FAQ’s

Frequently Asked Questions

How does small business health insurance work?

There are four things every small business owner should know about how small business health insurance works.

  • Coverage is generally guaranteed issue
  • You need at least one employee to qualify
  • You must contribute toward employee premiums
  • And you can shop for coverage at any time of the year

Let’s look at each of these in more detail:

Coverage

First, if you’re eligible for a small business health insurance plan, your coverage is generally guaranteed to be issued by the insurance company.

This means that you, your employees and dependents cannot be turned down for coverage based on pre-existing medical conditions.

All the eligible employees of your small business, and their eligible dependents, have the option to enroll in the new plan regardless of their medical condition.

Number of employees

Second, you need to have at least one payroll employee in order to qualify for small business health coverage.

That said, rules can vary from one state to another, and from one insurer to another. Wall 2 Wall Benefit Services can help you understand if you qualify for coverage in your area.

Employee premiums

Third, you typically need to pay at least fifty percent (50%) of the monthly health insurance premiums for your employees.  The minimum percentage can also vary by state or insurance company.

You may also opt to contribute toward premiums for dependents.

Shop for health insurance coverage

Finally, as a small business owner, you can shop for health insurance coverage at any time of year. You don’t need to wait for a special open enrollment period.

Once you buy a plan, your premiums are generally locked in for a year. During the year, you can add new employees and dependents to the plan or drop coverage for people who no longer work for you.

At the end of the year you can typically renew your coverage or shop for a new plan.

To learn more about your small business health insurance options today, give us a call at 281-313-9255

What’s the best insurance plan for my small business?

Three things that affect your health insurance costs:

Most small business owners will say that the best plan is the most affordable one, but there are three main factors that can influence what you’ll pay when picking a new plan:

  • The amount you pay toward employee premiums
  • The age and health needs of your group, which may affect out of pocket costs
  • And the type of plan you prefer

Employee premiums:

First, your premium share is the amount the business must pay toward employees’ premiums. Typically, the business must pay at least fifty percent of your employees’ monthly premiums under a small business health plan, though the percentage can vary by state or plan.

You’re not generally required to contribute toward the monthly premiums of your employees’ dependents, but some employers do.

Health of your group:

A second factor that may influence your choice in a plan is the health of your group. How old are your employees? Do they see the doctor frequently?

No qualifying employee will be refused insurance or charged more based on his or her medical condition or history, but these factors may still be important when choosing a plan.

Understanding how health insurance impacts your employees and their families is important and your employees’ needs should be discussed when shopping for a plan.

If your employees see the doctor frequently or use prescription drugs on a regular basis that may affect your choice of a plan.

Choosing plans with higher deductibles and copayments may mean a lower monthly premium, but you’ll want to make sure you and your employees can afford that deductible in case you need medical care.

Type of health insurance plans:

Finally, the type of plan you choose can play a factor in your costs.

HMO-style plans tend to have smaller networks of doctors and hospitals and so may cost a bit less than some PPO-style plans that allow you more freedom to choose your doctors.

You may also want to consider partially self-funded health plans.

With a partially self-funded plan, you set aside a certain amount of money to pay for employee medical costs, but that money may be refunded to you at the end of the year if it’s not used.

Work with a Wall 2 Wall Benefit Services Agent to learn more about your coverage options and to get quotes that are tailored to your group’s coverage needs and budget.

  • Coverage is generally guaranteed issue
  • You need at least one employee to qualify
  • You must contribute toward employee premiums
  • And you can shop for coverage at any time of the year

Let’s look at each of these in more detail:

Coverage

First, if you’re eligible for a small business health insurance plan, your coverage is generally guaranteed to be issued by the insurance company.

This means that you, your employees and dependents cannot be turned down for coverage based on pre-existing medical conditions.

All the eligible employees of your small business, and their eligible dependents, have the option to enroll in the new plan regardless of their medical condition.

Number of employees

Second, you need to have at least one payroll employee in order to qualify for small business health coverage.

That said, rules can vary from one state to another, and from one insurer to another. Wall 2 Wall Benefit Services can help you understand if you qualify for coverage in your area.

