COVID-19 Health Insurance Guide

How to use this guide

Updates are being announced hour to hour from the Department of Labor, the Department of Insurance, as well as the individual carriers with regulation updates pertaining to the COVID-19 pandemic.  During such a stressful time in general, this can be quite overwhelming as a business owner.

Our team has accumulated the most up to date information and consolidated Frequently Asked Questions (FAQs). Below, please find some important information pertaining to these changes.  In addition, you will find some excellent information in regards to the continuation of benefits, as well as the modified Family Leave Act, and how it now applies to small businesses.

Health Insurance Carrier COVID-19 Updates

Please select your current health carrier. Updated as of 3/31/2020

Original Source: Savoy Associates

Small Group New Business Submission Extensions

Exceptions

Off Anniversary plan downgrades are available through July 31, 2020. Businesses that temporarily close will be allowed to continue their AFA plan provided premiums are paid monthly based on the assumption that the business will reopen after the COVID-19 pandemic. Business that close permanently Aetna will waive the 30 day advance termination requirement upon group request. Such a request must be received prior to the termination date.

Furlough/Layoffs Special Rules

Furloughed (temporarily laid-off) employees and those with reduction in hours will be temporarily allowed to stay on the medical plan provided premium the option to remain insured is offered to all impacted employees. Employees who are terminated, should be terminated from the group health plan and offered State Continuation/COBRA. Upon rehire, wait period will be waived. These exceptions will expire on July 31, 2020.

Premium Grace Periods

Aetna will work with AFA plan sponsors to extend grace periods for the months and May. Group must contact the Answer Team to establish the extension.

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived 

Maintenance Medications

Waiving early refill limits on 30-day supply of maintenance medications. CVS waiving charges for home delivery of medications.

Telemedicine

Member cost-share waived,through 6/6/2020

Carrier Resources

https://www.aetna.com/individuals-families/member-rights-resources/need-to-know-coronavirus.html

COVID-19 (Coronavirus) Resource Guide

Small Group New Business Submission Extensions

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

Horizon is waving the “actively at work” requirement applicable to fully insured commercial plans.Furloughed employees or those with reduced work hours may remain covered under the group health plan provided medical premiums are paid. Furloughed employees may remain on the plan for the next 60 days (guidance released on 3/25/2020). Employees who are terminated should be offered State Continuation/COBRA.

Premium Grace Periods

Not applicable at this time. Visa and MasterCard will now be accepted for premium payments.

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived

Maintenance Medications

Waiving early refill limits on 30-day supply of maintenance medications

Telemedicine

Access to telehealth will be provided 24/7 and member cost share will be waived through June 13, 2020. In addition, 24/7 access to licensed nurses who can assess and assist members with symptoms that are consistent with suspected COVID-19 infection. Those service are available through the company’s free “Horizon Blue” app, the www.HorizonBlue.com online portal, or by phone at 1-888-624-3096

Carrier Resources

https://www.horizonblue.com/coronavirus-2019

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

AmeriHealth New Jersey will honor employer requests to continue coverage for employees furloughed or temporarily laid off as a result of impacts of COVID-19. This exception applies to fully-insured and self-funded business. This exception is in effect until June 30, 2020. This exception will not be valid on or after July 1, 2020. Contact your Sales Team for additional details.

Premium Grace Periods

Not applicable at this time

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived 

Maintenance Medications

Waiving early refill limits on 30-day supply of maintenance medications

Telemedicine

Member cost-share waived, through 6/1/2020

Carrier Resources

https://www.amerihealthnj.com/html/index.html

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

If an enrolled employee working 30 hours or more per week is furloughed or has hours reduced below 30 hours per week, Cigna will agree, at the groups formal request, to allow the employee to remain on the plan for the duration of the extended relief period as long as premium payments are made. “Extended relief period” is defined as the period starting on March 16, 2020 through May 31, 2020. This period may be extended by Cigna in response to evolving external events as well as Cigna’s financial capacity

Premium Grace Periods

Not applicable at this time

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived 

Maintenance Medications

No waiver at this time

Telemedicine

Telemedicine is available at the existing benefit level. Cigna has opened a 24-hour telephone HELP line, 866.912.1687, to allow you and your family members to speak with qualified clinicians about how to cope with anxiety, stress, or other issues related to the impact of the COVID-19

Carrier Resources

https://www.cigna.com/individuals-families/health-wellness/topic-disaster-resource-center

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

Laid off or furloughed employees that were covered by the plan may remain on the plan until May 31, 2020 without electing COBRA or continuation under state law. The group must continue to pay the monthly premium payments, and employee premium contributions must be the same or less than they were prior to the layoffs or furlough. Coverage must be maintained on a uniform, non-discriminatory basis to all eligible laid off or furloughed employees. At least one employee must remain actively employed. Terminated employees should be offered state continuation/COBRA. Upon rehire, the wait period will be waived.

