- Am I eligible to have group health insurance in my state?
You must meet the definition of a small employer, meet participation requirements, and meet
employer contribution requirements.
- What is a small employer?
Employ at least two eligible employees, but no more than 50 employees. You must also have a
majority of eligible employees working in your state.
- What is the participation requirement?
At least 75 % of your employees must participate in coverage as a condition of obtaining a small
group health benefits plan. Employees waiving for spousal coverage, another group health plan
offered by the same employer or another employer, Medicare, or Medicaid are considered to be
participating in your plan.
- What is the employer contribution requirement?
A small employer must contribute at least 10 % of the total cost of the health benefits plan. This is
calculated as the annual premium for the employee and dependents.
- What information do I need to provide in order to receive a quote?
Company place of business, a complete list with each employee’s date of birth, gender, and
insurance coverage status (single, husband/wife, parent/child, or family). The effective date of when
you want the insurance to start, as well as residential zip codes for each employee. You do not need
to provide any personal information for employees such as names or social security numbers. You
may refer to them on the census provided by their initials or last name.
- What paperwork or documentation do I need to start a plan for my business?
Master application for your company that includes a small employer certification form. Check for the
first month’s premium on your business checking account made out to the insurance carrier. Each
employee must fill out an enrollment form or a waiver depending on if they plan on electing the
insurance. A copy of your quarterly wage and tax report (WR-30), any employees not listed on the
WR-30 will need to be shown on your monthly payroll. Owners not on the payroll must be on the
Schedule C or K1. Newly formed businesses can provide other documentation to prove employee
eligibility. If your company has prior health insurance, then you will be required to provide a copy of
your last bill. HSA plans will require documents to be filled out by the employer and employee.
- What waiting periods can I have for employees?
An employer can have a waiting period of up to 6 months. You may have a different waiting period
for current employees and new hires.
- When can employees enroll in my group health insurance plan?
As an employee of a company that has a group health insurance plan, you are only allowed to enroll
during specified times. An employee is initially allowed to enroll when he or she is first hired. If your
company has a waiting period for new hires, then they may have to wait 30 days or more to enroll.
- What types of plans are available?
PPO, POS and HMO plans are available. HSA compatible POS and HMO plans are also a popular cost
effective way to insure your company.
- What are the main differences between plan types?
HMO plans offer in-network benefits only.
PPO and POS plans offer in-network and out-of-network benefits.
Employees receive greater benefits when using in-network providers.
PPO and POS plans are generally more expensive than similar HMO plans. Deductibles and co-
insurance for major medical services can be added to lower premiums.
HSA compatible plans have a high deductible that must be satisfied for all services, except for
preventive care. The health insurance plan may be used with a savings account that can be
obtained from the insurance carrier or from another financial institution.
- Will the plans in a quote cover employees outside the state the business is located in?
Yes, provide zip codes of current employees and let the insurance company know if you intend on
having employees outside of the state. Only select plans will work in specific states. This varies for
each plan type and insurance carrier presented in a quote.
- When are referrals required?
Some plans require referrals from your Primary Care Physician before seeing a specialist.
HMO plans require a referral from primary care physician (PCP) whereas PPO's do not.
- Do my employees need to select a primary care physician?
HMO's and plans that have separate co-pays for your primary care physician (PCP) and specialist
visits require you to choose a PCP. If you do not choose a PCP the insurance carrier will charge you
the higher specialist co-pay when visit your PCP or they will choose a PCP for you..
- How are rates determined for small business health insurance?
Rates in the small business health insurance market are based entirely on your employee
demographics or census, zip code of your office, and effective date of your new health insurance
plan. Co-pays, deductibles, and plan types all change your insurance premium.
Unfortunately negotiating on price is not available in the small group employer market. However this
is pretty logical, the more employees to be covered the more negotiating power you have.
- Do all insurance brokers and agents have the same rates?
If the exact census and other details are used for two quotes from different brokers or agents, then
the quotes will be exactly the same price. Agents and brokers vary heavily on the strategy they use
to insure your company, so it is very important to have an in-depth discussion with your broker
about your company’s health insurance plan, and to make sure he is constructing a plan and quote
that will not only meet your budget but your needs, NO SURPRISES!
Group Health FAQ's for
This page is meant to aid employers
when looking for a health insurance
quote for their company employees.
Our hope is to give you, as an
employer, a broad overview of the
different options available and the
questions you should be asking
from any insurance provider you are
This guide will also aid employees in
understanding coverage parameters.
NOTE: The information given herein
is based on New Jersey Banking and
Insurance regulations and that of
your state may vary as it relates to
certain elements of coverage and
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