California health
insurance
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California Group Insurance
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Group Health Employer ApplicationA quick
look at the Employer Application for Group health
insurance
The employer application is one of the key documents
needed to enroll in group health insurance in
California. Sometimes called the "Master Contract",
it establishes the contract between the employer and
health insurance carrier. Some of the sections are
basic in terms of what is needed while others
reflect California's high level of legislation and
regulation. Let's take a quick look at a sample Employer Application to help simplify it's
completion.
Employer Application general company information
The first section is where you list pertinent
company information such as name, address, phone,
etc. The carrier may also ask for the SIC code which
is the federal code for your type of industry or
business. You can find your company's SIC code with
a simple look-up. You will also need to enter the
type of company: Corporation, Partnership, Sole
Proprietorship, or Other. LLC can be listed under
other. Each type of company will have different
documentation requirements. There may also be an
area asking if you have been insured by the carrier for the past 12
months. They ask this question since you may have to
wait 12 months before being able to come back on
board if you cancelled coverage already under this
same group.
Medical, Dental, Vision, and Life plan choice on the
Employer application
There will be a section where you designate both
your plan choice and how much the company will pay
towards the premium. It is important to be sure
about this as it will likely hold at least 12
months. Changing plans can be difficult if not
impossible outside your anniversary date. Some
carriers such as Anthem Blue Cross offer Employee
Elect which allows you to offer the full suite of
health and dental plans to each employee and
designate your contribution based on a fixed amount
(say $100 monthly per employee) or a fixed
percentage (say 80% of any plan or 80% of a given
plan). The same contribution strategy must be
applied to each employee. You cannot discriminate
and offer better contributions to some employees and
not others. For AB 1672, or Guaranteed Issue group
coverage in California, the employer is required to
contribute at least 50% of the employee monthly
health premium. There is no requirement for
dependent coverage contribution. You can apply
different numbers to employee contribution and
dependent contribution (if at all for dependents).
If you choose the Employee Elect option, there is
usually an "All Plans" selection. We advise this
approach as it allows a great deal of flexibility
while allowing the company to control it's
contribution levels.
The Group dental section works the same way and has
the same 50% requirement mentioned above for health
benefits. Group vision has the same 50% requirement
but one vision benefit is usually chosen for the
entire group.
California Life Insurance varies depending on the carrier.
There are required contribution levels (usually
lower than the 50%) but you may also have schedules
of benefits you can offer. For example, you may want
to apply the same level of life insurance for all
job titles of offer different life insurance levels
by job type (say officers, managers, supervisors
versus all other group members). You can also apply
a certain amount times salary.
There may be an option for a P.O.P. or Premium Only
Plan. This can be very advantageous when employees
on salary will by paying part of their monthly
premium (including dependents). Essentially, with a
POP, the employees can pay their share of the
premium pre-tax. This saves them income tax on their
contribution and it saves the company payroll FICA
tax on that amount. The employer's savings usually
pays for the cost of the plan (runs around $120-150
annually) with some savings to spare depending on
the amounts contributed by the employees.
Group application eligibility questions
This is actually the part of the Employer
Application that can be more involved. Most of the
work has to do with establishing if the group is
eligible according to AB 1672. Essentially, we need
to figure out:
- the total number of employees (including
owners/officers)
- the number of eligible full time employees
- the number of part-time employees (if part-time
employees are being covered)
Of the eligible people, we need at least 75% of them
to enroll on the plan. Employees on another group
plan can be waived from the eligibility pool. This
above calculation is the one that causes the most
issue for qualifying with Group health insurance.
You will also find questions that speak more to
regulation at the Federal and State level. The
questions regarding Cal-Cobra versus Cobra, Family
Medical Leave Act, and TEFRA/DEFRA are all linked to
the size of your company.
More Employer Application items
You will now deal with more general
requirements/statements about your proposed small
Company.
For example:
- What effective do wish to request to start your
Group health insurance?
- Prior Group health and dental insurance for this
company information?
- Leave of Absence for medical or personal leave.
(Employee pays the premium during these leaves)
- Any employee unable to work due to injury or
illness?
- Worker's Compensation coverage information.
Employer Application and contract signature
There may be a section to designate how ERISA looks
at you. On the Blue Cross Employer Application,
there is also a section to initial part of the
contract regarding Rescission. Following, is the
signature section for the Contract itself.
Cobra Questionnaire form
This form is used if your company had other Group
health insurance (under this company) and there are
employees on that Group plan through Cobra. The
carrier will need this information as they do not
show on the DE6 or payroll.
Other important concepts to help you understand your
California group dental insurance quote are:
Guide to Group health insurance in California
California group health insurance
You can run your
California
Group Health Plan Quote here
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cost to you for our services. Call 800-320-6269 Today!