Office
430 E Bandera Rd.
Boerne, TX 78006
Boerne, TX 78006
Open Hours
Monday – Friday: 8am – 5pm
Saturday – Sunday: Closed
Frequently Asked Questions
There is no federal or state law requiring employers to offer health care benefits to employees. However, it’s common for employers to provide health benefits in order to attract and retain employees. Employers that offer health insurance must adhere to regulations, such as the requirement to offer continuation coverage like COBRA for companies with more than 20 employees. HIPAA (Health Insurance and Portability Act) also mandates rights to group health insurance for employees who have pre-existing medical conditions.
Insurance companies use two methods to calculate group insurance premiums: underwriting and community rating. The method used depends on the state your company is located in. Medical underwriting which is used in such states as TX means each employee is considered individually, so that the overall health of everyone in your group determines the overall cost. Rates may go up if you have one employee with a history of chronic illness (such as diabetes) or with a major illness. Rates are also age banded. The group cannot be turned down because of the health of one individual, nor can any single employee be denied coverage when the rest of the group has been accepted under HIPAA. This law also prevents insurers from charging different rates to individuals in the same group based on their health. Rates within the group may be based on age or gender. Community rating is used in states such as New York where age and health are not considered in setting group premiums for groups of less than 50 lives. Everybody in each geographic area pays the same premium for group health plans. Community rating is a good deal for older people and not for younger healthier people Community rating in most cases is based on the employer’s county to determine the group’s premium. When employees live out of the area, companies look at the employee’s ZIP code to determine cost for the overall group.
According to a Kaiser Family Foundation survey, “Employer Health Benefits 2000,” small employers (3 to 199 employees) typically pay 85 percent of premiums for single-employee coverage, and two thirds for family coverage. Midsize firms (200 to 999 employees) pay closer to 90 percent of single-employee premiums and 80 percent of family premiums, and large firms (1,000 to 4,999 workers) pay close to 90 percent of single employee premiums and 75-80 percent of family premiums.
Self employed people have options for finding coverage. Some states allow the self-employed to purchase health insurance at group rates, as a “group of one.” One-person group premiums are significantly lower than premiums on individual health insurance policies. Some states also offer sole proprietor group rates. Many states define a “group” as two or more employees, leaving the self-employed one other option: You may be eligible for an “association” health plan if you belong to the Chamber of Commerce or a trade association. Be careful with association plans, because it may not be regulated by the state you live in. So if you had a problem or dispute with the health plan, your state’s department of insurance would be less effective in helping you.
State’s laws control certain diseases and conditions must be covered by your group insurance plan. Coverage for other diseases and conditions is optional, and whether you choose to purchase it will depend on how much you’re willing to spend and what coverage your employees require. The Agency can help you tailor a plan that meets your needs and budget. What is a typical waiting period before newly hired employees become eligible to join an employer’s group health benefits plan? The average wait for health coverage at small firms (between 3 and 199 workers) is 2 months and an average of 1.5 months across firms of all sizes, according to a survey by the Kaiser Family Foundation, “Employee Health Benefits 2000,”
You only have to show are a small business with 2-50 employees, but neither you nor your employees will have to provide any medical evidence of insurability.
It depends! You may determine if a class or subgroup of your employees or if all of them are eligible for health insurance coverage through your business. For example, some employers decide that only employees working more than 20 hours per week are eligible for health insurance coverage. Most plans allow you to set the eligibility criteria. You’ll need to ask about that when you are looking at specific plans. Also, if you pay the entire premium, all of your eligible employees must be included, but if employees have to contribute, employees can choose to waive out. When a plan is contributory, Point of Service Plans (POS) and Preferred Provider Plans (PPO’s) usually require at least 50% of eligible employees must participate and many (but not all) plans require a certain percentage of employees to enroll for a business to qualify (normally 70 or 75%). One important exception is that HMOs may not establish any minimum participation requirements within a small group and accept any person within a small group who elects HMO coverage.
We recommend you have some period of time before newly-hired employees are eligible for enrollment. A waiting period is normally between one month and six months, often depending on your type of business.
You can include domestic partner coverage under you plan. Not all insurers, however, offer domestic partner coverage for businesses with 2-50 employees. We can help you determine what carrier will best meet your specific needs.
No. Your coverage cannot be canceled because you have a lot of claims. This is called “guaranteed renewability”. You have this protection provided that you pay the premiums.
Consolidated Omnibus Budget Reconciliation Act (COBRA) provides continuation of group health coverage for former employees, retirees, spouses, former spouses, and dependent children when coverage is lost due to certain events. Group health coverage for COBRA participants is often more expensive than health coverage for active employees, because the employer often contributed towards part of the premium for active employees, while COBRA participants generally pay the entire premium themselves. It is ordinarily still less expensive, than individual health coverage.
Generally speaking, Employees, spouses and dependent children are entitled to Cobra benefits as a qualified beneficiary.
