After reviewing this Buyers’ Guide, review the list of participating carriers and the premium comparison sheets for sample small groups. You may also want to look at information available through www.healthcare.gov, sponsored by the Federal government.
Contact the carriers offering coverage in the small group market for specific plan information, or a licensed insurance producer (agent or broker), who can help you evaluate choices for your group’s needs. Find agents under “Insurance” or “Health Insurance ” in your local phone book or the Yellow Pages online.
Note: Not all carriers use agents or brokers, and no agent or broker offers information about all carriers. Review the materials you receive from the carrier(s) or agent(s) and select the carrier and health benefits plan that best meets your group’s needs. Obtain a price quote from the carrier or its agent before making any decisions. A carrier should provide a price quote within 10 business days after you give the carrier all necessary information.
Complete the selected carrier’s application form. Carriers’ forms may look differently, but the information requested is standardized. Submit a completed employee enrollment form (sometimes called the HINT form) and waiver form with the initial application, if required. Employee enrollment forms are also standard from one carrier to another. Mail your completed application, completed employee enrollment forms and/or waivers, if required, and any required premium (typically, one month of premium) to the carrier. Carriers should approve or deny an application within 15 business days after receiving it. If approved, the group’s effective date of coverage will be no later than the first of the month following the date of notice of approval, unless you request a later effective date.
The carrier will issue ID cards to covered employees (and dependents, if appropriate) as proof of the group coverage. Remember to inform the carrier or its agent as employees’ circumstances change. Note: you may request a waiting period of up to 6 months for employees to be considered eligible for enrollment.
Every year thereafter, in order to renew your coverage, the carrier will ask you to verify:
- Whether you still meet the definition of a small employer;
- Whether your group continues to meet employee participation requirements; and
- Whether your group continues to meet employer contribution requirements.
At the time of initial application and upon annual renewal, the carrier may require documentation verifying an employee’s employment status. IF you fail to meet the requirements to keep your coverage in effect, or if you fail to return the annual certification, then the policy will not be renewed.