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How many employees are required for group health insurance?

Companies of all sizes pride themselves on offering health insurance with their employees’ jobs. It is an enormous perk, one that can’t be underestimated, and something that those searching for full-time jobs have come to expect. But with small businesses and those that employ remote workers on the rise, it can be common to question how many employees are needed to qualify for a group health insurance plan.

To be eligible for group health insurance (which is often cheaper than individual plans), a company must have between one and 50 employees. This allows companies to apply for small group coverage, and those with more than 50 employees can only apply for large group coverage. But, there are other requirements.

Requirements Beyond the Number of Employees for Group Insurance

In addition to the right number of employees, you need to satisfy the following requirements:

Certified Office Space.

Another key necessity to qualifying for group health insurance is that you must have a certified office or workspace in the state in which you are applying for group coverage.

One of the Employees Cannot Be the Owner.

Additionally, the only covered member cannot be the owner of the company — they cannot also be the spouse of the owner or member of the owner’s family. If your company is one that you and a spouse run as the sole employees, you would need to apply for coverage through a MEWA plan until other workers unrelated to the owners join the staff. But once you have enough employees to qualify for group coverage, the market would open up.

Full Time Employees.

Employees must work on a full-time basis. Insurance cannot be offered to part-time workers, but it is not necessary to as they won’t count toward your minimum to qualify for group coverage. Your full-time employees are considered those who work at least 25 hours per week. Note that seasonal employees do not count, even if they are indeed working for 25 hours during their term of employment.

Enrollment Percentage.

Companies accepting group coverage are also required to enroll at least 75 percent of eligible employees. Those with differing insurance plans do not count toward this minimum rule, and know that enrollment happens annually usually in the month prior to the group’s renewal.

Wondering how you and your company can qualify for group health insurance, and curious about which plan you should go with? Let the experienced insurance broker of Dawson Benefits help you navigate this intricate course — call today for a free consultation.

Can I keep my doctor if I switch health insurance plans?

Switching health plans can bring about a lot of anxiety — it’s a major transition for some, and it is often a highly personal, medical, and financial decision. As such many dally in changing their plans, even if it is more beneficial to, as they say, rip the band-aid off.

But one principal concern in switching health insurance plans is defining whether or not you get to keep your doctors after you make the change. Patients establish trusted, healthy, and sometimes even lifelong relationships with their doctors, and leaving your medical professional can be difficult; they are the keepers of your entire clinical history and know how to communicate with and treat you. But changing insurance plans does not also necessarily mean losing your medical contact.

Obtain a List from Your Doctor of Participating Insurance Plans

When choosing a new insurance plan, there are lots of steps to take to see if this means going to a new doctor. To start, request from your doctors or their staff a list of networks they are contracted with. (This may also be on their website.) From there, you know exactly who you can switch to while still staying in-network. The work that follows, of course, entails finding out which plan is a good fit, financial and otherwise, but websites like healthcare.gov or using state or private exchanges can be helpful.

What to Do if Your Doctor Is Not in the Plan You Are Considering

But it’s also very possible that the new health insurance plan that you’ve been considering is not one your beloved doctor accepts. Fear not: this does not mean the end of the road. Talk to your doctor; perhaps some kind of an agreement can be arranged, or perhaps he or she has been getting requests from other patients about your chosen network and so the office may consider adding it to their plans.

However if it turns out that plan cannot be accepted, you may have to make a firmer decision. Without your insurance to cover key expenses, you’ll have to decide whether staying with your doctor and paying out-of-pocket is worth it, or perhaps your doctor can still be of use: mention the network you plan on switching to, ask your doctor if they know of any neighboring facilities that accept that plan, and see if your doctor recommends any other professionals who could be a good fit for your needs. They’ll know you best and can find someone for you to have a fruitful relationship with.

If you’re considering switching plans or are unsure about what that means for your medical future, speak with our insurance broker — we’ll happily guide you through and discuss plans tailored to your needs!

Should you use a broker to get health insurance?

Health insurance application form with pen, calculator, and glasses

If you can find your own insurance company and quickly set up a plan over the phone or even online, why invest in a broker? The reasons to do so may surprise you.

As your policies, benefits, and employers shift, figuring out new health insurance plans can be become that check-list item you never quite get to. While trying to figure out a proper plan can indeed be a paperwork hassle and logistical, time-consuming nuisance, insurance is, innately, something that is meant to protect you and your staff. As such, might using a broker be the most plausible route?

Going Through the Insurer Directly May Not Be the Best Option

Myriad avenues toward securing a high-quality plan exist; you can buy straight from insurance companies, work with agents who will sell insurer’s plans on their behalf, or there are brokers who window shop for the best deals and most customizable plans for your company’s needs. It might seem most efficient to go through the insurer directly, but that road can be full of potholes: for one, going straight to an insurance company means you are at their whim and may be charged for a less cost-efficient plan if you are not savvy in the insurance marketplace. On top of that, strenuous hours, research, compliance issues, and phone calls go into locking down a plan that is best for you and your team.

Utilizing an Insurance Agent Also Has its Drawbacks

Similar gripes can come with agents who, though seemingly independent in their work, indeed collaborate with companies to hawk their product and make its case. Might an independent broker be the more solid, trusted, and cheaper option?

