FAQ
Question: Is it possible to offer one group
plan even though I have employees in several states?
Answer: Yes. Several companies offer plans with nationwide
networks.
Question: When does the "deductible" period start?
Answer:The deductible runs on a calendar year and starts
over every January. However, some plans may offer a deductible carryover credit,
which will allow the deductible to carryover to the next year, if you met
the deductible in the last 3 months of the year.
Question: Are there exceptions to this calendar year period for deductibles?
Answer:Yes, be careful of plans that have a deductible "per
surgery" or "per illness". These kind of deductions make it hard to protect
your total annual risk exposure.
Question: Are doctors visits covered?
Answer: Each plan design is different. For example, one plan
may cover doctor visits with just a co pay, while another may require the
charge go towards the annual deductible. It may also depend on the type of
visit (i.e.. Annual check-up, illness), as some plans only cover sick office
visits.
Question: What is generally NOT covered?
Answer: Each plan design should specifically list exclusions.
HSA plans are unique because they allow you to use your "savings account"
portion of the plan to pay for certain approved services that may not be covered
by an insurance policy. (For example alternative healthcare such as acupuncture
and chiropractic care)
Question: What is a PPO?
Answer: A PPO stands for "preferred provider organization".
This means that there is a preferred network of doctors that will offer contracted
or discounted rates to the insurance company. You do have the option to go
out of the network for care with a PPO.
Question: How do I know if my doctor is in my PPO network?
Answer: Most companies offer an updated directory on their
web site. However, it's always best to check with your doctor to make sure
they plan on staying on that network.
Question: Do any individual health plans offer dental benefits?
Answer: Several companies are now offering dental coverage
in conjunction with health insurance for an additional premium.
Question: I am thinking of offering dental benefits to my employees. Since I haven't
offered it in the past, will there be a waiting period?
Answer: Some companies offer immediate coverage for basic
and major services, even if you have not had previous dental coverage.
Answer: "Yes", many insurance companies will offer
coverage to a new company.
HSA Plans for Groups
Question: Do you have to be self-employed
to have a HSA account?
Answer: No, anyone can have an HSA, but you do have
to have a HSA compatible health insurance plan first.
Question: Can an employer offer an HSA plan to
their employees as a "group" plan?
Answer: Yes.
Question: What are the contribution limits for
HSA plans?
Answer:
- 2009: individual/$3000 family/$5950
- 2010: individual/$3050 family/$6150
Question: Are there rules on when you can contribute
to an HSA savings account?
Answer: You can contribute from January through April
15th of the following year, as long as you haven't exceeded limits per IRS
guidelines.
Question: I currently offer health insurance
to my employees and some of them have developed serious health conditions,
will this prevent us from being able to change carriers?
Answer: No. There are laws that actually "bridge" pre-existing
conditions, as long as you meet the qualifications.
Question: How many employees must I have to
be able to offer a group plan?
Answer: You only need 2 full-time employees to write
a group plan.
Question: Do I have to offer group benefits
to part-time employees?
Answer: No, only full-time employees are eligible for
group benefits.
Answer:"Yes", as long as they are full-time employees and
you don't discriminate among them.
Texas COBRA Insurance
Question: My COBRA has ended. How long do I have
before I am subject to pre-existing conditions?
Answer: 63 Days, but it is always best to keep continuous
coverage.
Question: Does every group have to offer COBRA?
Answer: No. In Texas, smaller groups are subject to
State Continuation.
Question: I have been denied
individual health insurance. Do I have any other options?
Answer: Texas offers an insurance pool for high risk
individual. You can find out more information: »
Texas Health Pool.
