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FAQs

Questions About Group Insurance

Are you looking into getting group health insurance for your employees? If it’s your first time, you probably have questions.

Not all companies are required to offer benefits to employees, but doing so can be an effective tool in employee retention and it can also serve as a tax advantage. Check out these common questions business owners ask.

A business needs at least two owners, or one owner and one full-time employee, or two full-time employees to qualify. Some insurance companies allow groups to be formed with a husband and wife owned company.

It may also depend on your business type and the level of participation.

Any employee working 30 hours or more a week is eligible for benefits coverage.

No, there is not!

Advanced Benefit Solutions is here to help your small business select quality benefits packages complete with health insurance for your employees. We are experts in each step of the insurance process from plan design to enrollment and other services.

We’ll be here for you and your employees, serving as a resource for your business.

Insurance is complicated.

We invest heavily in technology to help employers with the enrollment and administration of their policy. Onboarding is the technology based enrollment system.

Between online enrollment platforms, client portals, and DocuSign, among others, this reduces unnecessary steps that increase complications and eliminate paper forms.

In most cases, the terminated employee will still have company benefits through the end of the month following their date of termination.

When an employee’s coverage terminates, come the first of the following month, they will have one of three options:

  1. Continuation of coverage or COBRA.
  2. Join another employer’s plan.
  3. Acquire an individual policy.

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Common Questions from Employees

Your employees will have questions about their benefits! Here are some of the most common questions your employees may ask.

Each company is unique, however, your employer may contribute a portion to your benefits package. We recommend you speak to your company benefits administrator for further details.

Your company policy has a waiting period based on your date of hire. Additionally, there are qualifying events that allow you to enroll in benefits after you are initially eligible for coverage.

Typically, you will receive your (benefit) ID cards approximately 7-10 business days after your enrollment onto the insurance company site.

They will be sent to your home address directly from the insurance carrier. You will also be able to access your medical ID card via online or when you download the insurance company’s benefits app.

Remember that you can still use your insurance if the policy is active, even without your ID cards.

The person at your company in charge of your benefits plan will have a summary of your benefits.

Coverage can be confirmed by calling the carrier directly. Please refer to these websites:

Questions About Individual Health Insurance

An HMO is: Health Maintenance Organization Plan
These plans provide IN Network benefits only (typically within the insureds service area of residency) and require that an In Network Primary Care Physician is assigned to the policy and one must obtain an In Network Specialist referral from the assigned PCP before seeing the Specialist.

An EPO is: Exclusive Provider Organization Plan
These plans provide IN Network benefits only (typically within the insureds service area of residency) and do not require a referral from an assigned Primary Care Physician on your policy to see an In Network Specialist.

A POS is: Point of Service Plan
This plan will provide In Network benefits and Out of Network Benefits. With this plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. POS plans also require you to get a referral from your primary care doctor in order to see a specialist.

Short-term Plan
A Major Medical Health plan that has a defined start date and end date. The policy cannot last longer than three months, with a possible extension of one month beginning September 2024.

Indemnity Plan
This type of plan does not replace major medical insurance. The coverage amount for services is predetermined for this type of plan, typically paying the policy holder a fixed cash benefit for covered services.

Any consumer earning a Premium Tax Credit to reduce their monthly health plan premium will reconcile the amount of the tax credit earned when they file their income taxes for the year that the credit was earned. The premium tax credit is based on an estimated annual income and has to be “trued up” once the income for the year is actually earned.

To reconcile, you compare two amounts: the premium tax credit you used in advance during the year; and the amount of tax credit you qualify for based on your final income.

In Network means that Providers and Facilities have contracted with Insurance Carriers and accepted the reimbursement rate for services that the Insurance companies are willing to pay Providers/Facilities. This typically results in about an 40%-60% discount on services to the Insured.

Out of Network are Providers or Facilities have no agreed contract with a Carrier and therefore the patient will pay the Provider or Facility for cost of Services at their requested price for services. Basically the patient will negotiate price directly with Provider or Facility for Out of Network services, becoming a cash pay patient. Some Providers will not accept cash pay patients or have insurance with a Carrier that they do not accept.

Emergency services are defined as a medical event that could cause loss of life or limb if not treated immediately, where ever the patient is regardless of their Insurance being Out of Network as in the case of the HMO or EPO.

Open enrollment is the time designated each year when you can purchase or apply for health insurance or make changes to your current health insurance plan, without a qualifying event. Different plans have different Open Enrollments.

  • Individual Market is November 1st through January 15th annually.
  • Medicare Annual Enrollment Period (AEP) is October 15th through December 7th annually.
  • Medicare Advantage Open Enrollment Period is January 1 through March 31 annually.

Depending on the Clients situation and type of coverage they are needing, Special Enrollment periods are strictly defined and enforced. Certain situations allow for enrolling in a plan outside of Open Enrollment.