Employee premiums

Third, you typically need to pay at least fifty percent (50%) of the monthly health insurance premiums for your employees.  The minimum percentage can also vary by state or insurance company.

You may also opt to contribute toward premiums for dependents.

Shop for health insurance coverage

Finally, as a small business owner, you can shop for health insurance coverage at any time of year. You don’t need to wait for a special open enrollment period.

Once you buy a plan, your premiums are generally locked in for a year. During the year, you can add new employees and dependents to the plan or drop coverage for people who no longer work for you.

At the end of the year you can typically renew your coverage or shop for a new plan.

To learn more about your small business health insurance options today, give us a call at 281-313-9255

Are Small Businesses Required to Provide Coverage to their Employees?

Under current law, small businesses with less than the equivalent of fifty (50) full-time workers are not required to offer health insurance – but many do anyway.

Small business health insurance is a great choice for any employer that wants to hire and retain the best workers, but small businesses offering coverage tend to fall into three categories:

  • Growing, successful businesses moving up in the world,
  • Businesses with highly skilled workers, and
  • Businesses that are tax savvy

 

Let’s look at each in more detail:

 

First, there are the growing, successful small businesses that have worked hard and proven themselves. If that’s you – congratulations! You may be ready to reward yourself and your employees with small business health coverage.

Second, there are small businesses with skilled workers, even if it’s just a business with one or two employees.

If that’s you, you know that when competing with larger companies for skilled workers, offering health coverage may be a necessity.

Third, there are small businesses who are financially savvy and who understand the potential savings and tax benefits of offering a group health insurance plan.

For example, did you know that small business group coverage may be less expensive than buying coverage on your own? And that you can typically deduct your small business premiums from your taxable income?

To learn more about your small business health insurance options today, visit Wallbenefits.com or call us at 281-313-9255

  • Coverage is generally guaranteed issue
  • You need at least one employee to qualify
  • You must contribute toward employee premiums
  • And you can shop for coverage at any time of the year

Let’s look at each of these in more detail:

Coverage

First, if you’re eligible for a small business health insurance plan, your coverage is generally guaranteed to be issued by the insurance company.

This means that you, your employees and dependents cannot be turned down for coverage based on pre-existing medical conditions.

All the eligible employees of your small business, and their eligible dependents, have the option to enroll in the new plan regardless of their medical condition.

Number of employees

Second, you need to have at least one payroll employee in order to qualify for small business health coverage.

That said, rules can vary from one state to another, and from one insurer to another. Wall 2 Wall Benefit Services can help you understand if you qualify for coverage in your area.

Employee premiums

Third, you typically need to pay at least fifty percent (50%) of the monthly health insurance premiums for your employees.  The minimum percentage can also vary by state or insurance company.

You may also opt to contribute toward premiums for dependents.

Shop for health insurance coverage

Finally, as a small business owner, you can shop for health insurance coverage at any time of year. You don’t need to wait for a special open enrollment period.

Once you buy a plan, your premiums are generally locked in for a year. During the year, you can add new employees and dependents to the plan or drop coverage for people who no longer work for you.

At the end of the year you can typically renew your coverage or shop for a new plan.

To learn more about your small business health insurance options today, give us a call at 281-313-9255

How much does small business health insurance cost?

What you end up paying for small business health insurance may be influenced by at least three factors:

  • The ages of the people in your group and where you’re located
  • Your preference when it comes to out-of-pocket costs
  • How you shop for and buy coverage

Let’s examine each of these in more detail:

First, your small business health insurance costs will be affected by the age of the people who are going to be covered, and where you live.

Under the Affordable Care Act, pre-existing medical conditions generally won’t affect your premiums, and no one can be turned down for coverage because of his or her medical history.

Second, if you want to spend less in monthly premiums, you may want to pick a plan with higher deductibles and out-of-pocket costs.

Conversely, if you want a plan that offers lower out-of-pocket costs, you may consider paying more in monthly premiums.

You won’t save anything by buying a plan directly from the insurance company, instead of through a licensed agent, because insurance prices are fixed by law for each plan and all agency fees are included in the rates.  However, Wall 2 Wall Benefit Services has licensed agents that represent multiple insurers and will help you compare multiple plans from different companies to find the best match for your needs and budget.

