Group Health Newbies: Don’t Be Caught Off-Guard When Shopping for Your Business’ Plan

If you’re a newbie shopping for group health insurance for your small business, how are you feeling about the whole process? Confident? Nervous? Confused? We get it, there’s a lot of feelings to feel when it comes to picking a plan. But we’re here to guide you, and steer you past some of the common surprises and pitfalls that may come your way.

You Might Need More Info Than You Thought

caucasian hand holding a pen filling out a survey
Conduct an anonymous employee health survey prior to shopping, so that you know what your employees want in a plan.

We’ll start you off with an easy one. When it comes to getting accurate quotes, you used to be able to simply provide the age ranges of employees. Now you need to have their exact date of birth, as well as the dates of birth of any spouses or dependents they want to cover. Don’t be caught fumbling around for info, make sure you’ve collected all of your data before even looking for a plan. We would suggest conducting an anonymous employee health survey prior to shopping, so that you have all of the facts at your fingertips, as well as a good idea of what your employees are looking for in a plan.

A Provider You Thought Was Covered Isn’t

A lot of people are attached to a certain doctor or healthcare provider. When choosing a plan, you need to pay close attention to the network that is offered, especially since many plans are reducing the size of their networks to cut insurance costs. You could end up with unhappy employees who are unwilling to enroll in your plan if the network is too small or if their doctor isn’t included. And if this is your second time offering insurance, pay extra close attention to any changes made to the network; plans can change from year to year, so the providers that you were sure were covered, may not be. 

Your Employee Isn’t Eligible

time sheet
Employees are usually required to work at least 30 hours to be eligible for certain plans.

This one might really come as a surprise. You’ve decided to offer healthcare to all of your employees, but that doesn’t mean that all of your employees are eligible. The state your business is in, your insurance company’s rules, or even the policy you choose can dictate the number of hours an employee must work to be eligible for your plan. Employees are usually required to work at least 30 hours to be eligible for certain plans; they must also satisfy a waiting period before they are covered. It could be disastrous to extend coverage to an employee who signs up, only to find out later that they were ineligible for the plan. They could end up saddled with a giant medical bill even though they thought that they had insurance.

You Need to Communicate with Your Employees – A LOT

Keeping your employees informed about their health coverage is not a courtesy, it’s an absolute must. You need to provide a Summary of Benefits Coverage (SBC) to participants and beneficiaries prior to enrollment in the plan, at renewal of the plan, within 90 days of a special enrollment period, and within 7 business days of a written request. 

You also need to give each employee covered under the plan a Summary of Material Modification (SMM) when there are changes made to their health benefits. We know, that sounds like a lot of paperwork, but it’s important that you familiarize yourself with all of these notices. Remember, EZ’s agents can help you manage all of the crazy insurance admin that you have to deal with! 

Prescription Drug Pricing Is Complicated!

If your employees are counting on prescription drug coverage in their group health plan, then you’re going to want to take a closer look at how your chosen plan covers medications. All drugs are priced differently, and generics cost less than brand name medications, but what you might not know is that the same drug may be priced differently by different insurance companies. The same drug might even have a different copay on different plans with the same company. Familiarizing yourself with different plans’ drug formularies can help to cut down on prescription price surprises.prescription drug bottles

One more thing that you might not have realized in regards to prescription drug coverage is that some plans now actually have a separate drug deductible. Just as with a general deductible, your employees would have to meet a set amount of drug expenses out-of-pocket before their plan would begin covering the cost of prescription medications. Again, this is where an employee health survey would help to give you an idea of what your employees need, and what you need to avoid when looking at healthcare plans.

A High Deductible Isn’t Always a Bad Thing

Yes, a high deductible can sometimes be a burden to employees, especially those with lower incomes, and you might think that if you’re providing healthcare you should avoid any plans that might pile high out-of-pocket costs onto your employees. But you might be surprised to find that some employees actually prefer these lower premium plans, especially if they rarely use medical services and are just looking for a safety net in case of emergency. This is especially true if you pay a higher percentage of their (low) premiums (meaning you’ll still be saving money), choose a plan that is HSA-eligible, and then contribute to those health savings accounts. HSAs have tax advantages for both you and your employees, and having that money put aside means that employees will be able to cover a surprise medical expense. 

The list of things you need to know about healthcare plans as an employer can seem endless, and it may feel like you are constantly being surprised by some new rule or protocol. But we promise, you’ve got this! And we’re here to support you, simply contact one of EZ’s knowledgeable agents and you’ll have all the answers to your insurance questions at your fingertips. We can also sort through all of the plans on offer and get you instant, accurate quotes so you can find the best plan for your business and your employees – and we’ll do it all for free! No hassle, no obligation, and no surprises! To get started with us, enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Catastrophic Plans Can Be Confusing, Let Us Help

The cost of health insurance is not one size fits all. If you’re healthy, under 30, and facing financial hardship, you could have some cheaper options available to you. For people in these categories, Catastrophic health insurance plans can provide essential health benefits without breaking the bank with monthly premiums. However, you should know that, while premiums on these plans are low, they have high deductibles. If you remain healthy, then your high deductible won’t be a problem, but if you have an accident or become ill, you could end up with huge medical bills. Before you decide if a catastrophic plan is right for you let’s take a look at how they work.