Premium Grace Periods

Not applicable at this time

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived

Maintenance Medications

No waiver at this time

Telemedicine

Telemedicine is available at the normal cost-share

Carrier Resources

https://www.emblemhealth.com/live-well/covid19/coronavirus

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Empire opened a Special Enrollment Period (SEP) from now until April 3, 2020 to make benefits available to employees in Fully-Insured Small and Large Groups who previously waived participation in employer-sponsored plans. State eligibility guidelines will apply. This SEP is in response to COVID-19. It’s another way Empire is helping people get the care they need. Who’s eligible? Employees who were eligible for benefits during employers’ Open Enrollment are eligible for this SEP if they had previously waived coverage. How it works: Employers will follow the standard process of sending updated enrollments to Empire, just as they would for any qualifying event or enrollment period, through their elected format of 834s, the EmployerAccess portal, or other approved methods.

Furlough/Layoffs Special Rules

Empire’s requirement for employees to be actively working in order to be eligible for coverage will be relaxed through May 31, 2020 as long as the monthly premium payment is received and at least one employee remains actively employed. Coverage must be offered on a uniform, nondiscriminatory basis to all employees and employee premium contributions must be the same or less than what they were prior to the layoffs. Employees who are terminated from employment should be offered state continuation/COBRA. Employees rehired prior to May 31, 2020 will not have to satisfy a new hire wait period.

Premium Grace Periods

Payment extensions are being evaluated on a case-by-case basis. Groups that are having trouble making premium payments should contact their account manager to discuss.

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived

Maintenance Medications

No waiver at this time

Telemedicine

You can contact Nurse Line anytime at 877-825-5276 with questions. You can also use LiveHealth Online to see a doctor from your home on your phone, tablet, or computer with video. Log in at empireblue.com to learn more about LiveHealth online.

Carrier Resources

https://www.empireblue.com/coronavirus/?brandcd=EBCBS

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

Not applicable at this time

Premium Grace Periods

Not applicable at this time

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived

Maintenance Medications

One-time refill for 30-day supply of chronic medications

Telemedicine

Request a Teladoc visit by phone at 1-800-Teladoc (1-800-835-2362) or by visiting this https://member.teladoc.com/healthfirst

Carrier Resources

https://healthfirst.org/

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

If an employee/member is laid off or furloughed prior to June 30, 2020, due to COVID-19 business disruption and rehired prior to June 30, 2021, Highmark will waive the waiting period for coverage. For coverage periods through June 1, 2020, we will waive “active at work” requirements for a period of up to 90 days. This enables coverage for employees/members transitioned to part-time or furlough status. The only requirements are that: a. the affected employees/members be currently covered on the plan, b. coverage be offered on a uniform, non-discriminatory basis, c. the premium is paid for the coverage with the same level of employer subsidies previously offered, and d. at least one employee/ member remains in active full-time employment.

Premium Grace Periods

Not applicable at this time

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived for fully insured, ACA and Medicare Advantage Members

Maintenance Medications

No waiver at this time

Telemedicine

Telemedicine and virtual visits will waive cost-sharing and copayments for fully insured and ASO members under Teladoc, Amwell or Doctor on Demand for 90 days. ASO clients have option to opt out.

Carrier Resources

https://faqs.discoverhighmark/

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

Independence will honor employer requests to continue coverage for employees furloughed or temporarily laid off as a result of impacts of COVID-19. This exception applies to fully-insured and self-funded business. This exception is in effect until June 30, 2020. This exception will not be valid on or after July 1, 2020. Contact your Sales Team for additional details.

Premium Grace Periods

Not applicable at this time

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived

Maintenance Medications

Waiving early refill limits on 30-day supply of maintenance medications

Telemedicine

Member cost-share waived, through 6/1/2020

Carrier Resources

https://news.ibx.com/coronavirus-2/

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

SPD allows for extended coverage to furloughed employees. Contact your Sales Team for additional details.

