Health Insurance Basics
True or False: Small group health insurance is available to employers with less than 50 active FTE employees to enroll in health insurance.
True, however, there are four states where the number is less than 100 active FTE employees enrolled in health insurance: CA, NY, Vermont, CO
What is step one of the New Plans Process?
The Customer Reaches out
What are some things an OA does upon receiving a new group?
1. Review the QA sheet
2. Review Tasklist v2
3. Set Open Enrollment
Define what a health insurance broker does.
Works with employers and insurance carriers to ensure that insurance plans chosen by the employer meet their needs/budget - someone who is licensed to sell insurance.
What is step two of the new plans process?
The customer works with our New Plan Advisors (sell and advise our customers on different benefits packages based on the needs of the company)
What should an OA do once OE has been set?
Chill and collect documents from the employer!
What is a copay?
This happens first and is the specific dollar amount you have to pay before care is provided. Does not count toward deductible.
What is step three of the new plans process?
The customer works with our Fulfillment Team
True or False: The status "Awaiting Routing" means we are waiting for Salesforce to update and send the ticket to the correct team for review.
False. Salesforce logic is broken. The OA manually moves the benefit/carrier order to the appropriate order status.
True or False: The Affordable Care Act (ACA) is a federal law that requires employers to pay all of their employees health insurance premiums to ensure that the employee can afford other things for daily needs.
False. The ACA is a federal law that aims to make healthcare more affordable and accessible to Americans. One section of this law governs employer-sponsored health insurance. Employers with 50+ full-time equivalent (FTE) employees need to offer affordable (less than 9.5% of the employee's annual household income) health coverage that meets the minimum standards. They must offer this coverage to employees and their dependents. Non-compliance here will bring a hefty fine to the employer.
What is step four of the new plans process?
The customer's information is submitted to the carrier (Generally, it takes 10-15 business days to hear back for a company's enrollment before underwriting)
How long does someone have to enroll into Cobra?
Employees have 60 days from their last day of coverage or the date they were notified of their COBRA rights (whichever is later) to enroll in COBRA.
True or False: Gusto will provide Broker of Record transfers to customers that currently do not offer medical insurance.
False. Customers must already offer insurance in order for us to work with them on Broker of Record Transfer.
What is step five of the new plans process?
The customer celebrates
True or False: If an employer wants to terminate coverage with one specific carrier, they must terminate coverage with all.
False. Employers can terminate coverage with one or more carriers of their choosing. It's their choice.