as legally the large employers. Since small companies apparently differ when it comes to number of employees as compared to large companies, the laws regulating group health insurance policies for each type also vary. It is important that this topic is being discussed in detail for better understanding about small group health insurance.

Understanding the Coverage Requirements

In searching for new talents and maintaining a high employee’s retention rate especially to keep best workers, providing group health insurance coverage is one of the important factors for most employers. This why even small companies are required by the law to provide group health insurance to their employees, they tend to provide one since they know how this benefit attracts and maintain best employees and talents.

Although federal and state laws may apply to small businesses, there are various factors are still being considered such as the type of business, how big or small the company is, and if their plan coverage is being provided by an insurance company. However, because of the existence of Affordable Care Act (ACA), small group insurance plans has to meet certain level of requirements. ACA set benchmark to make sure that employees get the right amount of benefits.

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

The tiers mentioned above reflect the average medical expenses they may cover. It isn’t the same as coinsurance, which requires an individual to pay a certain percentage of the overall medical expenses.

When it comes to group insurance coverage, there are also several other requirements that are based on laws that being covered under ERISA, HIPAA and other such acts.

Determination of the Premium Rates                                                        

Due to implementation of ACA, premium rates have changed a lot in different ways that they used to be. They are based on the modified community rating, which takes limited factors into consideration for coming up with the premium rates. Factors included are age, geography or employees’ lifestyle like if he or she is a smoker or not. Let’s say in a case of a middle-age male worker and a regular smoker who’s suffering from cancer, the rate would be higher then. However, the rate of a 30-year old healthy male employee with diabetes would be the same.

But still the bottom line is, it would still depend on the state if an employer may allow their employees to choose their insurance company. And in similar way, insurance companies may also be able to offer employees various plan options within a particular level (platinum, gold, silver or bronze).La Fayette CA April 2018

 

Eva No Comments

Things You Need to Know About Health Insurance Brokers and Agents

Things You Need to Know About Health Insurance Brokers and Agents

In choosing a health insurance for your company or for your family, your broker or insurance agent has different capability and level of knowledge. One can be helpful or not at all. A good broker is the one that’s helping you to save time and money. This means that he or she is providing you all the best possible plan coverage options that fits to your company or family needs because getting as what we know that it would be still best to get a consultation from one of them in choosing the right insurance plan to prevent a wrong decision. The one that understands what your business needs would be an experienced Group Health Insurance broker.  This kind of broker knows the different types of plans you can go for even those plans being offered by other broker and can give you enough information you need and will help you easily choose what would be the best for you.

Understanding your Insurance NeedsInsurance-Broker March

“Producers” is the official term named to licensed brokers or agents. Because of the complex American Health Care System, Americans need a good and knowledgeable insurance provider. This is to prevent confusions and wrong decision that you may choose regarding Group Health Insurance. Make sure to get help from the one that you think can explain you the policies in a simple and easy-to-understand way. This type of producer is also giving you insights of your insurance needs which in return, guarantees in choosing the best plan.

Types of Insurance Producers

Typical producers that work for a particular insurance provider as their employee are known as “Captive” producers. While those producers that don’t work under a particular provider are independent insurance producers but with many of them, and get a percent of the plan amount or a flat fee as a commission.

Should you go with an agent or a broker?

Why should we get some help from a broker or an agent? This decision can be really subjective and depends on a few different aspects. An agent who works for a particular company as an employee may help you get better rates; better knowledge and explanations make it easier to change plans and connect you better with your provider. However, on the other hand, 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.

Your decision should always be based on your needs then it is better to find your options from few agents or brokers. Always 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.

Health Insurance Compare to other types of Insurance

Buying a health insurance 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. You would want to search for an insurance producer who would not only help you choose the right health insurance plan, but also the right carrier, as it can be also critical when it comes to getting the help after purchasing the plan. 

 

Eva No Comments

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

Eva No Comments

Things You Need to Know About Group Health Insurance Plans

Things You Need to Know About Group Health Insurance Plans

Most companies in the United Stated, small or big corporations, employers offer group health insurance to their employees as one of the many benefits they can provide. This type of insurance is much known and in demand as it is being provided to more than half of the population of the American workers.

Insurance Feb 2018 (1)What are the Advantages?

On most health insurance policies that have been given to employees, it is usually half or more of the required of total monthly contribution are being paid by the employers which is apparently very advantages on employees part considering the benefits they are getting. And in the United States, most employees are covered under “POP” plans, or Premium Only Plans which allows them to have their health insurance contribution fall as pre-tax. Moreover, the employer’s contribution’s taxes are not being paid by their employees since these taxes are covered by POP and this makes these plans heavily subsidized in taxation.

Getting group insurance plans is very advantageous for both on employers and employees. It has very affordable rates if we are to compare it to any individual insurance. This is why even though it is not that necessity for most employees, most American companies purchasing the group insurance plans since it is resulting a win-win results for both employees and employers.

Good employees are talents and assets to the company. This is why employee retention is very significant factors in a company.  And that being said, employers are likely to offer great employees benefits to their best workers and perhaps it is proven as one of the most effective ways to retain best employees. This is also another way of attracting new talents to most companies.

Above of all the advantages that have mentioned is that, having group insurance plan leads to good outcome, preventing unplanned leaves and improved workers.

Are All Insurance Plans the Same?

Different insurance policies have similarities but definitely have differences. One of these reasons is the differences of laws in each and every state that regulate these policies. In addition, the federal government also affects the policies through Affordable Care Act (ACA). Federal government has been implementing regulation to such insurance plans. This also affects those individuals who purchase their own policies, especially those employees working in small companies. There are things that are not the same between working in small companies and in bigger one.

A company that has less than 50 fulltime employees are considered as small business company, while the one with bigger number of employees are large business types such as large enterprise or a corporation. This only means that the laws regulating the company insurance coverage varies depending on its business type as well.

When Losing Access to the Group Insurance Coverage.

Some of the reasons why a person could lose an access to his or her insurance coverage are job loss, divorce and such other similar reasons, however group insurance coverage can still be kept within a certain period of time. This is one of the good thing about group insurance compare to other insurances. Moreover, some can even extend their insurances as long as the group insurance is existing. Thanks to the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). However, COBRA doesn’t exist in all the states (and doesn’t apply to all employers), but in some of the states it doesn’t, there are actually better options that offer more generous benefits.

So better to be certain and have enough knowledge about your insurance policy once your employer have provided you the benefit summary reference.San Jose Feb 2018

Eva No Comments

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