What do I need to set up group health insurance?

*This post applies to small businesses only (under 50 employees).

Right now you're looking to set up benefits for your employees. Now, how do you make it happen? Also, are you eligible to get group health insurance? We set up a checklist to get you started.

  1. Do you meet carrier participation requirements?

  2. Do you have your most recent DE9C?

  3. Do you have your most recent payroll?

  4. Do you have details for each employee: name, address, and date of birth?

  5. Do you have a workers' compensation policy?

The list can seem daunting at first, but keep in mind that the beginning set up is always the hardest. Once you're enrolled, you are good to go!

1. Carrier participation requirements

Most carriers require around 75% of eligible full time employees to enroll in the group health plan you set up, unless they have a valid waiver.

A valid waiver is when an employee declines coverage because they have health insurance through one of the following:

  • Spouse's employer plan

  • Another employer (i.e. 2nd job)

  • Parent's employer's plan (up to age 26)

  • Medi-Cal

  • Medicare

Employees who have a valid waiver do not count into the full participation requirement. You can subtract the employees from the full time eligible employee count.

2. DE9C

This document is required to apply for group health insurance. It also helps to calculate full time eligible employees.

3. Payroll

Like this DE9C, this document is required to apply for group health insurance. It also helps to calculate full time eligible employees.

4. Employee information

You'll need to provide each employee's name, date of birth, and home zip code. This information is needed to get a quote (small group is rated based on age and zip code). It's also needed to get employees enrolled in the plan. If you're offering spouse and dependent coverage, we'll need their information as well.

5. Workers' compensation

California law requires that any company with 1 employee must have a workers' compensation insurance policy. This insurance provides compensation and benefits to employees who suffer work-related injuries or illnesses, regardless of who was at fault.

Take some time to collect the necessary documents listed above. Once gathered, we will help start the process with you and make it as seamless as possible. You can sit back and get your employees covered!

Open enrollment 2017

*This post applies to under age 65 only.

Open enrollment! It's the only time of year that you're allowed to start or change your health insurance plan. Once this period is over, you're typically locked in the plan for one full year until the next open enrollment (unless you experience a special qualifying event).

Dates to keep in mind

Please note these dates change year to year.

PLAN TYPE DATES

Individual and Family Health Insurance
On Exchange and Off Exchange

November 1, 2016 - January 31, 2017

Benefits
(Employer Sponsored)

Check with your employer.
Dates depend on your employer's group 'anniversary'

Medi-Cal No specific dates, can apply at any time

Open enrollment

This open enrollment period is for individual and family plans, whether through Covered California (on exchange) or direct to the carrier (off exchange).

During open enrollment, you can:

  • Change to a new health insurance company

  • Change your coverage by upgrading or downgrading (i.e. If you have a new health condition, or you've started taking more prescriptions, this would be the time to review and make a decision)

  • Look at your estimated income and make changes as necessary

Open enrollment for health benefits through an employer

The open enrollment period for employer-sponsored health plans will vary with each employer, because an employer can start a new group health policy at any time during the year. You need to check with your employer or HR department to find out.

Some people choose to opt out of their employer-sponsored health insurance, either because it's too expensive or they want other options. If you opt out, please note these rules:

  • You must decline coverage during your employer's open enrollment period

  • When you opt out, you most likely cannot qualify for premium tax credits through Covered California (the exchange). As long as the employer-sponsored plan is considered 'affordable' and meets 'minimum standards', you will not get premium assistance. An employer's plan is considered 'affordable' if your portion of the premiums are less than 9.66% of your household income.

If you miss open enrollment and do not experience a special qualifying event, you would be able to apply for a short-term health insurance plan. However, these do not count as minimum essential coverage, so you may still pay the penalty for not having health insurance.