Why You Should Use an Insurance Broker

It often is: for one, brokers are external workers, kind of like freelancers, and thus easily disposable. So it is very much in their best interest to discover and activate the most affordable and individualized health insurance plan for your company. As an experienced point person with a foothold in the insurance world, they can also act as advisors and guides for employee questions around doctors’ disputes about deductibles and co-pays. And since no insurance company employs a broker, their advice is sound and impartial. Plain and simple, they are their own employer working for your best interest.

Looking for a broker, or perhaps in need of a consultation about best practices and your company’s unique insurance needs? Let’s set up a call today!

How do I find an insurance broker?

Finding an insurance broker shouldn’t be as hard as finding an insurance plan: the latter entails rigorous research, aggregating the needs of your employees, and searching for what is the most cost-effective option for your company. Enter the broker: your advisor who works in your best interest, not the insurance company’s.

But What Is The Best Way To Find A Broker With Whom You’ll Maintain A Long, Trusted, And Healthy Relationship?

There are a few ways: for one, it is worth talking to your professional peers. Who are they using? Do they value their broker’s work? Are the employees satisfied? Talking to peers in similar fields is useful, and they may offer referrals. Municipal organizations (local association of health underwriters or chamber of commerce) may also be able to lend some advice about who to go to.

Credentialed advisors — such as lawyers, attorneys, and accountants — can also prove to be invaluable resources in your search for a broker. The internet will likely be able to help you find someone who works locally and specializes in your specific needs.

Take Time to Pick the Right Broker for You

Finding any broker is a step in the right direction, but work to ascertain that this person and/or business is the right fit for you. Put your cards on the table: ask how much the fees will be, what extra charges can be expected, and about their experience in the field. Have they worked with a company like yours? Will you have a primary contact? It might also be helpful, in interviewing your prospective broker, to bring along a co-worker who may have a different vantage from you. What important questions might they raise that you hadn’t thought of?

Online Brokers vs. Real Relationships

It’s important to note that in your search you will likely come across some online brokers. In our digital marketplace, such services are becoming more popular. Some might prove useful, especially if you work in an isolated community, but for those in the city or suburbs there are plenty of brokers to work with, and the experience of working with a real human can’t be surpassed.

Shopping around for an insurance broker? Consider collaborating with Dawson Benefits — give us a call today to set up an introductory conversation about your company’s needs.

What Variables Are Affecting Increased Insurance Costs for Group Plans?

Time goes by, advancements are made, prices go up — it’s hard to pin down exactly what contributes to increasing costs for group insurance plans, but rising prices are often testament to strategies that aim to make being a patient a little easier.

Multiple factors aggregate towards the increasing cost of health insurance: plans shift, procedures evolve, or new technologies like open MRI’s, Imaging Improvements, and robotic procedures come along. But these increases also represent a cultural shift in the field. A decade ago, prescription costs accounted for up to 15% of overall premiums. Today, that percentage has doubled.

How to Combat Skyrocketing Group Plan Pricing

Co-Pay Choices

There is a plethora of insurance carriers and plans that grant users multiple options for copays, which helps bring down coverage costs.

Prescription Options

Some plans allow you to remove prescriptions from them, if that is not a benefit the user and his/her dependents need.

Using Insurance Brokers

Brokers can be instrumental in helping families and businesses find the plan that is economically feasible and tailored to their needs. For example, brokers can use a healthcare software that lets individuals find generic substitutes that they can discuss as options with their physicians; the cost for these generics is typically lower than copays.

Some Government Protections Help with Keeping Costs Down

Additionally, to protect users, several factors are in place to not offset or increase healthcare costs — these include the overall medical claims history of the group, the health status of enrollees, and the industry/business type of the group, which is all stipulated by the Affordable Care Act. (What can affect premium costs, however, are age of employees and location of business.)

The ever-shifting terrain of insurance and its myriad policies can be tricky to decipher. Consider switching to or initiating a group plan with Dawson Benefits for clarity and efficiency — call today for a free consultation!

How Much Does an Insurance Broker Cost?

Insurance — and its benefits, costs, and policies — is too often shrouded in mystery. As such, it can be more efficient to collaborate with an insurance broker, someone who has your best interests at heart and whom you can directly deal with instead of going back and forth with pesky customer service teams. Unlike agents who serve their insurance company, brokers exclusively serve their clients, mapping out the best plan and strategy for the types of insurance they deem practical.

Because brokers deal with individuals, they do not receive a commission from insurance companies; instead, they charge something akin to a broker’s fee. This amount is disclosed transparently as a cost separate from insurance, and it varies depending on the size of your group.

Fixed Small Group Broker Fees

If your company has between two and 50 people, rates are pre-determined and are filed with the State. This rate includes a broker’s commission, and since the premiums are the same whether or not you use a broker, it makes little sense to deny using one.

Customized Individual or Large Group Broker Costs

Larger groups of 51 or more people have somewhat more malleable rates: they are negotiated on a case by case basis, varying based on the amount of outsourcing a client requires. Still, to save time, allow your company to focus on its work, and not worry about the headache of insurance policies, a broker may be the best way to leave the paperwork and logistics to the experts.

Looking for a specific quote for your family or company? Dawson Benefits has a quick and easy form to evaluate your needs and the services that accompany them — fill this out today for a quote, and we’ll reply within 24 hours!