Premium Grace Periods

Not applicable at this time

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived 

Maintenance Medications

No waiver at this time

Telemedicine

Member cost-share waived, through 6/6/2020

Carrier Resources

https://membershealthplannj.com/resources/news/

Small Group New Business Submission Extensions

Not applicable at this time

Exceptions

Not applicable at this time

Furlough/Layoffs Special Rules

Not applicable at this time

Premium Grace Periods

Not applicable at this time

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived 

Maintenance Medications

No waiver at this time

Telemedicine

Telemedicine is available at the normal cost-share. $0 non-HSA plan/$15 HSA members

Carrier Resources

https://www.hioscar.com/covid19

Small Group New Business Submission Extensions

Exceptions

UHC is providing fully-insured Small Business and Key Accounts clients with a Special COVID-19 Enrollment Opportunity to enroll employees who did not previously enroll in coverage. The opportunity will be limited to employees who previously did not elect coverage for themselves (spouses, children) or waived coverage. The opportunity will extend from March 23 to April 3, 2020.

Furlough/Layoffs Special Rules

Furloughed employees and those with reduction in hours will be temporarily allowed to stay on the medical plan premium provided payment continues and that the option to remain insured is offered to all impacted employees. Employees who are laid-off, should be terminated from the group health plan and offered State Continuation/COBRA. Upon rehire, wait period will be waived.

Premium Grace Periods

Groups in need of assistance should contact their billing rep directly to discuss options available.

IN-Network Diagnostic Testing for COVID-19

Member Cost-Share Waived for fully-insured commercial, All Savers, Medicaid and Medicare members

Maintenance Medications

Waiving early refill limits on 30-days supply maintenance medications.

Telemedicine

Telemedicine is available at no cost. For groups enrolled on the Oxford platform, members should contact member services to request an online access code for telemedicine services. 

Carrier Resources

https://www.uhc.com/health-and-wellness/health-topics/covid-19

Layoff vs. Furlough

What is the difference between layoff and furlough?
Generally, when the employer is furloughing employees this is a situation where the employer/employee relationship is not severed. Conversely, when the employer is laying off employees, the employment relationship is terminated.

Under a layoff, will I lose health benefits?
Under a layoff, the employment relationship is terminated therefore the employee loses eligibility under the plan. This is a COBRA triggering event for the health benefits (medical, dental, vision, health FSA, etc.) Loss of eligibility is also a qualifying special enrollment event for the individual market.

If COBRA is elected and the person does not enroll in individual coverage, they cannot do so until the next annual open enrollment for the marketplace.

If I am laid-off, can I enroll in an individual plan instead of COBRA?
Yes. Loss of eligibility is also a qualifying special enrollment event for the individual market.
If COBRA is elected and the person does not enroll in individual coverage, they cannot do so until the next annual open enrollment for the marketplace. You are “stuck” with COBRA, for the remainder of the COBRA period, until the next annual marketplace open enrollment or until you become eligible for new group health plan.

IMPORTANT: The employer should clearly advise that an individual who elects COBRA will have to exhaust it before becoming eligible for Individual coverage and will in essence be “stuck” until COBRA runs out or the next Open Enrollment.  That means they also cannot apply for a subsidy until the next Federal Open Enrollment.  An individual obtaining a subsidy will not harm the employer if the individual is not working.

If I enroll in an individual plan, can I receive a subsidy to help pay for the cost of the plan?
In order to qualify for a subsidy (premium tax credit) there are certain criteria you must meet; most notable is subsidy eligibility is based on income.

Who pays for COBRA coverage?
The employee generally pays the full cost of the insurance premiums. The law allows the employer (COBRA administrator) to charge up to 102 percent of the premium to cover administrative costs.

Employers can choose but are not required to subsidize COBRA for terminated employees.

Under furlough, will I lose health benefits?
All eligible employees are still entitled to benefits while on furlough. If eligibility for health care benefits is maintained during a furlough, the employer can collect the employee’s share of premium to maintain the coverage during a paid or unpaid leave of absence.

