Ready to get started?

How many employees do I need to qualify?

To qualify for group coverage, your company needs at least two full-time employees (including the owner). A full-time employee is defined as someone that works at least 30 hours per week.

What is health insurance?

Health insurance is a contract between a policy holder and a health insurance company that requires the insurance company to pay or reimburse some or all of a member’s health care costs for covered services.

Frequently Asked Questions

How does a deductible work?

A deductible is the amount of medical expenses an employee is required to pay before the health plan kicks in and pays for care.

How does the out-of-pocket maximum work?

An out-of-pocket max is the maximum amount an employee will pay for health care during the year (in addition to the monthly premium). After they meet this amount, their plan will pay for all covered medical expenses.

What is the difference between in network vs. out of network?

Any health insurance company has a network of doctors, hospitals, clinics, labs, and pharmacies that it works with. "In-network" means seeing a health professional in this network.

When employees see a doctor the health insurance company doesn't have a relationship with, they've gone "out-of-network" and their care may not be covered except in certain situations like emergencies.

What is the difference between HMO vs. PPO?

HMOs are small networks designed around a single medical group or hospital system.

PPOs are broad networks that cover a large option of doctors and hospitals, and typically cover care from both in-network and out-of-network doctors and facilities.

Why are there different network options?

All health plans give access to a health network. A network refers to the doctors, hospitals, labs and other medical facilities that your employees will have access to as part of their health coverage. A good rule of thumb: the bigger a health insurer’s network, the more coverage usually costs.

Do I get cheaper rates if I do not have any health conditions?

No, the rates are strictly based on the age of the member and the location of the business. Previous and current health conditions do not affect the rates of a fully insured Affordable Care Act plan.

Every full-time employee needs to be offered coverage, however, at least one full-time employee needs to participate under your group plan. Other employees must have a valid waiver reason if they are choosing to waive coverage. A couple examples of valid waivers reasons are getting coverage through a spouse or Medicare eligible.

How much does insurance cost?

The cost of health insurance usually depends on three things: what plans are available in your area, how comprehensive you want the coverage to be, and which plan you ultimately choose. A good rule of thumb: the bigger a health insurer’s network, the more coverage usually costs.

Can I get denied coverage due to health conditions?

No, you cannot be denied coverage under a fully insured Affordable Care Act plan.

How much do I need to contribute?

Each carrier has different contribution rules usually ranging from 25% - 50% of the employees monthly premium. There is a special enrollment period each year between November 15th – December 15th where a company is not required to contribute any portion of the premium for one year.

How many employees need to participate?

Employees will pay their portions of the premium via payroll. If your company has a Premium Only Plan (POP) document on file, then your employees can pay their portion of the premium with pre-tax dollars.

How do my employees pay premiums?

The company will receive a monthly invoice directly from the carrier. The company will pay the full invoice and then deduct the proper amount out of each employee’s paycheck. You can run a report directly from the platform to provide to your payroll administrator.

How do I pay premiums?

Do I get cheaper rates if more of my employees enroll?

No, for companies with 50 employees or less, the participation level does not affect the rates. Rates are based on the age of the member and the location of the business, regardless of how many employees participate. The overall premium will be greater if more employees participate, however, the employee’s premium will not be affected.