How do small business health insurance tax deductions work?

Like larger companies, small businesses are typically able to deduct most of their health insurance-related expenses from their federal business taxes.

For example:

  • You can usually deduct premiums
  • You can usually deduct contributions to an HSA
  • And, in many cases, you can set aside tax-advantaged dollars to help employees buy coverage on their own

 Let’s look at each of these in more detail:

Monthly premiums

First, when you offer small business health insurance, the amount of money you pay toward the monthly premiums of your employees is usually tax deductible.

The money that employees contribute toward their own monthly premiums can usually be deducted from their payroll on a pre-tax basis – so they get tax benefits too.

Health Savings Account (HSA)

Second, if the health plan you offer is eligible for use with a Health Savings Account (or HSA), the contributions you and your employees make to these accounts are also typically tax deductible up to annual limits.

So long as you use the money in your HSA to pay for qualified medical expenses, you generally will not need to pay taxes on it.

Tax-advantaged dollars

Finally, if you’re a small business owner who can’t afford to sponsor a group health insurance plan, but you want to help your workers buy coverage, you can often do that in a tax-advantaged way too.

Under federal law, qualifying small businesses can now fund special health reimbursement accounts for their employees to purchase individual or family health insurance. Within limits, the money deposited into the account is tax-deductible for qualifying small businesses.  Some states have additional rules and restrictions.

To learn more about your small business health insurance options today, visit Wallbenefits.com or give us a call at 281-313-9255.

How do I get small business health insurance quotes?

If you’re in the market for a small business health insurance plan, there are three things you should know about getting quotes:

  • You’ll pay the same price for the same plan no matter where you buy
  • Comparing quotes for different plans can save you money, and
  • Online quotes are subject to change

Let’s look at each of these in more detail:

First, you should know that health insurance prices are filed with state authorities each year, and nobody is allowed to sell a health insurance plan for a price that is different from the officially filed price.  

If you buy through a licensed agent at Wall 2 Wall Benefit Services you get personal help and advice for the life of your coverage – at no additional cost to you.

Second, we compare quotes from multiple insurance companies and multiple plans. The only way you’re going to find the best match for your needs and budget is to shop around and we do that for you.

We will show you quotes from all the different insurers in your area.

Third, you need to know that the final premium you’ll pay may change based on your final employee count and other factors specific to your situation.

Many small businesses also adjust the deductible and copayment options for plans they’re considering, in order to make monthly premiums more affordable.

To learn more about your small business health insurance options today, visit Wallbenefits.com

How do small business health reimbursement arrangements work?

A federal law passed at the end of 2016 known as the “21st Century Cures Act” provides small businesses with a potential new way to help their employees pay for health insurance.

Under this law, qualifying small businesses can use health reimbursement accounts – or HRAs – to help their employees buy health insurance and pay for health care related expenses.

Here is how it works:

  • A qualifying small employer opens an HRA account on behalf of an employee.
  • Then, in 2019, the employer can put up to $5,150 into the account for a single employee, or $10,450 for an employee with a family.
  • The employee can then buy their own individual or family health insurance plan.
  • And, they can use the money in their HRA to pay their monthly premiums or certain out of pocket costs.

 Be aware that employees who receive HRA contributions typically won’t be eligible for government subsidies when buying coverage on their own through a government exchange.

However, employees can shop for individual or family coverage on non-government exchanges or when buying directly from Wall 2 Wall Benefit Services.

Although federal law allows HRAs to be used in this way, HRAs may not be an option in all states because some state laws restricting HRAs have not yet been updated.

For more information about Health Reimbursement Arrangements for small businesses, speak with an accountant or a legal or tax advisor.

To learn more about your small business health insurance options today, visit Wallbenefits.com or speak to one of our licensed insurance agents at 281-313-9255

When can I apply for small business health insurance?

Here are four things you should know about applying for small business health insurance:

  • You can apply at any time of the year
  • You need to qualify as a small business
  • You need to contribute toward employee premiums
  • And a minimum number of your employees must enroll

 Let’s look at each of these in more detail:

When to apply

First, unlike individually-purchased health insurance plans, small business health insurance plans can be purchased at any time of year by qualifying small business owners.