How do I pay my employee contribution if I am on furlough?
Premiums may be collected (as determined by the employer’s policy) in one of the following manners:

  • Catch up. Some employers choose to keep employees on leave enrolled in their benefits until they return to active work, and then recoup those payments at the time the employees return to work.  If there is a fairly large premium payment due at the time the employees return to work following the leave, it may be necessary for the employer to take deductions over several payroll periods.  In some cases, state wage and hour laws will limit the amount that can be deducted from pay (thus the cap may be necessary).
  • Pre-pay. If the leave is scheduled in advance, and the employee remains eligible for benefits during the leave, the employer may collect the employee’s share of premium for the rest of the plan year from the employee’s pre-tax earnings before the start of the leave.  However, if the leave is anticipated to span more than one plan year, then the employer cannot collect the premiums for the latter part of the leave since this would violate the cafeteria plan regulations prohibiting deferred compensation.
  • Pay-as-you-go. During the leave, the employer may require the employee to pay the employee’s portion of the premiums to maintain coverage.  Such payments would generally be on an after-tax basis, by remitting payment to the employer, and the employer could require payment no more frequently than regular deduction frequencies for employees during periods of active work.  Most employers collect premiums from employees on leave of absence on a monthly basis.

In cases where there is paid leave, the employer may collect those premiums through salary reductions under the cafeteria plan.  However, for periods of unpaid leave, where the “pay as you go” method for collection is utilized, the employee would remit those amounts to the employer on a post-tax basis.

Families First Coronavirus Response Act

I heard that the new Act includes tax credits. For what size employers does this apply and what is the credit?
First, most importantly, be sure to familiarize yourself with the requirements under the Families First Coronavirus Response Act provisions. You can do so by referring to the chart we have made available in the COVID-19 Resources. Affected employers are employers with 1–499 employees.

Specifically addressing the tax credit, The U.S. Treasury Department, Internal Revenue Service (IRS), and the U.S. Department of Labor (Labor) announced in a News Release on March 20th, that small and midsize employers can begin taking advantage of two new refundable payroll tax credits, designed to immediately and fully reimburse them, dollar-for-dollar, for the cost of providing Coronavirus-related leave to their employees.

Eligible employers will be able to claim these credits based on qualifying leave they provide between the effective date, April 2nd and December 31, 2020. Equivalent credits are available to self-employed individuals based on similar circumstances.

The chart goes into detail about the credit for Paid Sick leave. Note: Eligible Employers receive 100% reimbursement for paid leave pursuant to the Act.

Health insurance costs are also included in the credit.

Employers face no payroll tax liability. And Self-employed individuals receive an equivalent credit.

The next logical question is how quickly will the employer be reimbursed?

If there are not sufficient payroll taxes to cover the cost of qualified sick and childcare leave paid, the IRS Notice released on 3/20 addresses Prompt Payment for the Cost of Providing Leave.

When employers pay their employees, they are required to withhold from their employees’ paychecks federal income taxes and the employees’ share of Social Security and Medicare taxes. The employers then are required to deposit these federal taxes, along with their share of Social Security and Medicare taxes, with the IRS and file quarterly payroll tax returns on Form 941 with the IRS.

Under guidance that will be released later this week, eligible employers who pay qualifying sick or childcare leave will be able to retain an amount of the payroll taxes equal to the amount of qualifying sick and childcare leave that they paid, rather than deposit them with the IRS.

If there are not sufficient payroll taxes to cover the cost of qualified sick and childcare leave paid, employers will be able file a request for an accelerated payment from the IRS. The IRS expects to process these requests in two weeks or less. The details of this new, expedited procedure are expected to be announced this week.


a hand holding a lit cigarette and breaking it in half

Using Group Benefits & Incentives to Quit Smoking & Vaping

It’s no secret that it is difficult to quit smoking.

A habit that kills over 480,000 each year in the United States according to the Centers for Disease Control and Prevention (CDC), it’s something that needs to be stopped.

Alongside premature deaths, numerous tobacco-related diseases affect millions of people every year; including:

  • Cardiovascular disease
  • Emphysema
  • Various cancer, including lung cancer
  • Diabetes

When you are running a business that has smokers within it, it’s at risk.

Not only will you see many absences because of related conditions, but a decrease in productivity as employees will be distracted with smoking breaks throughout the day.

So, how can you combat this?

Research undertaken by professors at Ohio State University has found that employers can save an average of $5,816 for every employee that quits smoking.

Savings that come from lower healthcare costs, prevented premature deaths and an increase in workplace productivity, this along with saving your employee’s lives make it well worth it.

Although over 50% of people in the US try to quit smoking every year, and there has been a significant drop in the amount of people that smoke over the years, the success rate is only 7.2%.

