A special enrollment period (SEP) allows you to potentially enroll in coverage outside of the open enrollment window if you miss the general open enrollment period due to losing health coverage, moving, getting married, having a baby, adopting a child, etc. Visit Healthcare.gov to learn more about SEPs and check if you qualify.
Association health plans (AHPs) allow self-employed and small business owners to band together to purchase health insurance. Unlike ACA-compliant plans, they may charge different rates based on age, gender or location and they are not required to offer the same comprehensive benefits as ACA-compliant plans.
A federal law that governs many employee benefit plan aspects, including how employers must provide plan information to employees. ERISA also governs the claims and appeals procedures for qualified plans.
A federal law that may permit you to retain existing coverage if your employment ends, if you lose coverage through your spouse or other qualifying events. You are required to pay 100% of the premium for coverage as well as administrative fees. As an employer, you must comply with COBRA if you have more than 20 full- and part-time employees.
Under the Affordable Care Act, individuals and small employers are guaranteed coverage should they choose to purchase it, regardless of an employee’s health status, age, gender or other factors. Guaranteed issue does not limit the amount an insurer can charge you for enrolling, but prevents an individual from being denied the right to purchase insurance.
This is the amount of time an insured must wait before some or all of their coverage goes into effect. You may not receive benefits for claims filed during the waiting period. Waiting periods may also be known as elimination periods and qualifying periods.
Insurers use an “employee census” to obtain specific information to estimate the healthcare costs your group is likely to incur. A census does not include health status, race, religion, sexual orientation (even if applying for domestic partner benefits), Social Security number, or U.S. citizenship/immigration status.
Professional health insurance brokers provide expertise that can be helpful in finding a health insurance plan for your business and they can direct you to products offered by a range of companies. This is in contrast to a health insurance agent, who works with only one company and promotes that company’s products. If you do not use a broker, you will likely work with an agent at each company you contact.