1. I just formed a company; can I apply for group medical insurance？Yes. Please provide most recent 6 weeks payroll journal to apply.
2. We are a husband and wife company; can we apply for group medical insurance?According to insurance companies' underwriting guideline, a company with only husband and wife cannot apply for group medical insurance. It needs at least one additional full time employee to qualify.
3. How much premiums are employers are required to pay for employee and employee's dependents?If it's group medical plan, employer are required to pay at least 50% of employee's premium. For employee's dependents, dental and vision plans, such requirement is not mandatory (depending on employer's benefit package).
4. Does the insurance premium paid by employer have any tax preference?The premium employer paid can use for tax deduction; it will help in saving money for the company. To form a group insurance will be a win-win situation for the employer as can sustain valuable employees and at the same time can have tax preference.
5. Our company has more than 50 full time employees but not exceeding 100, will we be penalized if we do not provide medical insurance?Yes! Per ACA regulation, a Large Group company has to provide to at least 95% of its employees a medical plan that is in compliance to the minimum essential coverage plan or will be subject to penalty.How penalty is calculated：
6. Can my company reimburse employees' individual medical plan's premium?No. According to ACA, if the company reimburses employees' individual medical plan's premium, the company will be facing penalty at $100/day/person, or $36500/year/person, whichever is lower will be the penalty amount.
7. If employee left the company, can he or she join COBRA or CAL-COBRA?Yes. If company has less than 20 employees, when the employee left the company, he/ she can elect to join CAL-COBRA and can use up to 36 months. If company has more than 20 employees, he /she can elect to join COBRA for 18 months, and once COBRA lapsed, he/she can continue to elect to join CAL-COBRA for an additional 18 months.
8. What's the difference between group dental insurance plan and individual dental insurance plan?Compare to individual dental plan, group dental plan's greatest advantage is “no waiting period”. For individual dental plan, a simple tooth extraction or filling, for example, need to wait for 6 months in order to receive treatment and crown will need to wait for 12 months. In addition, group dental insurance plan can select to have additional feature like orthodontic, in which individual plan does not and cannot be added.
9. Our company provides group medical insurance. What are the regulations for new hire's insurance effective date?Due to Health Care Reform, starting 1-1-2015, employer needs to enroll an eligible new hire within 90 calendar days. The effective date for new hire's insurance plan can be any of the followings:
10. Can we select different tiers of medical plan when applying for group medical insurance?Yes. The employers can select different tiers of plan for the employees in order to meet their needs.
11. What is 1095B?1095B is form provided by the insurance carriers to show employee's insurance coverage in the past year. Employees should receive the form by March 31st every year.
|Suitable for||Situation||Penalty Amount||Penalty applies to|
|All Employers||Company reimburses /pays for employees' individual plan.||$100/day/person; up to $36,500/person||Employer|
|Small Group Employers(50-100 full time employees)||Company does NOT provide medical insurance at all||$2,000/year/person (penalty assess from the 31st full time employee, the first 30 full time employees are exempted)||Employer|
|Small Group Employers (50-100 full time employees)||Company's insurance does NOT meet ACA requirement; or the insurance provided is not “affordable”||$2,000/year/person (same as above) ；$3,000/year/person (if full time employee applied through Covered CA and received subsidy), whichever is lower will be the penalty amount.||Employer|
|Large Group Employers (≥101 full time employees)||Company does NOT provide medical insurance at all||$2,000/year/person (penalty assess from the 31st full time employee, the first 30 full time employees are exempted)||Employer|
|Large Group Employers (≥101 full time employees)||Company's insurance does NOT meet ACA requirement; or the insurance provided is not “affordable”||$2,000/year/person (same as above) ；$3,000/year/person (if full time employee applied through Covered CA and received subsidy), whichever is lower will be the penalty amount.||Employer|
|Type\Number of Full Time Employees||Suitable For||Duration|
|COBRA||20 and more employees||18 or 36 months|
|CAL-COBRA||2-19 employees||Up to 36 months|
|Target (individual/ company)||Applicable Form||Issuer|
|Individual and family Plan with Covered CA (On-Exchange)||1095A||Covered CA(Covered California)|
|Individual and family plan without Covered CA (Off-Exchange), MediCare, and Medi-CAL||1095B||Insurance Carriers, Medi-care, Medi-CAL offices|
|Employees with Small Group Medical Plan||1095B||Insurance Carriers|