Group Health Plan FAQs
- Does the individual / employee really have to be on payroll?
Bottom line… yes.
The insurance companies don’t check at the time of enrollment, but they will request an audit before paying a large claim. The audit usually requires the employer’s “wage & tax” report and payroll records for 12 months to verify the individual is a full-time eligible employee.
- Can the employer exclude certain classes of employees from eligibility for the plan?
It may be possible to exclude certain employee classes from eligibility, such as salaried vs. hourly or management vs. non-management. Please discuss with your broker.
There still must be a minimum of two employees in the eligible class enrolled in medical.
- Do employees have to pass medical underwriting with health history questions?
No, all small group plans (2-50 employees) are now guaranteed issue. No medical questions must be answered.
- Are pre-existing conditions covered?
Yes, all pre-existing condition are covered on the first day of the new group plan.
- Will my future rates be affected by my group’s claims?
No, claims’ rating is now prohibited by law on 2-50 employees’ size groups
- When can a Group Plan be started?
Group Plans can be started on the first day of any month.
- What about independent contractors – 1099’s?
It may be possible to include independent contractors – 1099’s, provided:
a. They meet the FT definition and work exclusively for the company
b. The employer pays the same % of their medical premium as they do for the W-2 employees
c. If the employer is including 1099’s, it must be offered to all eligible FT 1099’s.
Independent contractors – 1099’s must be approved, check with your Broker.