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Frequently Asked Questions

By Business Owners

1. Do I have to offer insurance to my employees?

2. What portion of an employee's health insurance do I have to pay?

3. Is the premium I pay considered taxable income to my employees?

4. Can I offer coverage to my management employees only?

5. I want to offer an HSA-compatible plan. Do I have to fund the employee HSA?

6. Do I have to choose a specific plan for my employees?

7. My employees have asked for dental and vision insurance, but I don't want to pay for it. Is there a group plan available to my employees?

8. Do I have to explain the plan options to my employees?

By Individuals

1. I've heard that I can't be denied for insurance regardless of my pre-existing conditions. Is that correct?

2. Do I have to purchase health insurance?

3. I'm afraid that if I have a serious medical problem, the insurance company will drop me or raise my rates?

4. Why do my rates increase?

5. Will the new PPACA Legislation keep costs down?

6. What options are available to keep my costs down?

7. What's the difference between deductible, coinsurance, and out-of-pocket maximum?

Answers

By Business Owners

1. Do I have to offer insurance to my employees?

No, not now and maybe not in the future either. Most Central Coast employers have fewer than 50 full-time (equivalent) employees. New legislation mandates groups that have 50+ full-time employees provide coverage after January 2014 (delayed to January 2015). Small employers can, however, earn a tax credit by providing coverage.

2. What portion of an employee's health insurance do I have to pay?

Insurance law requires that the employer pay a “substantial portion” of the employee-only premium. That amount varies by insurance company, but is commonly 50% of a chosen plan.

3. Is the premium I pay considered taxable income to my employees?

Not at this time.

4. Can I offer coverage to my management employees only?

Probably not. Provisions in the new health legislation specifically restrict doing so. However, management-only groups may be eligible if union employees comprise the remainder of the employees (union-carveout).

5. I want to offer an HSA-compatible plan. Do I have to fund the employee HSA?

No. Contributions to the account may be made by the employer, employee or a combination of both (or not at all)

6. Do I have to choose a specific plan for my employees?

No. Most companies now allow you to determine how much you want to pay, and your employee chooses what plan they want.

7. My employees have asked for dental and vision insurance, but I don't want to pay for it. Is there a group plan available to my employees?

Yes. Many carriers now offer voluntary coverage to groups. Those employees that want coverage pay for exactly what they want.

8. Do I have to explain the plan options to my employees?

Absolutely not. We will meet with your employee at your office or our office, individually or as a group, and educate them on the offered plans. You should be free to do what you do best.

By Individuals

1. I've heard that I can't be denied for insurance regardless of my pre-existing conditions. Is that correct?

You can no longer be denied coverage due to a pre-existing condition.  However,  you do have to apply during the open enrollment period.

2. Do I have to purchase health insurance?

Health Insurance coverage became mandatory on January 1, 2014. You must either purchase insurance or pay a fine.

3. I'm afraid that if I have a serious medical problem, the insurance company will drop me or raise my rates?

Insurance companies in California have not been able to drop you or raise your rates based on medical claims, for many years. Your policy can only be taken from you if you intentionally withheld information from the company when originally applying for insurance, and even then, only in rare cases.

4. Why do my rates increase?

Medical treatment continues to increase in price. New technologies, treatments, and medications continue to be introduced. At the same time, our nation is getting older and using medical treatments more frequently. Those increased costs, as well as cost-shifting caused by the uninsured, are spread across those who are insured.

5. Will the new PPACA Legislation keep costs down?

Probably not. Implementation of the first provisions of the act have actually caused rates to increase. In theory, if everyone had insurance, insurance rates might stabilize. It will be many years before we can hope for any positive effects of the legislation. At the same time, no provision of the PPACA can keep our nation from aging and demanding more care.

6. What options are available to keep my costs down?

Shop the market for the most competitive company. All options, including high deductible plans, should be considered. Premium is the only cost you know you’ll have each month. Keep your premium low and be prepared to self-insure the small stuff should something happen.

7. What's the difference between deductible, coinsurance, and out-of-pocket maximum?

The deductible is that amount that you have to pay before any benefits are paid by the insurance company. Coinsurance is the portion of claims payment shared by you and the insurance company (usually 20% or 30% paid by you). The out-of-pocket maximum is made up of your deductible and coinsurance, and limits your annual claims exposure. The insurance company pays 100% after your maximum is met. It is very important that your maximum out-of-pocket per year be manageable.

Applying for Individual Insurance just got easier!

Click on the links below to apply online with Anthem Blue Cross and Blue Shield. Please let us know if you have any questions.

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