You may face a change in your premiums or benefits once per year. If you’re unhappy with your coverage, you can look at new options any time of the year.

Qualify as a small business

Second, you generally need to have at least one full-time employee on payroll in order to qualify for coverage.

If you want a group health insurance plan but you’re the only full-time employee of your company, you may still qualify in some cases if you’ve paid 1099 contractors within the past year.  The qualification details will vary based on your specific situation, the state, and the insurance company.

Wall 2 Wall Benefit Services can help you understand if you qualify.

Employee premiums

Third, you should know that you will need to pay at least fifty percent (50%) of the monthly premiums for your employees. This percentage can vary by state or plan.

You’re generally not required to contribute toward premiums for their dependents.

Minimum number of employees

Finally, in order to qualify for small business health insurance, typically at least 75% percent of your eligible employees will need to enroll in the plan, unless they already have acceptable coverage from another source.

  • You’ll pay the same price for the same plan no matter where you buy
  • Comparing quotes for different plans can save you money, and
  • Online quotes are subject to change

Let’s look at each of these in more detail:

First, you should know that health insurance prices are filed with state authorities each year, and nobody is allowed to sell a health insurance plan for a price that is different from the officially filed price.

If you buy through a licensed agent at Wall 2 Wall Benefit Services you get personal help and advice for the life of your coverage – at no additional cost to you.

Second, we compare quotes from multiple insurance companies and multiple plans. The only way you’re going to find the best match for your needs and budget is to shop around and we do that for you.

We will show you quotes from all the different insurers in your area.

Third, you need to know that the final premium you’ll pay may change based on your final employee count and other factors specific to your situation.

Many small businesses also adjust the deductible and copayment options for plans they’re considering, in order to make monthly premiums more affordable.

To learn more about your small business health insurance options today, visit Wallbenefits.com

If I have 1099 employees do I qualify for small business coverage?

If you’ve had employees or contractors that you paid by using IRS Form 1099 within the past year, you may qualify for a small business health insurance plan in some cases.

Generally speaking, you need three things in order to qualify:

First, you need to show that you have employees. It is possible that people you pay with IRS Form 1099 on a contract basis could still be considered employees in some states for the purpose of small business health insurance plans.

Second, you typically need to have at least one employee on regular payroll. This may include yourself.

Third, at least 75% of your eligible employees will need to enroll in the new small group health insurance plan in most cases.

Eligible employees are generally payroll employees who do not already have coverage through another source.

Remember, the rules governing who qualifies for small business health insurance may differ from one state to another and from one insurance company to another. Whether you’re eligible will depend on your specific circumstances.

When is open enrollment for small business health insurance plans?

There are three things you should know about enrolling in small business health insurance:

  • When can you apply for a new plan
  • When can you make changes to an existing plan
  • And how can you add and remove new employees and dependents from your plan

 Let’s look at each of these in more detail:

When can you apply for a new plan:

First, if you’re a qualifying small business owner, you can apply for small business health insurance at any time of year. These policies are generally effective on the first day of any month.

When can you make changes to an existing plan:

Second, once you’ve enrolled, you may make changes to your current benefits with the same insurer once per year.

When can you add/remove employees from your plan:

Third, you can add new employees or remove former employees or dependents from your plan during open enrollment, a qualifying event or with a new hire. Wall 2 Wall Benefit Services will help with this.

When can you add/remove dependents:

You can add dependents to the plan after a qualifying life event such as marriage or the birth or adoption of a child, among other things.

If dependents miss their special enrollment window for a qualifying life event, they generally have to wait until the next annual open enrollment period.

To learn more about your small business health insurance options today, visit with one of our experienced agents.

Can I or one of my employees be turned down for coverage due to a pre-existing condition?

Coverage

First, if you’re eligible for a small business health insurance plan, your coverage is generally guaranteed to be issued by the insurance company.

This means that you, your employees and dependents cannot be turned down for coverage based on pre-existing medical conditions.

