Group Health Insurance Experts

Frequently Asked Questions

Answer: Yes, and the paperwork must be processed within 30 days of the date in which they should have become effective. Waiting periods may no longer exceed 90 days. 

Q.  Do I have to use the same waiting period for all employees under my group plan? 

Answer: Their health coverage can be postponed until your group’s open enrollment. Their life and disability coverage could be medically underwritten and subject to denial.

Q.  What if new employees apply late?

Answer: They can make changes and additions to their contract if there is a qualified event. Qualified events are birth, adoption, marriage, court order, divorce, involuntary loss of other group coverage (if they waived your plan and were covered under their spouse’s employer’s plan, then lost that coverage due to change in job, etc.). They only have 30 days in which to react to a qualified event.

Q.  Can employees make changes to their health plan during the year or just at renewal?

Answer: Yes, we recommend such meetings so that the benefits are understood and properly used. If you have multiple locations we can offer the option of meeting with your employees through a webinar. 

Q.  Would our agent be available to provide employee meetings and explain the programs?

Answer: Many policies permit us to add an employee back into the plan within 60 days without going through the waiting period.  

Q.  Will employees be subjected to a new waiting period when returning from a layoff?

Answer: Some carriers do provide this benefit. If your carrier does not, we will be happy to quote an individual product.  

Q.  Can employees purchase additional amounts of life coverage through the group-term life program?

Answer: If your group plan meets the affordability test and the minimum value test, the employee would not be eligible for subsidies, even if they waive your plan.  

Q.  Are employees eligible for subsidies through the government exchanges if they are eligible for our group’s plan?

Answer: No, they may enroll during the mandated open enrollment period in the fall, or due to a qualified event. They may not simply go without insurance and then randomly decide to purchase when their budget allows, or when medical risks develop. 

Q.  Can people apply for health insurance in the individual market at any time?

Answer: It depends on the employer’s size. The count is based on the total number of full time equivalent employees (there is a factor for counting part time employees) across any controlled group (commonly owned companies), not just those on the health plan. Full time is currently defined as averaging 30 hours per week. For 2015 the requirement will apply to groups with 100 or more full time equivalents. For 2016 it will apply to those with 50 or more full time equivalents. 

Q.  Are employers required to offer health insurance due to the ACA (health care reform)?




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