Frequently Asked Questions


Health Reform


Prospective Clients

Question: Can different agents quote me different rates?

No. All agents have access to the same rates. We recommend choosing an agent based on their experience and level of service.

Question: How long does it take GBL to perform a comparative analysis of my benefits?

Our process generally takes three to four weeks. We start by discussing your needs with you. Then, we’ll submit your group’s information to carriers and analyze the information we receive from them. Finally, we’ll show you a comparison of the results and make recommendations. 

Question: How much of the premium do I have to contribute to a group plan?

Most carriers require employers to pay 50% of the premium. However, required contributions range from 25% to more than 50%.


New Hires

Question: What are special events?

A special event is an event that allows a member or dependent to enroll in 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: What is a new hire waiting period?

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. Under the Affordable Care Act, 1st of month following 90 days will not be allowed after 1/1/14.

Question: When can an employee enroll with the group policy?

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.


Participation

Question: Can an employer purchase direct pay policies (individual) for their employees rather than a group policy?

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. However, you can provide access to employees to purchase their own individual coverage.

Question: How do I determine if a group meets participation requirements?

The majority of carriers require 75% of eligible employees, excluding valid waivers, to enroll.

Question: What is the minimum number of members needed to enroll for a group policy?

At least two full-time employees must enroll.


Regulations

Question: How do I know if a group falls under COBRA or State Continuation?

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. 

Question: Is an employer required to contribute to the employees’ premiums?

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: What is a JSR (Job Service Report) or Wage and Tax Report – and why do I need it?

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 any new hires not listed should be added.

Question: What is the Health Insurance Portability Accountability and Access Act (HIPAA)?

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.


Pre-Existing Conditions

Question: Can employees receive a rider or amendment on a small group plan?

No. Riders or amendments are not imposed on group policies.

Question: What is the maximum pre-existing waiting period that can be applied to an employee’s policy?

HIPAA regulations limit pre-existing waiting periods to 18 months.


Medicare

Question: If a member is enrolled with Medicare and group coverage, is Medicare primary or secondary?

If the group has 20 or more employees, the group benefits are primary and Medicare is secondary. If the group has 19 or fewer employees, Medicare benefits are primary and the group benefits are secondary.


Flex Spending Accounts

Question: How do I start up a flexible spending account for my employees?

GBL works with several companies who administer flexible spending accounts and can work with you to set one up. Please contact your agent or call GBL at 515-453-8207 or 800-640-7382.

Question: What type of expenses can employees pay through my flexible spending account?

Unreimbursed medical, dental and vision expense, as well as dependent care, and health insurance premiums can be paid through your account. The employee, their spouse, or their children can incur these expenses. Over the counter medications are only an allowable expense if you have a prescription.