Employer FAQ

How many employees are required to qualify for group health coverage?
You need at least two full-time “eligible” employees or owners. The two “eligible” can be an owner and an employee, two partners of a partnership, or two officers of a corporation.

Does group health insurance cost less than individual health insurance?
No. Individual health insurance is usually less expensive and offer more cost effective plan options. However, it may be difficult to qualify for individual coverage since many individuals are declined due to pre-existing medical conditions. Group policies guarantee coverage to eligible employees, regardless of health history.

How many employees have to enroll?
As a general rule, most carriers require at least 70% of eligible full-time employees must enroll under the plan or document they have other group coverage through a spouse. Participation requirements do not apply to dependents.

What is the definition of eligible "full-time” employee?
An employee who works at least 30 or more hours per week, and who has met the company waiting period to be eligible for group benefits.

Can part-time employees enroll?
If the employer chooses to offer coverage for part-time employees, employees who work as few as 20 hours per week may qualify. There are additional underwriting restrictions which may apply.

How much of the premium does the employer have to pay?
As a general rule, most carriers require that the employer contribute at least 50% of the employee health insurance premium. The employer is not required to contribute to the cost of dependent coverage.

Does my company need Worker’s Compensation Insurance to qualify?
Yes. In most cases, 100% of the eligible employees must be covered by Worker’s Compensation Insurance, except for those people that are exempt under Federal or state laws.

What documentation is required to qualify?
This depends on the structure of your business. If you have employees, you will typically need to provide a copy of your most recent quarterly wage and tax report (DE-6 in California). Some health insurance companies will consider payroll records to be sufficient documentation of employment. For partnerships or corporations, in which owners may not be drawing wages, you may need to provide a business license, articles of incorporation or other documents verifying the legitimacy and your involvement in the business.

My business currently provides group health insurance coverage. Will a replacement group health plan apply pre-existing condition exclusions?
In most circumstances the answer is NO: If an employee has satisfied the pre-existing condition limitation waiting period under the previous group plan, that employee will not have to re-satisfy the pre-existing condition exclusion waiting period under the replacement plan.

What is the pre-existing condition exclusion rule for pregnancy?
Under group plans, pregnancy is NOT subject to a pre-existing condition exclusion. This is federal law. The rule applies equally to new and current employees.

Can a group health insurance application be declined?
Group coverage is “guarantee issue”, and therefore, cannot be declined due to medical history. However, if the business does not meet the insurer's participation and employer contribution requirements, they group application can be declined.

When does COBRA continuation apply?
COBRA applies to employer groups that averaged 20 or more full-time employees during the previous calendar year. COBRA compliance regulations apply to the employer, not to the insurance company. Potential civil and regulatory penalties for COBRA noncompliance can be considerable. We suggest employers should not rely too heavily on insurance agents for COBRA advice. This area of expertise is better suited to professional COBRA administrators or legal counsel.

Can any group of people organize to purchase group health insurance?
No. There must be a legitimate “employer-employee” relationship to qualify.

Can independent contractors be insured under a group health plan?
Usually not, although some group health insurers offer limited flexibility on this issue.

Can I save money by working directly with the insurance company?
No. The rates are the same for small group (50 or fewer employees) and rate filings are regulated by the state. Most group health insurance companies prefer that you work with an independent agency like Benefit Pro Insurance.

Is any one insurance carrier really better than another?
YES. There are big differences in rate competitiveness, benefit choices, network access, administrative services and financial stability. We can assist you with making the right choices.

Can we offer employees a choice of different health insurance plans?
YES. Such options are typically available to groups of 10 or more employees, though a few insurers make such options available for as few as 2 employees.

What are Health Savings Account (HSA) plans?
Small employer demand for Health Savings Accounts (HSAs) has become a popular option for employers. Most health insurers that are not already offering HSA-related products are rapidly developing such offerings. Although HSAs and their accompanying qualified High-Deductible Health Plans (HDHPs) are not for everyone, they merit consideration by some small employers.

For how long am I committed to keep a policy?
Most group health insurance policies are purchase as a month-to-month contract. Should you discontinue your current plan, be sure to notify your insurer in writing.

What can one do to minimize group health insurance rate increases?
We offer to annually shop the group health insurance coverage to assure that we’re consistently getting the best value and benefit options available in the market.