Source: Statista

To help increase this, there are certain group benefits and incentives that businesses can offer to give their workers the push that they need to try and quit.

These resources are incredibly beneficial, from both financial and health perspectives as aforementioned.

Although these financial incentives might seem expensive in the short term, the end result makes it more than worth the initial investment.

Showcasing how your business can help to transform your worker’s lives, these incentives illustrate the influence of your policies.

The Rise in Vaping

However, it’s not only tobacco that is popular in the US.

Some favor vaping, as they believe that it’s the lesser evil out of the two habits.

With an increase of 50% between 2011 and 2018 that vape according to the World Health Organization, it’s a habit that many younger adults are starting as they believe that it’s less dangerous than its counterpart.

However, according to several sources, including the CDC, vaping has been linked to an outbreak in lung injury.

With a sharp increase in visits to the emergency department across the states (with over 60 confirmed deaths, including 1 in New Jersey), certain employers have taken action by banning the products in their workplaces.

Along with workplace bans, several states have issued both temporary and permanent sales bans or restrictions on vaping products – including New Jersey, Oregon and Rhode Island.

These smoke-free indoor air laws ban vaping in areas where smoking is also banned.

However, not all workplaces have policies that align with the ban.

Which faces employers with whether they will allow vaping in the workplace or if they will ban it.

An Alternative to Quitting Smoking

Many people across the country are opting for vaping as a way of quitting smoking.

Stepping away from the traditional cessation techniques of nicotine patches and gum, they believe that it will help them to break the habit.

As it’s aimed as a way of reducing the amount of nicotine over time, many e-cigarette companies argue that it’s effective.

However, as vaping is believed to be just as harmful according to research, it’s clear that this could just be their way of continuing their habit.

Conclusive evidence of the effectiveness of vaping as a cessation tool is still underway.

How to Choose an Incentive

When choosing an incentive to encourage employees to quit smoking, you need to think about which ones will engage them.

For example, you could give them the following group benefits:

  • Guaranteed bonuses every few months
  • Discounts on health insurance premiums - something that 16% of employers do according to the 2018 Employee Benefits Survey Report
  • Free cessation aids – such as pharmacotherapy or nicotine-replacement therapy
  • A wellness program - including access to an on-site (or external) health clinic, fitness area and personal coaching
  • Ensuring that all treatments and medications under the U.S. Public Health Service Guideline are covered
  • Eliminate cost-sharing on counseling and medications

How To Create Effective Anti-Smoking Policies

Before rolling out the policies, you need to consider exactly what they include.

For example, will you implement a surcharge the moment that an employee smokes a cigarette outside your office or will you give them a warning before fining them?

You also must consider if your policies will solely include tobacco, or whether they will include vaping.

If you want these bans to be applicable in the long term, you must bring in measures that ensure they stay actioned – such as making your employees take saliva or blood tests.

Any smoking cessation program should be crafted so it covers every psychological, emotional and physical aspects that come with trying to quit.

Giving your employees the right support and resources, they’ll be more likely to stick to it.

If there are any changes to the policies, you’ll also have to communicate them in advance and clearly to your employees.

Anti-Smoking Policies You Can Implement

  • Prohibit smoking in the workplace and on your entire work campus. (alternatively, you can limit it to only outside your building)
  • Publicize group benefits and incentives, whilst ensuring that your business’ health plan includes them
  • Offer several types of modalities
  • Encourage employees to take regular Health Risk Appraisals
  • Educate employees on the risks and promote the incentives
  • Actively encourage employees to participate in events such as World No Tobacco Day and the Great American Smokeout

Acts That Align With Anti-Smoking Policies

  • The Health Insurance Portability and Accountability Act (HIPAA) - under this act, employers are legally allowed to impose surcharges on smokers. However, the act also discloses that as an employer, you should offer cessation resources to your employees (such as the Freedom From Smoking cessation program offered by the American Lung Association).
  • The Affordable Care Act (ACA) - under the ACA, employers can charge employees up to 50% more to cover them with health insurance. However, the act also requires employer-sponsored health insurance to directly cover smoking cessation.

How To Measure the Success of Group Benefits and Incentives

You might wonder, how do I measure the success of the group benefits and incentives to quit smoking?

And while the financial return on investment will not be visible for a while after they are implemented, the physical success of them will be transparent almost straight away.

Not only will you see an increase in productivity in the workplace, but a decrease in absences related to smoking.

Before settling on policies, you must look at these potential benefits and weigh them up against the cost of delivering cessation programs and other incentives.

