TRBenefits | San Jose Group Health Insurance Broker

Generally, businesses are categorized into two major types, a small company or a large company. A company reaching 50 full-time employees or equivalent, or has more than this number is legally a large business. On the other hand, a business having less than 50 full-time employees is then considered as small business. That being said, laws governing different types of businesses also differ quite a bit when it comes to health insurance. The objective of this article to provide some learning to workers or employees regarding small group health insurance that is very important to them.

Learn about Coverage Requirements

Based on laws, small employers are not obliged to provide group health insurance coverage to their employees. However, there are important business needs or factors that most small employers have given a lot of consideration. These are employee retention, especially when keeping best workers and attracting new talents for the business, reasons why small group health insurance are being provided by the employers. Meanwhile, there are some cases that federal and state laws may apply to small employers. However, there are factors that still need to be considered such as number of employees and the type of business and if the coverage is being provided through an insurance company. But because of the implementation of the Affordable Care Act (ACA), certain level of requirements has to be included in a small group health insurance plans. ACA has set different benchmarks to ensure that employees get the right amount of benefits.

“Metal tiers” or the different levels of benefits are basically based on the plan pays of the average total medical expenses.

• Platinum plans: These are the best ones, but also the most expensive. They usually cover as much as around 90% of medical expenses
• Gold plans: These plans cover 80% of medical expenses
• Silver plans: A silver plan would usually cover around 70% of medical expenses
• Bronze plans: These are the most affordable ones and offer the least benefits, paying just around 60% of medical expenses

Please take note that the levels mentioned above reflect the average medical expenses they may cover. It isn’t the same as coinsurance, which requires an individual to pay a certain percentage of the overall medical expenses. There are also several other requirements when it comes to group insurance coverage, based on laws that are covered under the ERISA, HIPAA and other such acts.

Determination of the Premium Rates

Presenting of ACA affects how premium rates are being determined in different ways that they used to be. They are mainly based on the modified community rating that takes limited factors into consideration for coming up with the premium rates. These factors are age, geography and the life style or health status of an employee. For an instance, the rate of a 50-year old male employee happens to be a chain smoker and suffers from cancer would likely be higher due to his major health condition. However, a 30-year old healthy male employee with diabetes would still get the same high insurance coverage rate.

Depending on the state where you reside, as an employee, your employer may allow you to choose your insurance company. Moreover, they may also be able to offer you different plan options within a particular metal tiers or different levels.

San Jose March

If you’re in a business that’s looking for an insurance provider, an agent or broker can be very helpful in choosing the right plan for your company or even for the best insurance coverage plan for your family. A good broker can definitely help you to save a bit of time and money which probably you might be spending when you are trying to look for the best insurance plan on your own.

This is how important a health insurance agent or a broker in choosing the right coverage plan for you especially if one has enough understanding on your business need and for your employees. A knowledgeable agent or broker will provide you all the best options and let you understand them.

Help you understand your insurance needs

A licensed agent or broker is commonly named as “producer”. Due to the complexity of the American Health Care System, we likely need their assistance to prevent any confusion in choosing the right plan. Explaining what are the insurance coverage plan is not that easy job that can be done by anybody. One should be knowledgeable enough to provide explanation and will let us understand the plan easily. Moreover, a good producer is providing you insights of your insurance needs and would be a guarantee that you’ll choose the best decision for your insurance needs.

Types of Producers

There are two common types of producers. They are the “captive” and “independent”. Captive producers are usually the one who are working under an insurance company while the independent producers work on their own or not for a specific insurance company or provider. However, most of them ae the same in a way that both types of producers are getting percent of the plan amount or a flat fee as a commission.

Should you go with an agent or a broker?

Getting consultation from a broker or an agent about how to choose the best insurance coverage plan would be a good step for a business owner. In this way, an employer will get his or her best options on what would be the right plan for his business, what’s best for their employees and even when looking for own insurances for his or her family. Brokers and agents are the one that has enough knowledge and understanding about business needs. They can provide insights of your insurance needs, which, in turn, will help you choose the right plan. They can also help you find a better fit by searching through the market for different plans and finding one that fits the bill perfectly for you. Since decision may depend on your needs, it’s better to meet a few agents and brokers. Finally, also remember that working with multiple agents may not be a good idea, as it would be pretty much the same as working with a broker, but with limited advantages.

Why health insurance is different?

