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We help you and your employees feel satisfied with your benefits program.
We specialize in employee health plans, and also provide all the standard ancillary types of coverage including dental, vision, life, acupuncture, chiropractic and disability.
We provide all of our clients with access to a custom-branded enrollment management portal to streamline your process of bringing on new hires, as well as guidance on how to best use the resources made available by the insurance vendors.
A group is defined as at least 2 people, at least one of whom is paid on a W-2 basis and who is not related by marriage to any owner of the business. Partner-only businesses are no longer eligible for group plans under the Affordable Care Act.
Generally you need to provide documentation of the legitimacy of your business and sufficient payroll history to show you've been around at least a short while. The types of documents usually include a business license, proof that you are registered with the California Secretary of State's office, a Statement of Information listing business owners and address, and any DBA (Doing Business As) paperwork if applicable.
For payroll purposes, most insurance carriers will insist on a copy of the latest DE-9C Quarterly Contribution Return and Report of Wages form showing that at least one full time employee has been active for at least half of the prior calendar quarter. However, some carriers will accept less payroll, especially if you are a newly incorporated startup. If you have questions as to whether a group plan is a viable option, please contact us.
In some instances, a group plan will not consider an individual or family plan a qualifying reason to waive coverage. We can help you sort out the factors in play and find the right solution.
Except in one particular circumstance, you cannot. This is specifically prohibited under the ACA and carries stiff tax penalties of up to $36,500 per year per employee if you are shown to be reimbursing for open market plans.
There is a particular type of Health Reimbursement Arrangement (HRA) that small businesses can set up to allow partial reimbursement for purchase of plans on the individual market. This <strong>Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) must be done instead of a standard group plan and has far fewer protections for employers and employees. These arrangements do not have access to group plan networks, have no provisions for enrolling employees in coverage if they have missed the standard open enrollment period.
If you are a small group between 1-50 employees, you are not required to put a plan in place. However, the plan options available for groups are substantially more comprehensive than those available on the individual and family market.
Not all doctors contract with all plans, it's best to use these provider links and to double check with your doctor before scheduling any visits.
Nothing. A broker's services are always free to the consumer. We are paid by the insurance vendors, and it is a large part of our job to service your account and help resolve any issues that may arise.
It varies depending on the plan. Similar to your insurance, a deductible is the amount you pay in full up front before the insurance company steps in and pays the lion's share of the costs. However, there are some services that you pay for on a strict copayment structure that you do not need to meet the deductible for. These include almost all basic medical visits.
The amount you typically pay for office visits, laboratory tests, X-rays and prescriptions. After you pay the copay for these services, the insurance company typically pays the remainder. There are different copays and limits for out of network care, so try to stay in network whenever possible.
This is the maximum amount you could be required to pay out for claims incurred during any calendar year, provided that you are only using in-network services. The maximum is considerably higher if you use non-network services, so try to stay in the network.
In some plans, these providers are not covered at all. In other plans, they are covered to a much lower level. It is highly recommended not to go out of network if at all possible. If you must see an out of network provider for an emergency issue, this would be paid as an in-network expense.
These claims will often be declined or considered as out of network. Please use our services to help you attempt to get reimbursement on an in-network basis. We have a good track record with helping sort out claims problems, although we cannot guarantee this will always work out.
There is a requirement under the Affordable Care Act, frequently referred to as Obamacare, that all legal residents of the USA have coverage compliant with the new plan requirements. There are tax penalties for deciding not to purchase insurance. For members with coverage starting in 2015, this is 2.0% of your overall income, or $295, whichever is larger. For coverage beginning in 2016, the penalty will be 2.5% of your overall income or $695, whichever is larger.
No. Under the Affordable Care Act, there are no health questions asked and no effect on rates if you have a condition.
If you choose to set up a company plan, you are typically required to contribute at least 50% of the lowest-cost plan you implement. You are free to put in multiple plans (the number of plans will vary depending on the size of your company) and allow staff to customize their plan choice and pay any difference in premium as pre-tax payroll deductions.
We can set up a wide variety of different types of coverage for your firm. For more information, please take a look at our Other Benefits Page.
