F.A.Q. Group Coverage

How do Group and Individual Health Insurance plans differ?

Group health plans is coverage for group of employees of a company, non-profit or governmental entity. Group coverage is guarantee issue, which means a policy will be issued regardless of medical conditions of the employees. However, if there was no prior coverage, there may be a waiting period of up to 12 months for preexisting conditions. A group’s health plan’s rate will be determined by the age and health conditions of the group; location; industry. Group plans generally include maternity coverage. The plans are frequently more expensive than individual plans, but the coverage tends to be more comprehensive. Finally, group health plans have significant tax advantages to both the employer and employees. For the employer the premium is tax deductible. In addition for smaller groups there may be an additional tax credit, subject to certain restrictions. For the employees the group health coverage is not taxable.

An individual health plan includes and individual and can include a spouse and children. However, they differ from group plans in that companies are able to deny coverage based on an individual's medical conditions at time of application. Thus, they are limited to individuals in by and large in good health. If one has preexisting conditions most individual plans will either exclude (known as a rider) the condition, increase the premium or both. In certain circumstances a company may decline to coverage. In addition, depending on the carrier. maternity coverage is either optional (generally rather expensive) or is not offered. Since the passage of healthcare reform companies have tended to increase their underwriting standards. Finally, except for self employed individuals health insurance premiums are generally not tax deductible.

Why should a company offer a Group Health Insurance Plan?

Health insurance benefits are highly valued by employees. It is generally agreed that they are second in importance only to financial compensation.

What products does incSurance provide?

incSurance provides a full range of group insurance products including health insurance both traditional major medical and limited benefit health plans; dental plans; accident plans; critical illness; disability both long and short term plans; and vision plans.

What companies are eligible for Group Insurance Coverage?

Generally any business or non-profit entity with two or more full time employees is eligible for group coverage. Group health insurance is known as Guarantee Issue, which means that subject to certain conditions the insurance carrier has to issue a policy to all applicants.

Who is considered a full time employee?

For heath insurance a full time employee is usually defined as someone working 30 hours a week (those this will vary to some degree by state) whose income is reported on a Form W2. Some companies will allow 1099 employees if they comprise a small percent of the total employees insured. Owners working full-time in the business and taking Schedule C income are of course considered full time employees.

Do health insurance rates increase as you get older?

Unfortunately, yes both for both group and individual plans. As people age they tend to use more medical services and health insurance companies rates reflect this. The rates for a 60 year old are generally two to three times those of a 30 year old.

How does one get a Group Health Insurance Proposal?

The first step is take a couple of minutes and fill out our Group Health Insurance census. Then speaking with a member of our licensed insurance staff to discuss your individual needs and requirements will allow us to develop a customized proposal that meets your specific needs. We constantly talk with business owners who have plans that do not meet their coverage or budget needs. Taking a few minutes to provide us with the basic information and discussing your needs has No Obligation on you or your company.

What is the process for applying for group health insurance?

The process of applying for group health insurance is usually more straight forward and faster than generally expected.

The first step is to discuss with your advisor or broker the coverage needs and budget for your group. Coverages and thus costs vary widely between companies even for similar coverage. Coverage varies from very generous plans to those providing more limited catastrophic benefits. You should determine what percentage of the employee only premium the business is willing to pay (the minimum is 50%) and that of dependents (optional).

The next step is to provide a very basic census of those to be covered including employee name, date of birth; who is to be covered - employee, employee and spouse; employee and child (ren) or family. date of birth of the spouse; and number of children to be covered.

The third step is to discuss and review the proposals to determine which fit your needs and budget.

The fourth step is to fill out enrollment forms to a company for underwriting. The underwriting will determine final rates based on the enrolling demographics of the group and medical conditions for the group.

The final stage is to review the final rates and offer from the carriers and determine which is best suited to a company’s needs.

How are Group Health Insurance rates determined?

In most states rates are determined by the demographics of the group. Demographics include age, gender, size, location and industry of the group. Further, in most states rates can be adjusted (also called medical load) for preexisting medical conditions in the group. The amount of this medical load is determined based on medical conditions listed on the application and is limited to a maximum under state law. No medical exams are required.

Does Group Health Insurance have a waiting period to cover a preexisting condition?

If an employee has had coverage for 12 months with no gap in coverage exceeding 62 days, there is no waiting period preexisting conditions. If an employee has had coverage for less than 12 months the waiting period is 12 months less the number of months previously covered. Thus, an individual with six months coverage would have a waiting period of six months. If an employee has not had coverage for more than 12 months the waiting period for preexisting conditions is 12 months.New medical conditions are covered immediately for all employees.

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