Idaho Small Group (2-50)
SMALL GROUP MEDICAL INSURANCE RESOURCES
| Insurance Company | Insurance Type | Comparisons | Network |
|---|---|---|---|
| Aetna Funding Advantage | MEDICAL - Fully-Funded | Aetna-ID Plan Brochure | Aetna Networks |
| Allstate Benefits (PPO) | MEDICAL - Level-Funded | Allstate Benefits (PPO) Plan Brochure | First Choice |
| Allstate Benefits (RBP) | MEDICAL - Level-Funded | Allstate Benefits (RBP) Plan Brochure | Reference Based Pricing (No Network) |
| Blue Cross of Idaho | MEDICAL - Fully-Funded | Blue Cross of Idaho Plan Brochure | Blue Cross of Idaho Networks |
| PacificSource | MEDICAL - Fully-Funded | PacificSource-ID Plan Brochure | PacificSource Networks |
| Regence - ID | MEDICAL - Fully-Funded | Regence-ID Plan Brochure | Regence-ID Networks |
Personalized Quotes set up in Private Page
Check out an example of a Private Page Quote from Owen Rose Benefits. Here, you will find an amazing interactive tool that will show you all of your benefit options and provide you with resources for further review. The Password to access the page is: PNW123
Small Group FAQs
| Category | Question | Answer |
|---|---|---|
| General | Are small businesses required to provide employee benefits? | Small businesses (businesses with less than 51 employees) are not legally required to provide employee benefits. |
| Plan Options | What are the options for providing health insurance to employees? | There are many options for small businesses to purchase health insurance plans such as: on the open market, group plans through a professional or industry association, or self-insure. In addition small businesses can choose from a variety of health insurance plan options which vary in network (HMO, PPO, Reference Based Pricing), deductible, and benefit design (Copays, HSAs). |
| Cost | How are the rates determined for employee benefits? | The cost of providing employee benefits can vary depending on a variety of factors. Generally the rates for employee benefits is dependent on the age of the participants. For plans through a professional or industry association cost is dependent on the demographics of the participants in addition to age of the participants. For self-insured (level-funded) groups the premiums are dependent on the perceived health of the participants in addition to the demographics and ages of the participants. |
| Eligibility | Who is eligible for health insurance benefits through a small business? | Eligibility for health insurance benefits through a small business can vary depending on factors that the employer sets up, such as: hours worked, job title, and length of employment. |
| Plan Administration | What is COBRA and how does it relate to health insurance benefits for small businesses? | COBRA is a federal law that allows employees to continue their health insurance coverage after leaving their job. Small businesses that offer health insurance benefits must comply with COBRA requirements if they had 20 employees in the proceeding calendar year, and provide eligible employees with the option to continue coverage. For employers who do not meet COBRA requirements - State Continuation Coverage may be offered (State Continuation Coverage is variable from state to state). |
| Plan Options | What is a deductible and how does it affect health insurance costs? | A deductible is the amount that an individual must pay out of pocket before the health insurance plan begins to cover medical expenses. Plans with higher deductibles typically have lower monthly premiums, but may result in higher out-of-pocket costs for employees. |
| Plan Options | What is a provider network and how does it affect health insurance coverage? | A provider network is a group of healthcare providers and facilities that participate in a health insurance plan. Employees who choose providers outside of the network may face higher out-of-pocket costs or may not be covered at all. |
| Plan Options | what is a copay and how does it affect health insurance cost and coverage? | A copay, short for "copayment," is a fixed amount of money that a patient pays out of pocket for a specific medical service or prescription drug. Copays are a common feature of many health insurance plans, and are typically a set amount, such as $20, $30, or $50 per office visit or prescription. Copays can affect both the cost and coverage of health insurance. In terms of cost, plans with copays generally have higher monthly premiums than plans with higher deductibles and no copays. This is because the insurance company is taking on more financial risk by agreeing to pay a portion of the cost of each medical service or drug. |
| Plan Options | What are health savings accounts (HSAs) and how do they work with small business health insurance plans? | HSAs are tax-advantaged savings accounts that can be used to pay for qualified medical expenses. Small businesses can offer high-deductible health insurance plans that are compatible with HSAs, allowing employees to save money on premiums and contribute to their own healthcare costs through the HSA. |