All the eligible employees of your small business, and their eligible dependents, have the option to enroll in the new plan regardless of their medical condition.

Why should I offer benefits to my employees?

There are many benefits you can offer through your business, but there’s one winner that rules them all: Health insurance. That’s because it keeps your team healthy and happy, and it signals that you care about their well-being. In fact, many small business owners agree, even if they aren’t required to provide coverage by the Affordable Care Act.

A little over one in four companies with fewer than 50 employees provides health insurance. Why do these small businesses cover their employees through group plans, even if they’re not legally required to? Because it’s good for their teams and good for them. If you’re on the fence yourself, here are the top five reasons to offer health insurance:

 It’s easier than you think

 First thing’s first: You don’t have to do this alone. Wall 2 Wall Benefit Services can guide you through the whole process. As your go-to agent, we’ll:

  • Help select a plan that’s right for you and your team, based on your industry and the coverage preferences of all the folks in your company
  • Set everything up and keep you compliant on an ongoing basis
  • Wall 2 Wall Benefit Services will be the resident healthcare expert for your employees, so you don’t have to answer difficult questions on all thing’s health insurance.
  • Recommend money saving options that do not affect the quality of the benefits.

It makes your employees happy

According to a survey by Glassdoor, employees said health insurance is, by far, the most important benefit they receive from their employer. That’s why employers should offer health insurance as their first company benefit, then add on additional benefits over time.

The top three benefits that make employees the most satisfied, according to Glassdoor’s study, are:

  1. Health insurance
  2. Vacation and PTO
  3. Pension plans, 401(k) & other retirement plans

If health benefits are a top priority for your employees, it should be a top priority for you. Offering benefits has been proven to help with recruiting and in reducing turnover.

It saves you money on taxes

This is a big one! In fact, employers and employees pay less for insurance when they purchase it as a group.

Savings for employers:

Here are all the tax savings you get by offering group health insurance:

  • Employer contributions are tax-deductible
  • Employer payroll taxes are reduced by 7.65 percent of employee contributions
  • Employer workers compensation premiums are reduced

Paying for health benefits instead of higher salaries can also save you money because you don’t pay payroll taxes and workers compensation premiums on money used towards health benefits. Plus, your employees may prefer benefits over salary as well. According to that same Glassdoor study, nearly 80 percent of workers would prefer new or additional benefits to a pay increase.

It can give you access to more doctors and hospitals

Group insurance networks are often larger than individual networks. That means on an individual plan, you don’t have access to the same doctors and hospitals you would on a group plan.

 It helps boost employee productivity

A study from MetLife found that 60 percent of employers say offering health insurance has led to higher productivity levels. And according to the CDC, employees who prioritize preventive care — like regular checkups — get more accomplished at work.

As an employer, you want your employees to focus on being their best productive and successful selves at work. Worrying about health insurance drains their energy and time.

 And there you have it, from building a healthier, happier team to actually saving money, there are many reasons to take the plunge and offer health insurance to your team. Offering health benefits signals that you care about your team, ultimately building a culture of trust.

Does providing benefits to my employees make it easier for recruitment and retention?

Businesses that offer group medical coverage report there are several advantages to doing so. Having group medical coverage may:

  • Lower your hiring costs. Looking for, hiring and training new employees takes time and costs money. Having insurance helps you to recruit and retain talented employees.
  • Reduce absenteeism and decrease risks associated with poor health in the long run. When employees don’t have health insurance, they wait longer to seek treatment, which can lead to the need to stay home from work or go out on disability. Healthy employees are less likely to injure themselves and more likely to do their jobs well.
  • Enhance your office atmosphere and improve morale. Employees tend to be happier and more satisfied with their jobs when they are offered group insurance. Some small employers indicate that their employees will accept slightly lower wages if those wages come with health insurance. In addition, employees can benefit tax-wise (see Tax Benefits above) and convenience-wise by paying premiums right from their paychecks.

A majority of small business owners reported several positive effects of offering health insurance for their employees:

  • 78% said it increased loyalty and decreased turnover.
  • 75% said it helped employee recruitment.
  • 64% said it increased productivity by keeping employees healthy.
  • 62% said that employees demanded or expected health insurance.

