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Frequently Asked Questions


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Question
How many employees do I need to have to receive a quote? 
Answer
You must have at least 2 employees. Most carriers will require that the second employee is a W-2 employee that is not the spouse of the owner.
Question
Do small business plans cover pre-existing conditions? 
Answer
Yes. Additionally, carriers cannot increase premiums based on pre-existing conditions.
Question
What factors are used to determine the monthly premiums for a small business medical plan? 
Answer
Under the ACA’s reforms, issuers and carriers may vary the premium rates charged to a non-grandfathered plan from the rate established for that plan based on age, family size, geographical region and/or tobacco usage. All other factors are prohibited. This means that several factors commonly used by issuers to set higher premiums prior to 2014 (such as health status, claims history, duration or coverage, gender, occupation, small employer size and industry) can no longer be used.
Question
When can I start my health insurance plan for my Small Business?
Answer
You can start a new insurance plan any month of the year and most insurance companies begin coverage on the first of the month. Some carriers will allow coverage to begin on the 15th of the month and every carrier has a deadline on when your submission documents have to be received in order secure the effective date you are requesting.
Question
How long are rates guaranteed for?
Answer
The standard rate guarantee period for medical premiums are 12 months. Ancillary coverages such as vision or life insurance can have longer rate guaranteed periods.
Question
What is a waiting period?
Answer
A waiting period is the period of time that must pass before coverage for an employee is eligible to enroll in your company-sponsored benefits.
Question
What is the maximum waiting period I can add to my benefit program?
Answer
For plan years beginning on or after January 1, 2014, the Affordable Care Act (ACA) prohibits any group plan and group health insurance issuers from applying a waiting period that exceeds 90 days.
Question
What is the permitted orientation period? 
Answer
Employers may impose a one month orientation period as a condition for eligibility for coverage under a plan. During this time both parties could evaluate whether the employment situation was satisfactory and standard orientation and training processes would begin. The waiting period would begin once the orientation period ended. Employers are not required to select an orientation period.
Question
When will I receive a copy of my small business renewal?
Answer
Carriers will release a copy of your renewal between 30 and 60 days prior to your renewal date. Your renewal date is typically 12 months from your plan effective date. If you have not received a copy of your renewal, please reach out to your benefit service team using one of the options listed at the bottom of the page.
Question
What is a Qualifying Life Event (QLE)?
Answer
This is an event that will trigger a special enrollment period during the plan year that will allow you to make midyear changes to your benefit elections. Examples of a QLE are: Loss of other coverage, gain of other coverage, marriage, divorce, birth or adoption, death of a dependent or Medicare/Medicaid entitlement.
Question
How long do employees have to make a midyear enrollment change if they experience a QLE? 
Answer
All QLE’s must be reported and processed within 30 days of the QLE Event Date. If the request is submitted after 30 days, the employee will need to wait for the annual open enrollment period in order to make changes.
Question
How long can my adult child remain covered under my health plan?
Answer
Health plans are required to permit children to stay on family coverage until they turn 26. This rule applies to all plans in the individual market. Note that state law requirements may require offering coverage beyond age 26.
Question
Is the coverage for my adult dependent taxable?
Answer
No, the value of the coverage is not subject to federal tax for the employee or dependent. The health care reform law revised the Internal Revenue Code to clarify that the cost of coverage for a taxpayer's child is excluded from income through the end of the year in which the child turns 26. However, state requirements may differ, so state taxes may apply.
Question
Can I get coverage for my child who has a pre-existing condition?
Answer
Health plans that cover children are not able to deny coverage to your child under 19 years old based on a pre-existing condition.
Question
What consumer protections will I get if I obtain insurance at work? 
Answer
Effective for the first plan year beginning after September 23, 2010, health plans will be prohibited from placing lifetime limits on what they will pay for your medical care and they can only apply restricted annual benefit limits. Insurers will no longer be able to arbitrarily cancel your insurance policy when you get sick, except in cases of fraud or material misrepresentation.

Health plans will be prohibited from denying coverage to children with pre-existing conditions. This applies to all non-grandfathered and grandfathered plans.
 
All non-grandfathered group health plans must provide coverage for preventive services. Recommended prevention and vaccination services will be covered without any deductibles or copayments. Plans must also have a straightforward and independent appeals process so you can appeal decisions by your health insurance company.
Question
Can my insurance company terminate my coverage if I get sick?
Answer
Effective for the first plan year beginning after September 23, 2010, insurance companies will be prohibited from retroactively dropping, or rescinding, your coverage when you get sick. Rescissions of coverage will only be allowed in cases of fraud or material misrepresentation. This rule will apply to all non-grandfathered and grandfathered plans.
Question
When does free preventive care start and will it affect my plan?
Answer
Effective for plan years beginning after September 23, 2010, all non-grandfathered group health plans and plans in the individual market must provide coverage for preventive services. Recommended prevention and vaccination services will be covered without any deductibles or copayments. Seniors enrolled in Medicare will also no longer have to pay for proven preventive services.

Effective for plan years beginning on or after Aug. 1, 2012, non-grandfathered health plans must provide additional preventive services for women without cost sharing, such as coverage for well woman visits, breastfeeding support and contraception. Exceptions to the contraceptive coverage requirement apply to religious employers.
Question
Did the health care reform law eliminate COBRA? 
Answer
No. The health care reform law did not eliminate COBRA or change the COBRA rules.
Question
Did the health care reform law extend the COBRA premium subsidy extension?
Answer
No. The health care reform law did not extend the eligibility time period for the COBRA premium reduction. Eligibility for the subsidy ended on May 31, 2010; however, those individuals who became eligible on or before May 31, 2010 can still receive the full 15 months as long as they remain otherwise eligible.
Question
Did the health care reform law extend the time period I can have COBRA beyond 18 months?
Answer

No. The health care reform law did not extend the maximum time periods of continuation coverage provided by COBRA. COBRA establishes required periods of coverage for continuation health benefits. A plan, however, may provide longer periods of coverage beyond those required by COBRA.

COBRA beneficiaries generally are eligible for group coverage during a maximum of 18 months for qualifying events due to employment termination or reduction of hours of work. Certain qualifying events, or a second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum of 36 months of coverage. Individuals who become disabled can extend the 18 month period of continuation coverage for a qualifying event that is a termination of employment or reduction of hours.

To qualify for additional months of COBRA continuation coverage, the qualified beneficiary must:

 

  • Have a ruling from the Social Security Administration that he or she became disabled within the first 60 days of COBRA continuation coverage (or before); and
  • Send the plan a copy of the Social Security ruling letter within 60 days of receipt, but prior to expiration of the 18-month period of coverage.
  • If these requirements are met, the entire family qualifies for an additional 11 months of COBRA continuation coverage.
Question
How does the health care reform law help me learn more about my health plan coverage?
Answer
Your health insurance company or group health plan is required to provide you with an easy-to-understand summary about benefits and coverage. This requirement is designed to help you better understand and evaluate your health coverage choices. This summary is called a Summary of Benefits and Coverage, or SBC. You may also request a glossary of terms from your health plan or health insurer. The glossary includes definitions for commonly used terms in health insurance coverage, such as "deductible" and "copayment."
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