Ultimately, it’s your choice whether you offer these or not.

But the benefits are undeniable and should not be ignored.


stack of blocks depicting health coverage

What Is Group Health Coverage? Here's Our Complete Guide

Business owners across New Jersey struggle to remain competitive and profitable. It’s hard to keep good employees and keep costs low at the same time. Group health coverage can help you do just that.

Yet, only 41% of small businesses with less than five employees offer insurance. Larger companies with less than 500 employees, about 61% offer insurance.

You can set your business apart by offering top-tier benefits like health insurance to your employees. Ready to learn more?

Read on to find out what group health insurance is and how it can help your business.

What Is Group Health Coverage?

Group health insurance refers to one health insurance policy for a group of people. The group is usually a small business or a trade organization.

How much does group coverage cost? It’s usually lower than if you or your employees were to get individual coverage. Insurance rates are based on risk to insurance companies.

Think of risk like getting a loan from a bank. People with good credit scores will get a better interest rate because they’re more likely to pay the loan back than someone with a bad credit score.

Banks want to protect their profitability, so they’ll charge more for people who are a higher risk. Health insurance companies also calculate their level of risk and profitability.

With individual insurance, there is a higher level of risk to the insurance company, especially if the individual is older. They’re more likely to need to use their insurance more often.

That will result in a higher premium for the individual. Group health coverage allows insurance to absorb risk between more people.

So, in a group of 10 people, some people may need to use their coverage more than others. Since the risk is spread out among more people, insurance companies are able to charge less.

Most group plans have a 70% participation threshold. That means that 70% of your group must participate in the plan. A business with 10 employees (including yourself) must have 7 people take part in the plan.

Are You Required To Provide Health Insurance?

Small business owners usually agree that health insurance can be a big benefit and lower employee turnover. That doesn’t mean that they’re going to provide group health benefits.

Are you obligated by law to provide health coverage? It depends. The Affordable Care Act says that businesses with less than 50 employees don’t have to provide coverage. Those with 50 or more employees do need to provide insurance to employees.

Just because you don’t have to provide health insurance coverage, doesn’t mean that you shouldn’t provide insurance. There are hidden costs to your business by not providing group insurance coverage to your employees.

For starters, how much does employee turnover cost your business each year? One study found that employee turnover costs about $15,000 per employee.

You can retain employees by providing health insurance coverage. Your employees are likely to leave for another position that offers that benefit.

You also need to account for sick days and lost productivity. Employees with health insurance coverage are happier, healthier and more productive.

Finally, there are potential tax credits and deductions for your business. That can lower your tax burden while creating a more productive workforce. In other words, you can be more profitable by investing in group health coverage for your business.

Shared Costs With Employees

When you buy group health coverage, you don’t have to shoulder the responsibility for the entire cost of coverage alone.

Most businesses will share the costs with employees. The percentage that your business pays and your employees pay will depend on a few factors.

You’ll want to weigh the premium costs, the number of employees you need to cover and your eligibility to receive tax credits. There is no set number, but it is something that you and your insurance partner can discuss.

Finding Group Health Coverage

Is your business ready to provide group health coverage? How can you provide the best coverage to your employees? Here are some tips to find the right group health insurance plan.

Gather Your Paperwork

You’ll need to get your paperwork together to apply for group insurance. You’ll need your business name, EIN, industry code, address and payroll records (Quarterly Tax and Wage Report).

A list of employees needs to be part of your application, too. That list needs to have each employee's name, home zip code, gender, birth date, tobacco usage and participation in other health insurance.

Work with a group health insurance agent to find your options. They’ll take your information, look for plans on your behalf and go over your options with you.

You also want to educate your employees on their health insurance plan. Most people know they have coverage, but a very small percentage of people fully understand what is covered or not.

Take the time to educate your employees on the basic terminology. They need to what a deductible is, their monthly premium, their level of coverage and the doctors covered in the group insurance network.

Get Health Insurance For Your Business

Your employees are your company’s biggest asset. Doesn’t it make business sense to not provide health coverage as an employee benefit?

You could lose more money by not providing coverage in the form of lost productivity and employee turnover.

Group health coverage is a way to provide an affordable health insurance option to your employees. You’ll want to bring in the expertise of an insurance agent who can help you find the best group health coverage for you and your employees.