58% said it reduced absenteeism by keeping employees healthy.

How do I choose the right plan for my employees?

Whether you’re an established organization and are looking to switch health insurance plans or are a new entrepreneur in search of the ideal health insurance for your growing staff, it’s important to choose your health insurance carefully. When selecting health insurance, be mindful of whom your employees are. If your workforce is made up of mostly young and healthy adults, you may want to choose a plan with a low monthly premium and higher deductible as these individuals are less likely to use their insurance on a regular basis. We can assist you in determining what your competitors are offering so you can gain an upper hand when it comes to attracting new talent.

When choosing a health insurance plan for your employees, take the time to really think about what plans could benefit their life, and in turn, create a thriving workforce. When an employer has the means to meet the healthcare needs of employees, attendance, motivation, and productivity is greatly affected. Whether you’re considering a PPO, POS, HSA, HMO, or HRA, you’ll want to learn the various benefits and downfalls of each. We’re here to assist you in making the right decision for your business.

What are the different types of plans available?

Level-Funded vs. Fully-Insured Plans

Employers that offer health insurance may finance these benefits in one of two ways. Level-funded benefits are health insurance benefits that are free of most of the ACA restrictions. Fully-insured benefits involve purchasing health insurance from an insurance company. With a level-funded health insurance plan, many employers choose this option as it saves them significant money. Larger firms typically choose partially-funded plans. As of 2008, 89 percent of employees in firms with 5,000 or more employees were in level-funded plans.

Traditional fully-insured health insurance plans involve the company paying a premium to the insurance carrier. These premium rates are fixed for a year and are typically based on the number of employees enrolled. With fully-insured plans, the covered persons (e.g. employees and their covered dependents) are responsible for any co-payments or deductible amounts required for services covered by the policy. Small businesses with fewer employees are often fully-insured.

PPO and POS Health Insurance Plans

When developing your employee benefits package, one of the biggest decisions is a choice between health insurance plans. Choosing between Preferred Provider Organization (PPO) and Point of Service (POS) will ultimately depend on the features you desire most in a health plan. PPO is a managed healthcare system consisting of a group of doctors and/or hospitals that provide medical service to an exclusive association or group. A PPO may be sponsored by one or more employers by a particular insurance company or by another type of organization. With PPO, there are limited out-of-pocket costs. However, there is less coverage offered for treatment provided by non-PPO physicians.

POS plans are also managed healthcare systems. There are several key advantages of POS insurance, including greater options for physicians, and the freedom to go outside the POS network for treatment without having to consult your primary care physician (PCP). However, going outside your network will result in significantly more out-of-pocket costs. With a POS plan, it can be slightly trickier to get a referral for specialized care as you must consult with your PCP first.

HSA, HRA, and HMO Insurance Plans

Having the right health insurance plan can improve employee health and productivity. The most common types of insurance plan include HSA, HRA, and HMO plans. Health Maintenance Organization (HMO) health insurance plans typically require less out-of-pocket costs, but can have less flexibility in the choice of hospitals and physicians. With an HMO, you may be required to choose a PCP who will take care of most of your health needs. To see a specialist, you will need to obtain a referral from your primary doctor. With a HMO, you will likely have wider coverage, including more coverage for preventive services.

A Health Reimbursement Arrangement (HRA), also known as a health reimbursement account, is an employer-funded health benefit plan that reimburses workers for individual health insurance premiums and out-of-pocket health expenses. With an HRA, the account is funded completely by the employer, meaning the employee is not responsible for contributing any money to the account. Each year, the employer contributes a set amount to each worker’s HRA. The funds can be used towards any eligible HRA purchases.

Another option is a Health Savings Account (HSA). While not exactly a health plan, a HSA is a savings account that is typically used in conjunction with a high deductible health plan which pays for qualifying medical expenses. An HSA may be a good option for your employees if you want to provide them with greater control over how, when, what, and how much is paid for healthcare, would like them to save tax-free money for current or future medical expenses, or would like them to gain better control over the health plan. With a HSA insurance plan, any funds contributed to an account are not subject to federal income tax at the time of deposit.

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