Health insurance is different from other type of insurances. This is because buying the plan is only a small part of the process. It’s also not very uncommon to switch plans a few years down the line, as the health insurance needs of your employees or family are constantly changing. Getting help from the right people, searching for options, and having enough information about group health insurance may take a bit of time but these are ways to save your time and money and will provide you a long term good result and will definitely be beneficial to the people your providing for. Please be also reminded that health insurance needs of your employees or family are constantly changing. 

One of the main factors that people considers in accepting a job offer is the insurance coverage that is being offered by the company they’re applying to. Therefore, for employers, it is very crucial for them in choosing what coverage they should be offering to their employees to improve retention percentage and in attracting new talents as well.

Most insurance companies offer affordable and competitive insurance coverage. Thus, they opt to offer a group health insurance wherein more than half of the American employee population is covered under. In this type of policy, employers are the one to acquire the insurance for their employees and shoulder half or most part of the monthly contribution. And since it is more about getting coverage due to a common cause than a necessity, it would still cost less than purchasing individual plans. So this will result into a win-win situation on both sides. And this is the reason how health insurance benefits is the most popular among company offers.

A Premium Only Plan allows members to make their share of contribution on a pre-tax basis. This is the type of plan most employees in the U.S is covered under. They are not taxed for company contribution as well which makes this heavily subsidized in terms of taxation.

Are All Policies applicable to all types of companies?

Based on laws that govern in a particular state, health insurance policies may actually vary. Moreover, the comprehensive health care reform law enacted in March 2010 (Affordable Care Act (ACA) also enabled the federal government to lay down several regulations on such insurance plans.

The same applies to those with self-acquired plans or those working in small or minor companies. Hence, there are differences in the laws for the coverage offered and the premium when working in a small company, which is considered to have less than or equal to 50 full-time employees and a large company with larger number of heads mentioned. This leads us to the conclusion that not all policies are the same.

Lost Group Insurance Coverage

Thanks to the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA), individuals who have lost access to group insurance due to job loss, incidents, or any other reasons, may still be allowed to keep their group coverage for a certain time. Most are even given the privilege to enjoy unlimited group coverage.

Though proven beneficial, this may not be applicable in some states wherein COBRA does not exist.  However, better options that offer ample benefits are provided.  Consider going through the benefit summary booklet provided by your employer for more information with regard to how this may affect you.

In the year 2012 the U.S. Census revealed that there are around 28 million small businesses in the state that provides employment to 52.6 million Americans. Although at present it isn’t a legal requirement for small business to provide insurance coverage to their employees, it’s certainly one of the most important factor when recruiting and retaining top talents.

Traditional Plans vs. “Managed Care”

Small group benefits offered by a particular group health insurance plan depends on many different aspects, including whether it’s a traditional plan or a “managed care” plan.

Traditional plans often come with higher premiums, but offers access to wider option for medical practitioners, services and institutions. On the other hand, a managed care plan would usually cost considerably less, however the choices would be a little limited when it comes to medical services.

Both type of plans are sold by major health insurance providers, and most states require that the employer covers at least 50% of the premium costs.

However, many employers think that they need to pay 100% of the premium costs, discouraging them from offering this crucial employee benefit. Most of the employers agree that not offering adequate health insurance coverage affects their relationships with the employees in an adverse way, with 75% revealing that their business suffers due to not offering small group benefits related to health insurance coverage to their employees.

Reasons for Providing Health Insurance Coverage to Your Employees

After going through the information above, it could be concluded that providing employees with health insurance coverage may not be as expensive as many employers think, and not doing so may not allow the business to grow at its full potential.

Let’s take a look at why a small business should consider providing health insurance coverage, though it isn’t required to.

Recruiting and Retaining Top Talent

As mentioned,  group insurance coverage is currently considered to be one of the most important employee benefits, it displays a great impact on attracting new talent. This is especially true when it comes to small companies, as most new employees may be interested to join a large business instead of a small business.

Similarly, even some of your best employees may consider joining another company that offers better employee benefits at some point in the future, but with the help of a great group health insurance plan may prevent them from doing so.

Tax Benefits

Offering a group health insurance coverage would also present a considerably wide range of benefit for both employees and employers in terms of taxes. Firstly, all the expenses incurred for providing the insurance coverage would be 100% tax-deductible for the business.

If the employer exerts effort in taking care of the legal formalities, even the employees’ contribution can be made on a pre-tax basis. The employer can also make the employees’ contribution BEFORE paying them, so that they won’t have to deal with any tax liabilities related to their contribution and end up with a higher take-home pay than they otherwise would.

