Question: Is it possible to offer one group
plan even though I have employees in several states?
Yes. Several companies offer plans with nationwide
Question: When does the "deductible" period start?
The deductible runs on a calendar year and starts
over every January. However, some plans may offer a deductible carryover credit,
which will allow the deductible to carryover to the next year, if you met
the deductible in the last 3 months of the year.
Question: Are there exceptions to this calendar year period for deductibles?
Yes, be careful of plans that have a deductible "per
surgery" or "per illness". These kind of deductions make it hard to protect
your total annual risk exposure.
Question: How are preventive visits covered?
Preventive care is now covered at 100%. Plans after
10/1/2010 are not even subject to a copay.
Question: What is generally NOT covered?
Each plan design should specifically list exclusions.
HSA plans are unique because they allow you to use your "savings account"
portion of the plan to pay for certain approved services that may not be covered
by an insurance policy. (For example alternative healthcare such as acupuncture
and chiropractic care)
Question: What is a PPO?
A PPO stands for "preferred provider organization".
This means that there is a preferred network of doctors that will offer contracted
or discounted rates to the insurance company. You do have the option to go
out of the network for care with a PPO.
Question: How do I know if my doctor is in my PPO network?
Most companies offer an updated directory on their
web site. However, it's always best to check with your doctor to make sure
they plan on staying on that network.
Question: I am thinking of offering dental benefits
to my employees. Since I haven't offered it in the past, will there be a
Some companies offer immediate coverage for basic
and major services, even if you have not had previous dental coverage.
: "Yes", many insurance companies will offer
coverage to a new company.
Question: How many employees must I have to be able to offer a group plan?
You only need 2 full-time employees to write a group plan.
HSA Plans for Groups
Question: Do you have to be self-employed
to have a HSA account?
No, anyone can have an HSA, but you do have
to have a HSA compatible health insurance plan first.
Question: Can an employer offer an HSA plan to
their employees as a "group" plan?
Question: What are the contribution limits for
- 2015: individual/$3350 family/$6650
- 2016: individual/$3350 family/$6750
Question: Are there rules on when you can contribute
to an HSA savings account?
You can contribute from January through April
15th of the following year, as long as you haven't exceeded limits per IRS
"Yes", as long as they are full-time employees and
you don't discriminate among them.
Question: Does every group have to offer COBRA?
No. In Texas, smaller groups are subject to
State Continuation for up to 9 months.
Question: How long can a child stay
on their parent's plan?
Per the new Health Care reform to age 26, whether
the child is married or not.
ACA/Health Exchange Questions
Question: I know that in 2014 everyone must have
insurance but what if I can't afford it?
Based on your income, you may be eligible for a government