Who These Plans Are For

homeless person sitting outside with a black bag full of clothes
Catastrophic plans are ideal for people dealing with hardships such as homelessness.

Catastrophic plans are designed for individuals who are young or struggling to afford health insurance. Not everyone qualifies for these plans. They are only available to people who are:

  • Under 30 or are over 30 and meet the guidelines for a hardship exemption. This includes people whose plan was canceled by their insurer or small group employer.
  • Dealing with hardships such as homelessness, eviction, foreclosure or bankruptcy, domestic violence, or medical debt
  • Considered low-income and cannot afford insurance

These plans have the lowest premiums of any plans on the ACA exchanges, but they also have the highest out-of-pocket costs.These plans do not have a copayment or coinsurance and premiums will vary depending on where you live. Generally all plans have the same high deductible: deductibles were $7,900 for 2019, and they have risen to $8,150 in 2020. Once you meet your deductible, then the insurance company will pay for all covered services.

Who They Are Not For

weekly pill container filled with pills in it with Tuesday tab open.
If you are unhealthy with a condition, then these plans are not right for you.

Do you see the doctor often? Do you need a lot of coverage? Do you plan on starting a family in the next year? If you answered yes to any of these questions, then a catastrophic plan is probably not the best choice for you. Because of their high deductibles, these plans are not for people who have health conditions that need constant attention. In this case, you will probably want to look for a plan with a lower deductible, even if it means a higher premium. 

If you are over 30 or do not qualify for a hardship, then you can look into getting a Bronze level plan on the ACA Marketplace. These plans are very similar to Catastrophic plans, but with slightly higher premiums and without the same qualification requirements of Catastrophic plans. Even if your income isn’t low enough for a Catastrophic plan, you may still be able to get subsidies for a Bronze plan. 

Just The Essentials

Catastrophic plans must include all of the ACA’s benefits, and include some free preventive care. These plans cover:

  • Outpatient services

    tubes with purple tops filled with blood being held by a person with purple gloves on.
    Catastrophic plans cover the 10 essential benefits such as lab work.
  • Emergency services
  • Hospitalization
  • Pregnancy, maternity, and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Lab work
  • Preventive and wellness services, and chronic disease management
  • Pediatric services, including oral and vision care

Catastrophic plans aren’t for everyone. If you’re unsure what plan is right for you, come to EZ.Insure for help. We understand how intricate the insurance world is, and because we have been in the industry for over 10 years, we can offer you free expert advice on which direction you should go in. To get free quotes, enter your zip code in the bar above, or to speak directly to one of our experienced agents, call 888-350-1890.

Making The Most Of Your High Deductible Health Plan

High deductible health plans are rising in popularity, with more companies offering them and even more people purchasing them individually. These plans definitely have benefits, like their lower premiums, and they can be great for healthy people on a budget. On the other hand the high deductibles of these plans can be a problem, because going to the doctor or hospital can mean being stuck with a big bill. Or knowing you have a high deductible to meet might make you think twice about seeking care, and you might end up ignoring symptoms until things get worse. However, there are ways to make the most of your high deductible health plan while getting the care you need and saving money.

Utilize Your Freebies

the word free in caps and in red

Under the ACA, all insurance plans must provide coverage for some preventive health services with no out-of-pocket costs- this applies to high deductible health plans. These free preventive services will not have a copay and do not count towards your deductible. You can expect to get free vaccines, cholesterol and blood pressure screenings, birth control, and some cancer screenings such as mammograms and colonoscopies.

Check with your insurance plan’s details and be sure to stay in-network to avoid unexpected costs; these services are free but you still have to stay within your plan’s network.

Ask For Discount

If you are sick and need to seek treatment, but are worried about a high medical bill, ask your provider if they offer any discounts. Some doctors’ offices will offer a discount if you pay with cash, or you can ask your doctor for a discount on a service that you will have to pay for entirely out-of-pocket. If they do not offer any discounts, then ask if they offer payment plans so you can avoid medical debt

black silhouette of a piggy bank with a gold dollar sign in the middle
HSA accounts have triple tax advantages which can help you save money for medical expenses.


Triple Tax Advantages With HSA

One of the major benefits of having a high deductible health insurance plan is the ability to have a health savings account (HSA) alongside it. HSAs allow you to put money aside, pre-tax, to help you pay for qualified medical expenses. These accounts offer a triple tax advantage because:

  • Contributions are tax-deductible
  • Contributions roll over and can continue to grow tax-free into the following year
  • Withdrawals are not taxed if you use them for qualified medical expenses. 

Take note that unqualified expenses incur a 20% penalty.

Stay In Network

caucasian womans hand pressing into the middle of a blue network

This is said a lot, but it is worth repeating. In order to avoid major out-of-pocket expenses, you must stay within your plan’s network. When you have a high deductible plan, it is especially important to stay within the network to avoid extra charges. Only in-network services will count towards meeting your deductible; any care you get outside of your network will not count. Make sure to double check with your insurance company and doctor’s office that any specialists you are referred to are in your plan’s network. 

Do you have a high deductible health insurance plan? Are you considering one? If you are in need of help, EZ.Insure is here for you. We provide accurate quotes on all plans in your area, and our trained agents will go over each plan and will find one that fits your needs and budget. To get free quotes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.