| Plan Options | What are HMO Networks, PPO Networks, and Reference-Based Pricing Networks and how are they different? | HMO and PPO are traditional health insurance networks that differ in terms of provider choice, out-of-pocket costs, and premiums. HMOs require patients to receive care from within the network and have lower out-of-pocket costs and premiums, while PPOs offer more provider choice but have higher out-of-pocket costs and premiums. Reference-based pricing networks are a newer approach that set maximum prices for certain medical services, and often offer lower costing alternatives to traditional network choices without sacrificing network coverage. |
| General | Does health insurance cover preventive care? | Yes, most health insurance plans are required to cover preventive care services, such as annual checkups and screenings, without requiring a deductible or copayment. |
| Plan Options | Are prescription drugs covered by health insurance? | Yes, most health insurance plans provide coverage for prescription drugs. However, the cost and coverage of prescription drugs can vary depending on the plan and the specific medication. |
| Plan Administration | How are health insurance claims processed for small businesses? | When an employee receives medical care, the healthcare provider submits a claim to the health insurance company for payment. The insurance company processes the claim and pays the healthcare provider directly. |
| Plan Administration | How does health insurance plan renewal work for small businesses? | Health insurance plans typically renew annually, but the renewal process can vary depending on the plan. |
| Cost | Can employees be required to contribute to the cost of health insurance? | Yes, the employer decides amount that is required for employees to contribute in combination with what the employer contributes. Insurance companies generally have minimum contribution limits that the employer is allowed to set. |
| General | What is minimum essential coverage and how does it relate to small business health insurance? | Minimum essential coverage is the type of health insurance coverage that most Insurance Carriers are required to offer under the Affordable Care Act (ACA). |
| Plan Administration | What compliance requirements do small businesses need to follow when offering health insurance benefits? | Small businesses offering health insurance benefits must comply with a variety of federal and state regulations, including COBRA (for employers with over 20 employees in the previous calendar year), HIPAA, and the Affordable Care Act (ACA). |
| General | Should I use a broker to help select and manage health insurance benefits for my small business? | Yes |
| Plan Administration | When is the open enrollment period (also known as renewal) for small business health insurance plans? | The open enrollment period for small business health insurance plans typically occurs once a year, but the timing can vary depending on when the employer sets up the plan. During open enrollment, employees can enroll in or make changes to their health insurance coverage without the need for a qualifying event. |
| Plan Options | What is an out-of-pocket maximum and how does it affect health insurance costs? | An out-of-pocket maximum is the maximum amount that an employee is required to pay for healthcare expenses in a given year. Once the out-of-pocket maximum is reached, the health insurance plan typically covers all additional expenses. |
| Eligibility | Can health insurance plans exclude coverage for pre-existing conditions for employees? | Under the Affordable Care Act (ACA), health insurance plans cannot exclude coverage for pre-existing conditions for employees. This means that employees with pre-existing conditions must be treated the same as other employees when it comes to health insurance benefits. Certain Insurance Options can however deny an employer the option to write business with them if they do not meet certain health related criteria. |
| Plan Administration | What is COBRA coverage and how does it apply to small business health insurance plans? | COBRA is a federal law that allows employees, of businesses who employed 20 or more employees in the previous calendar year, who lose their jobs or have their hours reduced to continue their health insurance coverage for a limited period of time. Small businesses that offer health insurance benefits must comply with COBRA requirements and provide notice to employees about their rights to COBRA coverage. |
| General | Should small businesses offer dental and vision benefits as part of their health insurance plans? | Offering dental and vision benefits can be a valuable addition to a small business health insurance plan, as these benefits can help promote overall health and wellness for employees. Employers can choose to offer standalone dental and vision plans or include these benefits as part of a comprehensive health insurance plan. |
| Plan Administration | How do I administer a small business health insurance plan? | Employers can work in collaberation with Owen Rose Benefits by leveraging our resources to manage plan enrollment, plan design, and other administrative tasks. |
| Plan Options | How do I compare different small business health insurance plans? | Ask Owen Rose Benefits to help - that's what we're here for! |
| Eligibility | Can small business health insurance plans cover dependents of employees? | Yes, small business health insurance plans can cover dependents of employees, such as spouses and children. Employers can choose to offer dependent coverage as part of a comprehensive health insurance plan, or allow employees to purchase dependent coverage separately. |