Contact us today to find out about how we help New Jersey businesses with their health insurance needs.


doctor with crossed arms holding stephoscope

Out-Of-Network Health Benefits: How They Work

Watch Our YouTube Video Here:

Hi everybody! It’s Kate Plageman with Central Jersey Insurance. Most of us have a health plan that has good in-network benefits.

If you do have a plan that has an out-of-network benefit feature, it’s really important that you understand that there can be a lot of hidden costs.

I’m going to give you an example of a claim and how that was likely processed with a typical direct access product with say Horizon Blue Cross Blue Shield of New Jersey.

Say you’re in the hospital and you see a doctor that is out-of-network, does not take any insurance. A lot of orthopedics, dermatologists, psychologists, psychiatrists won’t take any insurance whatsoever. That’s where the out-of-network benefit comes into play.

So, as an example, you go into the hospital, you see a doctor, you incur a claim, say it’s $5,000 total. That claim will come through to the carrier, in this case Horizon, and be discounted to what is considered to be reasonable and customary on an in-network level, okay?

So, that $5,000 will be discounted to say, $3,000. That’s considered reasonable and customary in-network. That difference between the $5,000 and the $3,000 is on you to pay and you will be responsible for that difference.

The out-of-network provider can balance bill you that. That $3,000 that’s left will then be subject to the out-of-network deductible, which is most commonly separate from your in-network deductible.

So, that usually is around $2,500. So, that $3,000 is now $2,500 on you, So, that $3,000 is now $2,500 on you, and then that difference of $500 will be paid at the coinsurance rate which is usually between 60% and 70%.

So, you may have a benefit of a couple hundred dollars out of that $5,000 claim, yet the provider can balance bill you all of that difference.

So, it’s really, really important that you understand how those benefits work before you get involved with out-of-network providers. Also as a footnote to that, if you have a plan that has out-of-network benefits, the premium is significantly higher than those that have in-network benefits only.

So, it’s just a little tip that I wanted to share with you, buyer beware.

Many professionals with gainful employment have group health plans that offer in-network benefits. This means that in-network health care providers have agreed to discounted rates for those covered by specified insurance companies.

Did you know that some plans also have out-of-network benefits? When seeing an out-of-network doctor, you may still receive a discount from your insurance provider, but won’t get a discounted rate on behalf of the doctor.

Keep in mind there are other hidden costs and complexities that can leave you with a hefty out-of-pocket bill to pay. In this post, we’ll break down the difference between in-network and out-of-network benefits and discuss some situations you may encounter.

Why Don’t All Doctors Accept All Insurance Plans?

There are a number of reasons all doctors don’t just accept all insurance plans. Most of the time, it comes down to cost, meaning the doctor believes that the rate offered by the insurer is not enough to warrant their participation.

Some doctors prefer to keep their networks small, working with only a few, or sometimes one (or no) insurance providers. This helps them simplify operations and increase leverage with patients and potential providers.

Another reason is that insurers may have a limited number of provider slots available, whether they are based on the total number of doctors or the services they provide. For example, they may already have enough in-network orthopedists, or they can’t take on over 100 individual practices and have hit their limit.

That said, several states have “Any Willing Provider” or “Any Authorized Provider” statutes which allow any healthcare provider to be an in-network provider if they meet certain requirements. This prevents insurers from blackballing providers and limiting access based on several factors. Depending on the state, these laws can be broad or limited in scope.

Accepting Insurance vs. In-Network

There’s also a difference between a physician “accepting your insurance” and them being an “in-network” provider.

Often when you call a doctor’s office and ask if they accept your insurance, they will tell you they do. But it’s important to dive a little deeper.

A doctor may accept your insurance carrier, Selective for example, but not your specific plan under Selective. This would make them on out-of-network provider vs. in-network.

This is an important distinction to make before making appointments and seeing particular doctors.

Emergency Care

If there is an emergency and you have insurance, you should have access to out-of-network services. Insurance and healthcare providers can’t require you to pay a higher copayment or coinsurance if you receive emergency care from a hospital not in your network. This is thanks to the Affordable Care Act.

The same applies if you don’t have insurance, and hospitals can’t refuse to give you emergency care. This is all because of the  Emergency Treatment and Labor Act (EMTALA). If you’re still concerned about costs, you might go to an urgent care center of the emergency room.

What Should You Do?

The most important thing to do if you’re not sure about in-network or out-of-network benefits is to speak with customer service for your insurance provider. They can check for you if a doctor you’re looking to see is covered under your current plan.