Kaiser Permanente is one of the reputed insurance providers out there that offers different types of insurance plans. It has a wide range of plans that are designed to meet the specific needs of a small business.

It also offers many resources to help new brokers get started with doing business with them. Finally, the application process is fairly simple as well, and if you’re qualified to become an insurance broker, you may get approved in less than 10 days.

However, despite these things, you may still need to educate yourself about many different things if you want to become a successful group Kaiser health insurance broker, or a successful insurance broker of any company for that matter.

So without further ado, let’s take a look at those things, which can make or break a new insurance broker.

Being Patient

One common mistake many new group health insurance brokers make is rushing the selling process. This is a big mistake while selling to businesses, as there may be many formalities involved and it may require the suggestions or approval of many different officials of the company.

That being said, while you need to be patient with the selling process, you should also understand when to move it along. You need to provide the information the business is looking for, or may help it take the right decision. You would also want to build a relationship with the client in order to turn them into a long-term one.

Identifying the “Quality” of Leads

It can be very frustrating for a new insurance broker to lose leads that they put in a lot of time and efforts to get. That is why it’s an important skill to learn for an insurance broker to be able to get an idea of the quality of leads.

Basically, you would want to focus on the most qualified leads and avoid the ones that may waste your time (and still may not result in a sale).

Back Your Claims with “Logic”

Exaggerating the facts and talking only about the rates are considered old-school tactics and don’t work effectively anymore. Instead, you may want to back your claims with logic, so that they make perfect sense to the potential client.

You should be more focused on understanding the business’ goals and offering a solution accordingly, instead of doing the same sales talk every time you meet a potential client. You can use the resources Kaiser Permanente offers to its brokers, and it may definitely help you find better plan choices for your potential clients.

Building a Relationship

Perhaps the only thing that used to work a decade back, and still works, and may also work for the next few decades or so in the insurance industry is building a relationship with your clients. It’s the best way to connect to your clients and get to know their requirements better.

And when the requirements are clear, you can come up with an effective solution and convincing explanation.

One of the benefits being offered to employees by the company whom they’re working for is a group health insurance. It’s a very popular employee benefit as it provides insurance coverage to more than half of the Americans.

Employers are the ones to purchase this type of insurance policy. Therefore, half or more of the required total monthly contribution usually comes from them. Most employees in the U.S. are under “POP” plans, or Premium Only Plans, which allows them to make their part of the contribution on a pre-tax basis.

Aside from several other tax benefits for the employees covered under a POP plan, they are not taxed for company contribution   As a result; these are heavily subsidized when it comes to taxation.

A group insurance plan is also very affordable. Insurance companies are usually more than willing to offer plans at considerably cheaper rates than what you would get while purchasing individual plans due to the fact that it is more about getting coverage due to a common cause than a necessity. Thus, makes this a win-win situation for both parties.

Offering great benefits is perhaps considered one of the most effective ways of retaining the employees. Therefore, the best insurance coverage would be advantageous for a company. In addition, a great group health insurance plan also attracts new talent to your company.

A better overall health of your employee means less unplanned leaves and an improved morale of workers.

Are All Policies the Same?

Technically speaking, no, not all policies are the same. Health insurance policies may vary depending on the laws that govern in a particular state. Secondly, with the implementation of the Affordable Care Act (ACA), the federal government, too, has laid down several regulations on such insurance plans.

This is also true for those who have acquired different plan on their own, as well as those working for minor companies. Basically, things differ when it comes to working for a small company compared to working for a major company.

It is taken into consideration that any company having less than 50 full-time or the “equivalent” of full-time employees is a small company. Other businesses having a larger number of workers base are large employers. That being said, the laws are different for the coverage offered by both, and the premium tends to differ as well.

What if I Lose Access to the Group Insurance Coverage?

Those who have lost access to group insurance due to job loss, incidents, or other reasons, may still be allowed to keep their group coverage for a certain time. Many are even able to continue with the group coverage without any time limitations, thanks to the federal Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA).

However, COBRA doesn’t exist in all the states (and doesn’t apply to all employers), but in some of the states it doesn’t, there are actually better options that offer more generous benefits.

Finally, you may want to be sure about how it may affect you by going through the benefit summary booklet provided by your employer.

An Overview of Small Group Benefit Administration

While group insurance is considered a very important employee benefit, and offers many benefits to both employer and employees, managing it may be a bit of a hassle. That being said, a small group benefit administration service may be the solution for employers who don’t want to deal with the hassle involved, but still want to offer their employees all the benefits of small group insurance they possibly can.

