Decide Who Should Be Covered — Before selecting a group health plan, you must decide who will be covered. It is traditional to cover only full-time employees who have been with the company for a certain amount of time. Coverage can be extended to include spouses and other dependents, as well as part-time employees. Insurance companies generally impose minimum requirements on the definition of dependents, and, once these requirements are in place, you are obligated to remain consistent with regard to who qualifies for coverage and who does not. To alter this definition after it has been established or to give the impression that the definition differs depending on the individual could be a violation of state and federal discrimination laws.
Deductions for Benefit Premiums — In most cases, employees pay for a portion of their insurance coverage. The employer often deducts these costs from their paychecks. Insurance carriers generally provide companies with all the forms needed to handle this. In many cases, these documents are completed at the time of enrollment. Always be sure to get written permission from employees before deducting anything from their paychecks. Deductions from Section 125 Plans are from gross rather than net income (in other words, they are pre-tax).
Enrolling Employees / Changing Coverage — After eligibility requirements have been determined, it is important to provide employees with straightforward information on the plans available and any deadlines that apply.
Employee-benefits plans typically impose limitations on when you or your employees can make any changes to the existing coverage. These are often events such as:
- Birth or adoption
- Changes in the employment of an employee’s spouse
- Changes in work hours
- Unpaid leave of absence
Gathering Employee Information — To obtain group health insurance, certain information is required. This is commonly known as the census. The census covers all pertinent information on each employee who will be enrolled in the plan. The information most commonly asked for includes the following:
- Full name of each employee
- Age or date of birth
- Home address
- Information on any dependents who will be covered
Opting Out of Insurance — Some employees may want to forego the insurance coverage if they are already covered under another plan, such as a spouse’s group insurance, or if they feel they can’t afford the additional expense. You can a) allow them to do so, or b) require that they obtain coverage regardless. If they do opt to decline coverage, be sure to obtain this in writing for your records. This confirms that the employee was given an opportunity to enroll and that he/she understands any restrictions that may apply to future participation. Remember, however, that if employees are expected to pay for part of their premiums, they should not be forced to enroll.
Reading and Comparing Proposals — When researching insurance plans, you will obtain many different proposals. That is why Cowtown Insurance offers simple comparisons of each plan’s features. The most important factors to check are the following:
- Premium schedule — cost per employee per month
- Benefits schedule — general overview of the benefits provided
- List of doctors in the network