Many insurance providers also have online portals where you can see which doctors are covered under your plan. It’s also recommended you confirm specific details with your doctors.

Still Confused?

Thinking of seeing a doctor that is out-of-network or still feeling confused? Before you take the leap and see a doctor you’re unsure of, click below and download our helpful guide to better understand the hidden costs.

Download Our Guide

two smiling workers bumping fists over their group benefits plan

Group Benefits Plan: What To Offer Your Employees

Employee benefits are insurance plans that employees gain through a business they work for.

They provide these benefits on a group plan that covers all employees in the company. This costs the business money, but it can provide a significant return on investment. By paying a premium, an employer typically gets insurance at lower rates compared to an individual employee finding their own coverage on the market.

Using group employee benefits, companies can attract the best, highly qualified workers to their business in a competitive job market. With a group benefits plan, businesses can reduce the amount that they will pay to cover individual employees. They are often customizable, so the plan can include the key areas that the employer wants to cover and that are attractive to the team.

 

Benefits Of Group Benefit Plans

For Employees

There are benefits to group insurance for employees. They include:

  • Gaining standard coverage without having to prove eligibility or affordability.
  • Lower costs compared to an individual searching for insurance coverage on the market.
  • Ability to share costs with the employer, leading to cheaper plans for each individual.
  • Access to benefits that are not available outside a group benefits plan including recreational options exclusive to workplace employees.

For Businesses

Group benefits also provide significant benefits to the employer or the business owner, including:

  • Protection of the investment made in their employees. If an employee gets injured or falls ill, expenses can be covered to ensure they can return to work as quickly as possible.
  • Improved levels of tax compensation. Benefits are paid before tax is taken from income, providing more money to employees.
  • Helps improve productivity by eliminating outside burdens for staff.
  • Positive employee satisfaction, commitment and loyalty to your business because they feel they are taken care of.

Primary Benefits Available

There are some standard options businesses can provide to their employees on a group benefits plan. You can watch our video summary below or continue reading:

Health

Health insurance offers support to employees who are dealing with health issues including long-term conditions. It guarantees that employees can get the treatment they need for different medical conditions. It improves their quality of life and ensures that they can get the support they need to be a vital member of the business team. 69% of private industry workers can access this through their employee while it is available to 89% of local and state workers.

Dental

This is one of the most sought after benefits according to employees. Dental allows employees to get regular oral checks and hygiene treatments. It also ensures that they can get the treatment they need for painful conditions such as a root canal.

Vision

Issues with vision can severely impact an employee's ability to work. Eye strain can cause pain and headaches that impact an employee’s level of productivity, ability to work and their general level of wellbeing. With vision insurance, employees can gain treatment including glasses and contact lenses. Sometimes, coverage may also provide for the costs of permanent solutions including laser surgery.

Life

This benefit provides support for the people whom employees leave behind. Life insurance is an attractive possibility for employees who have families and want to make sure that their descendants receive support if they suddenly develop a terminal illness or suffer an accident. 57% of employees working in private companies can access life insurance benefits from their employer.

Disability

Ensures that if an employee suffers from a disability while working for you, they can get the support they need for improved quality of life. This includes the cost of medical expenses, changes they may need to make to their home and the cost of long-term living.

Additional Benefits For Employees

Aside from the main options, there are a variety of other benefits that you should offer your employees.

This includes paid time off, or PTO. Paid time off can include anything from days where an employee is sick to time that they want to take on vacation. Typically, the employer will determine a set number of vacation days employees can take each year, which the benefit plan covers. If an employee wants to take further days, they may, but they will be without pay.

Certain businesses may include telecommuting plans in employee benefits, which come in the form of cell phone plans. It's usually the case where remote workers need to be in contact with the main business office or other colleagues throughout the day.

More businesses are now including wellness programs in group employee benefits to keep their work team healthy and fit. This leads to higher levels of productivity and ensures that job satisfaction improves as employees feel more comfortable and taken care of.

Childcare benefits are another popular option. Childcare can take the form of compensation for employees who need to take time off to care for their children. Alternatively, a business may also set up an on-site childcare system for parents who need options for care while they are at work.

Overall, group benefit plans provide financial advantages for both businesses and staff. They help boost morale and make a company more attractive to new employees. It can reduce staff turnover since employees feel safe and valued in their position. This means they have less reason to seek other opportunities, particularly if the benefits provide long-term support to their families.