Will
pre-existing condition exclusions be applied, if a business
is offering group coverage for the first time?
ANSWERS
Why
do rates increase year after year for group health insurance?
Though it is possible for group rates to remain the
same for several years, or actually go down, this is
not the norm. There are many factors in what seems to
be a permanent rise in health insurance costs. Primary
causes include:
General price inflation for medical services
The leveraging effect of fixed deductibles and co-payments
Insurance companies must adjust rates above the
general inflation rate when total claim cost increase,
but the portion paid by the insured person stays the
same.
Cost-shifting Providers make up for shortfalls
in government-sponsored program revenue by shifting
charges to the private sector.
Increases in health services utilization due to aging,
product promotion and improved diagnostic services.
The availability and use of more expensive treatment
and drug therapies.
Government-mandated benefits and other legislative changes.
Technological changes and their effect on the intensity
of care .
What
can an employer do to control group health insurance
rate increases?
The basic things you can do are:
Share more of the insurance premium cost with employees.
Choose medical plan designs that neutralize cost increase
components by providing incentives for more cost effective
plan usage, while channeling patients to the appropriate
provider and treatment options. HSA-compatible plans
are an example. Other examples are encouraging use of
centers of excellence, disease/case management programs
and eliminating fixed dollar co-pays.
Aggressively seek out more competitively-priced insurance
companies.
Individual Health Management Offer incentives
to use preventive care and wellness services.
For
group health insurance coverage, how many employees
are required?
At least two employees have to enroll, but you still
have to meet the insurance company's employee participation
requirement.
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What
percentage of a company have to enroll in the group
health plan?
As a general rule, at least 75% of eligible full-time
employees must either enroll in the plan or have other
group coverage through their spouse. At least 50% of
all eligible employees
must actually enroll. No participation requirements
apply to dependents.
Can
part-time employees be in the group plan?
Most health insurance companies will insure only full-time
employees (30 or more hours per week) under a small
group plan. Blue Cross Blue Shield of Arizona requires
25 hours a week.
When
can an employee sign up in a group health plan?
New employees can enroll upon completion of the initial
probationary period. Employees who don't enroll at that
time must wait for open enrollment (usually the policy
anniversary date) or a for a qualifying event.
When
can dependents sign up in a group health plan?
An employee's dependents can enroll upon completion
of the new hire probationary period. If dependents are
not enrolled at that time, they must wait for open enrollment
(usually the policy anniversary date) or a for a qualifying
event.
When
can a baby be enrolled in the group health plan?
A newborn baby can be added as of the birth date, but
it's critically important that the company
be notified within 30 days. Otherwise, the employee
may be
stuck with the nursery bills and the baby's health insurance
will have to wait until open enrollment or a qualifying
event.
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What
is a "qualifying event"?
A qualifying event is an occurrence (such as death,
termination of employment, divorce, etc.) that changes
an employee's eligibility status under a group health
plan. The term is frequently used in reference to COBRA
eligibility, but it can also refer to an event enabling
an active employee to make a coverage change at some
time other than open enrollment.
How
do insurance companies define "full-time"
employee?
A full-time employee is generally defined as an employee
working 30 or more hours per week, 25 with Blue Cross
Blue Shield of Arizona.
How
much does the employer have to pay of the group health
premium?
As a general rule, the employer must fund at least 50%
of the employee health insurance premium. The employer
is not required to fund any portion of the dependent
health insurance cost.
How
long does it take to obtain group health insurance?
From the time application materials are submitted, expect
at least a two or three week wait. However, it could
take longer, depending on how much additional documentation
the insurance company requests. If the application process
takes less than two weeks, consider it a pleasant surprise.
It helps if you work with an insurance broker who prepares
complete paperwork and anticipates concerns and questions
from the insurers underwriting department.
What
documentation is required by the health insurance company?
A primary concern of the health insurance company is
validating that enrolling persons are actually full-time
employees. Start-up businesses may not be able to provide
these reports. In such a circumstance, payroll records,
check stubs or other employment confirmation documentation
may meet the insurance company's requirements.
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Will
a replacement group health plan cover a pre-existing
condition exclusion to employees?
Persons who have satisfied the prior plan's pre-existing
condition exclusion should be credited likewise under
the new plan.
Persons who have partially satisfied the prior plan's
pre-existing condition exclusion should have the same
status under the replacement group plan.
Will
pre-existing condition exclusions be applied, if a business
is offering group coverage for the first time?
If a business is offering Arizona medical coverage for the
first time, will pre-existing condition exclusions be
applied?
Unless an employee or dependent has qualifying prior
health insurance that has ended no more than 62 days
prior to the effective date of the new group plan, that
person will have to satisfy the full pre-existing condition
exclusion waiting period.
Our
goal is to help consumers have informed decisions about
their health coverage. We encourage our visitors
to use this information for a more equipped
research process that involves many sources of information.
Send any questions to info@higginscompanies.com. Affordable Health Insurance.