Group health insurance is usually the only reasonable and economical insurance option for individuals and small businesses. As competition increases amongst insurance companies, more health options are available than ever before. Options that were previously available only to employees of a large corporation are now available to individuals and small businesses.
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Do I still need a certain number of people in my group to qualify for group insurance?
No! The definition of “small business” has changed, allowing sole proprietors and individuals who work alone, the full benefits of group health insurance coverage.
Insurance companies usually require some proof of business involvement, such as tax returns, bank statements or other financial documents. Some companies may also require a copy of a current business license or DBA, “doing business as” certificate.
How do I sort through all the options?
One of the best resources for services may be an insurance broker. A broker is a third party “middleman” who has access to and works with all local health insurance companies. A broker will lay out the options for competing insurance companies, side-by-side; helping consumers to make choices that are more informed.
Brokers assist in the application process. Once approved, they also administer policies, assist in claims processing and aid the insurance companies in billing and premium collection.
A recent New York Times article discusses the role of brokers in the health insurance industry. The article maintains that while changes are coming, our nation will continue to need health insurance brokers, who can expertly navigate complex insurance options for their customers.
Won’t using a broker cost me more?
No! The insurance companies pay the brokers for their services. Brokers are generally paid a small portion of the premium revenues they generate. This is considered part of the marketing or administrative costs for each insurance organization and has no direct impact on the rates it charges its clients.
Recent changes in federal health care legislation have tried to level the playing field for providers in an attempt to standardize insurance programs. This has only been partially successful and it remains to be seen if it will have a lasting effect on the insurance industry.
The government, in its recent Affordable Care Act, also establishes caps on insurance companies’ expenditures for administration and marketing. Electronic information gathering may also reduce costs to consumers and limit the need for third-party broker services in the future.
What specific health programs can my business apply for?
It is important to note here, that providers and programs vary widely from state to state and region to region across the United States. A consumer should thoroughly investigate all available resources in a given area before making a final insurance selection. Once again, the services of a broker can be invaluable in aiding this process.
As in the past, once an insurance provider is selected, the business owner and their employees will be limited to one or more specific health care programs. Membership is determined on an annual basis. There is usually a waiting period for new employees before becoming eligible for health benefits.
The employer decides which programs will be presented to its employees and how much money they will contribute to the program, if any. Employers also must decide if they will offer flexible spending accounts or other payroll benefits. Employers who use a professional payroll service are best equipped to offer these kinds of services to their employees.
Does everyone in a group have to have the same policy?
No, while all group members would be insured by the same insurance company under the company plan, there are still individual choices and benefits, which remain options for each insured individual or family member under the group plan.
Common options include:
- Individual or family coverage
- Regular deductibles or high deductible limits
- Prescription drug coverage
- Dental, vision, or hearing coverage (these may be added as separate insurance products)
- Coverage for mental health services
- Coverage for maternity
Do I have to accept group coverage?
No! If it’s to your advantage to refuse coverage, you may do so. Often, in a family, one spouse already has coverage, or a younger family member may already be covered under a family or school program. A careful study should be made of available options before refusing any insurance coverage since the opportunity to enroll only comes once each year.
For up-to-the-minute health insurance quotes, enter your zip code in the box provided!