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Insurance Definitions
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FAQ - Group Policies
Personal/Individual Policies
Q: When can an individual enter a group plan?
Open enrollment or within 30 days of a qualifying event.
Q: Can an employee come onto the plan outside of the open enrollment?
No - there are no late entrants.
Q: At what times throughout the year can a spouse or child be added to the plan?
Open enrollment or a qualifying event, such as loss of coverage, birth/adoption or marriage. The request for coverage must be made within 31 days of the event.
Q: When can a baby be added to the plan?
The insurance company must be notified within 31 days of the child's birth in order for the child to be added to the plan.
Q: At what age must children come off of group insurance?
The age varies from plan to plan. It is generally between the ages of 19-24, if the child is a full-time student and qualifies as a federal tax exemption.
Q: What is a pre-ex?
Pre-ex is a term used for a pre-existing condition that will not be covered by your insurance plan for a defined period after your enrollment date.
Q: What is a deductible rollover?
When a member incurs covered medical expenses during the last 3 months of a Benefit Period, which are applied against that year's deductible, those expenses may be carried over and applied against the deductible for the next Benefit Period but not to the out-of-pocket limit.
Q: What qualifies for a group plan?
You must have 2 employees on a W-2 and both must take coverage.
Q: Can I move my group health plan mid year?
Yes. Groups can move any time of the year.
Q: Is there a lapse in coverage when moving from one group plan to another?
No, as long as you have had current group coverage for over 1 year.
Q: I have two companies. Can I group them together for health insurance?
Yes, as long as you own both companies (IRS Code 414).
Q: What amount, as an employer, must I contribute to an employee's health premium?
You must contribute 25 percent of the total bill; 50% of employee medical only.
Q: How many of my employees must participate for group coverage?
50% to 75% must participate in group coverage.
Q: Can I insure my 1099 employees?
Yes, as long as you have 2 employees on a W-2. Also, what you do for one 1099 employee, you must do for all.
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Nefouse & Associates, Inc.
8465 Keystone Crossing, Suite 190
Indianapolis, IN 46240
Call today (800) 846-8615
or (317) 803-4220
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