| Group - General |
| What is the maximum pre-existing waiting period that can be applied to an employee’s policy?
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| What is the Health Insurance Portability Accountability and Access Act (HIPAA)? |
| How do I start up a flexible spending account for my employees? |
| What type of expenses can I run through my flexible spending account? |
| What is the minimum number of members needed to enroll for a group policy? |
| If a member is enrolled with Medicare and group coverage, is Medicare primary or secondary? |
| Why is the hire date of a new employee required on the enrollment application? |
| Can employees receive a rider or amendment on a small group plan?
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| When can an employee enroll with the group policy? |
| What are special events? |
| How do I determine if a group meets participation requirements?
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| What is a JSR (Job Service Report) or Wage and Tax Report – and why do I need it? |
| Can an employer purchase direct pay policies (individual) for their employees rather than a group policy? |
| Is an employer required to contribute to the employees’ premiums?
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| How do I know if a group falls under COBRA or State Continuation? |
| What is a new hire waiting period?
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| Group - General |
| Question: What is the maximum pre-existing waiting period that can be applied to an employee’s policy?
Answer: HIPAA regulations limit pre-existing waiting periods to 18 months. |
| Question: What is the Health Insurance Portability Accountability and Access Act (HIPAA)?
Answer: HIPAA is an act which makes health insurance more accessible and portable by permitting individuals the ability to maintain their health care coverage when they change jobs. If an individual purchases health insurance or is covered under a group policy and that individual does not permit a gap of 63 days or more without insurance coverage, then no insurer may impose a pre-existing condition provision.
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| Question: How do I start up a flexible spending account for my employees?
Answer: GBL works with several companies who administer the flexible spending accounts and can work with you to get one set up. Please contact your agent or call GBL at 515-453-8207 or 800-640-7382. |
| Question: What type of expenses can I run through my flexible spending account?
Answer: Unreimbursed medical, dental and vision expense, as well as dependent care, over-the-counter medications and health insurance premiums can be run through your account. These expenses can be incurred by employee, spouse or children.
Click here to view a partial list of eligible expenses. |
| Question: What is the minimum number of members needed to enroll for a group policy?
Answer: At least two (2) full time employees must enroll. |
| Question: If a member is enrolled with Medicare and group coverage, is Medicare primary or secondary?
Answer: If the group has 20 or more employees, the group benefits are primary and Medicare is secondary. If the group has 19 or less employees, Medicare benefits are primary and the group benefits are secondary. |
| Question: Why is the hire date of a new employee required on the enrollment application?
Answer: New hires must fulfill a waiting period that is determined by the group. The hire date verifies the new employee has satisfied the waiting period and is eligible to enroll. |
| Question: Can employees receive a rider or amendment on a small group plan?
Answer: No – Riders or amendments are not imposed on group policies; however, in certain situations a pre-existing waiting period may be applied to an employee’s policy. |
| Question: When can an employee enroll with the group policy?
Answer: An employee may enroll if they are a new hire and have satisfied their new hire waiting period, due to a special event (i.e. marriage, divorce, birth of a child). Some carriers may allow late enrollees to enroll, however certain restrictions may be imposed. |
| Question: What are special events?
Answer: A special event is one which allows a member or dependent to enroll with the group’s policy with the same treatment as a new hire. Special events include: marriage, birth, adoption, change in student status, court order or loss of other coverage. |
| Question: How do I determine if a group meets participation requirements?
Answer: The majority of carriers require 75% of eligible employees, excluding valid waivers, must enroll. |
| Question: What is a JSR (Job Service Report) or Wage and Tax Report – and why do I need it?
Answer: This document is the Employer’s Contribution and Payroll Report form 65-5300 and is required by carriers in order to verify the group is meeting participation requirements. The document must be submitted fully reconciled; all employees must be indicated as full time (FT), part time (PT), terminated (T), or waiving (W) coverage and add any new hires not listed. |
| Question: Can an employer purchase direct pay policies (individual) for their employees rather than a group policy?
Answer: No – if an employer offers health insurance benefits to its employees, they may do this only through a group plan. The only exception is if the group has only one eligible employee. |
| Question: Is an employer required to contribute to the employees’ premiums?
Answer: Yes – an employer is required to contribute to the employees’ premiums. Failure to do so will result in noncompliance. The minimum requirement may vary from carrier to carrier, but the majority of carriers require the employer pay at least 50% of the single premium. |
| Question: How do I know if a group falls under COBRA or State Continuation?
Answer: Employers who had 20 or more full-time employees during at least half of the preceding year must offer COBRA benefits. Employers with 2-19 employees must offer Iowa State Continuation.
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| Question: What is a new hire waiting period?
Answer: When a group enrolls with a carrier, the group must designate the length of time the employee must be employed before they are eligible to enroll with the group’s health plan. New hire waiting periods are typically the first of the month following the completion of 30, 60 or 90 days. |