In other words, it means that the insurance provider will take care of everything involved in the small group insurance process for the employer. So without further ado, let’s go through the things involved that are taken care of by the insurance benefit administration service.

Sharing the Group Details with the Employees

This is a basic, but fairly important part of the small group insurance process. When the employees aren’t aware of the plan details, or don’t understand what they mean, may end up making the wrong decision.

A group insurance provider that handles the administration of the plan would be in a much better position to explain all the important details to the employees in a way that makes it easier to understand for them. Similarly, it would also allow them to make changes to their contract easily if they want, which can otherwise be very confusing for them.

Handling Enrollment and Enrollment Changes

Many insurance benefit administrators would also handle the enrollment process as well as the enrollment changes in the event of marriage, divorce, death of dependant, new child, etc. Employees may be able to submit the file electronically, which would be considerably more convenient than submitting them manually through an employer.

Similarly, small group insurance administration would take care of the terminating enrollments, special provisions, as well as answer all the inquiries the employees may have about the plan, benefits or eligibility criteria.

Handling Claims

The administrator may also handle the claims directly for your employees, especially when it comes to POP. However, most providers may still not handle the claims if the employee seeks the services of a professional that’s not a part of their network.

Managing Billing

Similarly, managing billing and payments would get a lot easier as well, with the administrator taking care of most of the work involved.

The insurance provider handling the administration may generate invoices both online and as hard copies, and would make them available at different intervals, depending on the plan. Also, if any of the enrollees require special billing arrangements, the provider may help them make it a part of their contract.

Finally, they would also handle the payments by allowing the enrollees to pay using different payment methods as well as setting up automatic payments.

A Final Word

While there’s more to what we discussed above, we just wanted to give you an overview of what small group insurance administration means and how it can help you as an employer.

A good benefits administrator would help achieve a higher level of efficiency and a smoother integration between claims management and administration.

What are the Small Group Benefits When it Comes to Insurance Coverage?

The 2012 U.S. Census revealed that there are around 28 million small businesses in the U.S. that provide employment to as many as 52.6 million Americans. Now, while it isn’t a legal requirement for small business to provide insurance coverage to their employees, it’s certainly one of the most important factors when it comes to recruiting and retaining top talent.

Traditional Plans vs. “Managed Care”

The small group benefits offered by a particular group health insurance plan depend on many different factors, including whether it’s a traditional plan or a “managed care” plan.

Traditional plans often come with higher premiums, but offer access to a wide range of doctors and hospitals. On the other hand, a managed care plan would usually cost considerably less, but it would be a little limited when it comes to choosing doctors and hospitals.

Both types of plans are sold by major health insurance providers, and most states require that the employer covers at least 50% of the premium costs.

However, many employers think that they need to pay 100% of the premium costs, discouraging them from offering this crucial employee benefit. But most of them agree that not offering adequate health insurance coverage affects their relationships with the employees in an adverse way, with as many as 75% revealing that their business suffers due to not offering small group benefits related to health insurance coverage to their employees.

Reasons for Providing Health Insurance Coverage to Your Employees

After going through the information shared above, it can be concluded that providing employees with health insurance coverage may not be as expensive as many employers think, and not doing so may not allow the business to grow at its full potential.

With that being said, let’s take a look at why a small business should consider providing health insurance coverage to its employees, though it isn’t required to.

Recruiting and Retaining Top Talent

As mentioned above, group insurance coverage is considered to be one of the most important employee benefits nowadays, and helps attract new talent. This is especially true when it comes to small companies, as most new employees may be tempted to join a large business instead of a small business.

However, great employee benefits, including group health insurance coverage, can help attract them to your company. Similarly, even some of your best employees may consider joining another company that offers better employee benefits at some point in the future, but a great group health insurance plan may prevent them from doing so.

Tax Benefits

There are also many tax benefits of offering group health insurance coverage to your employees, for both the employer and the employees. Firstly, all the expenses incurred for providing the insurance coverage would be 100% tax-deductible for the business.

Similarly, if the employer puts in some efforts to take care of the legal formalities, even the employees’ contribution can be made on a pre-tax basis. The employer can also make the employees’ contribution BEFORE paying them, so that they won’t have to deal with any tax liabilities related to their contribution and end up with a higher take-home pay than they otherwise would.

