This month, we are continuing our answers to frequently asked questions from prospects and clients. These may be helpful to you in preparing for possible questions from your own clients and their employees.
1. What’s the application process like for employers and employees?
If your clients are interested in getting Health Insurance coverage that’s compliant with the Affordable Care Act (ACA), it’s simpler now than in the years before the ACA. That’s because the ACA allows employees who are parents to add children up to age 26 to their plans. It also prohibits insurance companies from denying coverage to those with pre-existing health conditions. It eliminates a ceiling on lifetime benefits and prevents insurers from dropping coverage for anyone who gets sick. It also requires insurance companies to spend at least 80% of premiums on medical services, or provide a rebate to policyholders.
As far as the actual application process goes, it’s quite simple. An employer application is required for each carrier selected – or for the exchange if your clients want coverage through CaliforniaChoice, the multi-carrier private exchange, or the public exchanges in California or Nevada (Covered California or the Nevada Health Link). An application is also required from each employee. If your client chooses more than medical coverage, additional forms may be required.
2. Can I get more than Health Insurance for my small business employees?
Yes. A broker can help employers understand all of their available options. While Group Health Insurance requires employer sponsorship, other coverage like Dental, Vision, and Accident Insurance is often available on a voluntary basis. That means employers can increase coverage options available to employees without increasing their costs – because employees pay the full cost of voluntary coverage through payroll deduction.
3. Do all employer-sponsored health plans include coverage for maternity?
Plans that are compliant with the Affordable Care Act (ACA) must include coverage for maternity care. It’s considered one of the ACA’s essential health benefits, which plans are required to include. The amount employees pay for maternity-related benefits depends on the metal tier (Bronze, Silver, Gold, or Platinum) of the plan selected. Another law that affects employers with 15 or more employees is the Pregnancy Discrimination Act of 1978.
While small businesses (those with fewer than 50 full-time or full-time equivalent employees) are not required to offer health care and maternity benefits, if they do, coverage must include maternity care.
The ACA prohibits health plans from rejecting applicants with pre-existing conditions (including pregnancy), so if an employer hires someone who is pregnant, she is eligible for coverage subject to the waiting period set by the employer, if any.
4. Are premiums for my employee health care likely to change?
Unfortunately, there is no easy answer. Premiums have increased at a smaller pace in recent years, but some plans have seen bigger increases. Rates vary by plan type and insurer. If an employer selects a group health plan, or exchange, rates are typically locked-in for 12 months. However, at renewal, rates are subject to change. A broker can provide information about the rates increase history for the carrier(s) being considered.
5. What different types of group Health Insurance plans can I choose from for my employees?
Word & Brown does business with dozens of Small Group and Large Group carrier partners, who offer a variety of coverage options, including:
- Health Maintenance Organization (HMO) plans;
- Preferred Provider Organization (PPO) plans;
- Point of Service (POS) plans;
- Exclusive Provider Organization (EPO) plans;
- Health Care Service Plans (HSPs); and
- High Deductible Health Plans (HDHPs), including some of the coverages listed above, which can be paired with a Health Savings Account (HSA).
Different plans offer different pricing and advantages for employees and dependents. Not all carriers offer all of the plan types mentioned in all markets in California and Nevada.
Answers to Your Questions
If your prospects and clients have other questions that you need help answering, you can count on your Word & Brown representative and our Account Management team to help you find answers. If you are not already a Word & Brown broker, visit our new broker web page to sign up, or contact any of our six regional offices in California and Nevada.