Frequently Asked Questions
1. Is this considered a group plan?
With respect to your group/practice, this is considered a group plan, so you have to offer the plan to all employees eligible in your organization (full-time employees working at least 30 hours a week).
2. What is the minimum number of enrollees per group?
If all employees decline/waive coverage, it is ok if only the employer or one employee enrolls.
3. Can I take my contribution out of my paycheck pre-tax?
4. What benefit plans are offered?
There are 4 health benefit plans (Platinum, Gold, Silver, BlueSaver 4000), 1 dental plan, and 1 vision plan offered. The health plans are similar in coverage to the standard Platinum, Gold, Silver, and BlueSaver 4000 BlueCross BlueShield plans except there is no pediatric dental or vision coverage and the Silver deductible is $2600/$5200.
5. What benefits are in the dental and vision plans?
The dental and vision plans are an open network of dentists and optometrists (meaning you can see any provider you want). The plan pays usual and customary rates to the providers on a weekly basis. The benefits have no waiting periods.
6. How many plans can I offer my employees?
The employer decides how many benefit plans are offered (could be all or 1), and then the employees can choose what level of coverage they want. This is benefit to small groups because they offer don't get to offer choices.
7. Does the plan offer a Medicare option?
Medicare products are not offered yet. If you are turning 65, you can continue on the plan as long as you are eligible as an active, full-time worker, or you can switch to full Medicare.
8. When do deductibles start over?
Deductibles reset every calendar year. So on January 1 each year, your deductible starts over.
9. When can a group start?
- Whenever the group desires! The group does not have to wait to their traditional renewal date. Your deductible for that calendar year will be rolled in if you switch to the same plan coverage (eg. gold to gold).
- If you are starting a group plan for the first time, then you can start on the first of any month. Your deductible for that calendar year will start new at your effective date.
10. How are contribution rates determined?
Contribution rates are determined on a group/practice basis. Rates are initially calculated based on the gender mix and average age of your group’s plan participants. So, the younger the employees you encourage to be on the plan, the lower the initial rates usually are. Final rates are determined after all participants answer a medical questionnaire.
11. Are there exclusions for pre-existing conditions?
There are no pre-existing condition exclusions, but rates are not final until after a medical questionnaire is completed during enrollment on all participants, and the underwriting department makes a rate recommendation. Final rates will be approved by the group prior to the effective date.
12. How are renewal rates determined?
At renewal, rates will be based on the experience of your group. Rates will be transparent and fair! Renewal is optional, of course.
13. How can a group leave the plan?
You can terminate your contract with the plan with a written notice 90 days in advance of the plan renewal.
14. How many people have to participate in the group vision plan?
All full-time employees must participate whether or not they take any other coverages. You must have a minimum of 5 employees to participate.
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