Understanding Requirements and Premium Rates for Small Group Health Insurance

Any company or business having less than 50 full-time or full-time “equivalent” employees is legally considered a small company or employer. Similarly, any business with more than 50 full-time employees would legally be a “large” employer.

The laws governing group health insurance policies for small businesses and large businesses tend to differ quite a bit, and this article will be discussing the ones related to small group health insurance, which is considered a very important employee benefit.

Understanding the Coverage Requirements

First things first, small businesses aren’t “legally” required to provide group health insurance coverage to their employees. However, many small employers still do so simply because it’s an important factor when it comes to attracting new talent and retaining the top employees.

Also, while the federal and state laws may apply to small employers, it depends on various factors, such as the number of employees, the type of business and whether the coverage is being provided through an insurance company.

However, the Affordable Care Act (ACA) requires that the small group health insurance plans meet certain requirements. It has set different benchmarks to ensure that the employees get a certain level of benefit.

The different levels or “metal tiers” of benefits are simply based on what the plan pays of the average total medical expenses.

• Platinum plans: These are the best ones, but also the most expensive. They usually cover as much as around 90% of medical expenses
• Gold plans: These plans cover 80% of medical expenses
• Silver plans: A silver plan would usually cover around 70% of medical expenses
• Bronze plans: These are the most affordable ones and offer the least benefits, paying just around 60% of medical expenses

You may also want to note that the above mentioned tiers reflect the average medical expenses they may cover. It isn’t the same as coinsurance, which requires an individual to pay a certain percentage of the overall medical expenses.

There are also several other requirements when it comes to group insurance coverage, based on laws that are covered under the ERISA, HIPAA and other such acts.

Determination of the Premium Rates

After the introduction of the ACA, premium rates are determined in a very different way than they used to be. Basically, they are based on the modified community rating, which takes limited factors into consideration for coming up with the premium rates.

Such factors include age, geography or whether the employee is a smoker or not. So for example, the rate would be higher for a 50-year-old male employee who’s a regular smoker and suffers from cancer and a major health condition.

However, the rate would be same for providing insurance coverage to a 30-year-old healthy male employee and a 30-year-old male employee with diabetes.

Finally, depending on the state, an employer may be able to allow their employees to choose the insurance company. Similarly, they may also be able to offer them different plan options within a particular metal tier (platinum, gold, silver or bronze), or different plans at different levels.

The Benefits of Small Group Insurance and Small Groups Benefits Administration

The best investment you can make for your business is in your employees. When you have employees, you must ensure that you protect them. The way to protect them is by offering them the benefit of group health insurance with your business. With group health insurance, you can give your employees affordable health care while working for you. The only problem is most employers don’t understand what small group health insurance is and the benefits that it offers to your employees. In this post, we hope to shed some light as to what small group insurance is, how you can use it to protect your staff and how you can go about getting this insurance for their business.

Small Group Health Insurance

With small group health insurance, an employer can offer the benefits of health insurance to their employees. Small group health insurance helps to make insurance more affordable for employees. If an employee were to get insurance on their own, it would cost them a lot more than if they were to get group insurance.

Affordable health insurance is also a benefit for an employer. When insurance is more available, your employees are more likely to take advantage of it by having checkups more regularly. With regular checkups, a person can prevent illnesses from early. Regular checkups result in healthier employees and more efficiency for your business. By now you should have a better reason why small group health insurance is a benefit for your business.

How Small Group Health Insurance Works

An insurance company can offer group health insurance at a discount. By creating a pool of people who will be on this insurance, the risk is spread evenly. When the risk is spread like this, each employee gets equal benefits.

With small group health insurance, an employee can see a doctor included in the network for cheaper than if they were to go to a doctor on their own. This offers an enormous financial benefit to the person who obtains this insurance.

Getting Small Group Insurance

Finding the right plan for your business starts with knowing what type of protection your business needs. Taking the time to sit down with a professional insurance company is how you obtain this information. As a small business, you can purchase insurance plans:

• Through a private website
• Through a public SHOP online marketplace
• Through a licensed health insurance agent or broker

Overall you want to work with a company that has a trusted reputation and one who will work with you to assess your situation. Once they assess your situation, they then create a plan that best suits your business. One such company is Kaiser Permanente.

Conclusion

Small group health insurance is one of the most important things you can include in your business. There’s no better way to build the confidence of your employees than having the benefit of better healthcare. Doing this will allows you to protect your employees and their families which then increases their productivity. Invest in your employees by investing in small group health insurance.