Small Business Group Health Insurance
Florida
Small business group health insurance is offered in many states to employers with 2 - 50 individuals and provides coverage for the employer, employees and their families. In Florida, the definition of “small group” is 1 - 50 employees, with a special rule for groups of one. Florida law states that insurers are required to guarantee issue the choice of a health plan to the self-employed during a one-month open-enrollment period. These health plans are made available to employees who become ineligible for group health plan benefits. This gives them access to individual conversion policies without limits due to pre-existing conditions.
Florida also has mandatory group conversion requirements. Conversion coverage is health insurance benefits providing hospital, surgical, major medical or comprehensive medical coverage to an individual under a conversion policy. Under Florida state law, conversion rights are required to be included in group health insurance contracts. When coverage under an insured group health terminates, covered employees and members must be entitled to convert to non-group membership without evidence of insurability. Conversion to an individual policy in Florida requirements include:
- That the individual be between the ages of 26 – 30
- Unmarried
- Have no dependents
- Not be covered under other insurance
- Be a full-time Florida resident or part-time student
Rating Restriction
In Florida, individuals electing expanded COBRA continuation coverage must pay the entire premium (employee and employer) share, giving Florida a rating restriction with the percentage of group rates at 115%.
As long as your business is a verifiably legitimate business entity and you can show two or more full-time taxable employees, you should be eligible for group health insurance.
Incentives
Business owners who participate in a group health insurance plan can take advantage of significant tax incentives. Since the financial risk is spread among all the members, coverage will be offered with lower premiums and more extensive coverage for everyone. Employer contributions for group health insurance are usually 100% tax deductible. Payroll taxes may also be reduced by offering health insurance as part of a compensation package. You may also find that by offering group health insurance you’ll be able to hire and keep better talent within your company or organization, since most workers greatly value health insurance benefits.
The Different Types of Group Health Insurance
There are two types of group health insurance: indemnity plans – also referred to as “traditional indemnity” or “fee-for-service plans” – and managed care plans. With an indemnity plan, employees can visit the doctors of their choice and pay for services at the time of the visit. The amount of coverage is a predetermined benefit level of covered medical expenses, based on the deductible and co-insurance amounts. With this type of plan, employees are typically responsible for filling out forms and sending them to the insurer and keeping track of all medical expenses.
Managed care is an insurance plan like an HMO, PPO or POS. A managed care plan offers the insured certain incentives for using providers that are contracted with the insurer. While managed care benefits will vary from one plan to the next, they all encourage members to use their pre-approved network of doctors and facilities, as well as limit coverage of any treatment sought outside the network.
Health Maintenance Organization
With a Health Maintenance Organization (HMO), members choose a Primary Care Physician (PCP) who is responsible for their healthcare, for making referrals to specialists and approving further medical treatment.
HMO’s greatly focus on preventative care and offer a broader range of preventive healthcare services than other types of insurance plans. With an HMO, members don’t have to pay a deductible before services are covered. However, services rendered out-of-network or without a referral will not be covered.
Preferred Provider Organization
A Preferred Provider Organization (PPO) is much like an HMO in that members pay a monthly premium. However, a Primary Care Physician is not required under a PPO. This means that members can see specialists without obtaining a referral.
With a PPO, members usually have to pay a deductible before the insurance company begins paying on claims. Once met, members are required to make co-payments for doctors’ visits. Also, out-of-network services are covered at a lower percentage, thereby encouraging members to visit in-network doctors.
Point-Of-Service
A point-of-service (POS) plan aims to combine the freedom of a PPO with the lower cost of an HMO. This type of plan is based on the basic managed care foundation: lower medical costs in exchange for more limited choices.
Members who enroll in a POS plan have to choose a Primary Care Physician to monitor their healthcare. This PCP must come from within the network and becomes a member’s “point of service.” Services rendered out-of-network may be subject to a deductible, and are typically only partially covered. Members have to pay out-of-network services upfront and must, themselves, submit these claims to the insurance company.
Smart Corner
Eligibility criteria for group health insurance may vary among carriers and by state. Please call one of our licensed representatives at 1-800-835-4607 for information about your company’s eligibility.
