EMPLOYER Frequently Asked Questions
Please use the links below to aid you in your search for answers to your small business insurance and wellness questions.
A PPO is a Preferred Provider Organization that has a network of providers but also allows use of medical providers outside of the plan’s network, typically with greater employee cost sharing. A PPO is generally more flexible than an HMO, as a Primary Care Physician (PCP) and referrals for specialty providers are not generally required.
Qualified life events include:
- Change in legal Marital Status (marriage, divorce, legal separation, death of a spouse)
- Change in number of dependents (birth, death, adoption)
- Gain or loss of eligibility of other Group Coverage
- Change in employment status of employee or spouse (loss of employment, start of employment, change in worksite, leave of absence)
- Change in place of residence of employee, spouse or dependent
Twelve workweeks of leave in a twelve-month period for the following reasons:
- The birth of a child and to care for a newborn child within one year of birth
- The placement with the employee of a child for adoption or foster care and to care for the newly placed child within one year of placement.
- To care for a family member’s serious health condition (spouse, child or parent)
- An employee’s serious health condition that makes the employee unable to perform the essential duties of his or her job;
- Any qualified exigency arising out of the fact that the employee’s spouse, son, daughter, or parent is a covered military member on “covered active duty” OR
Twenty-six workweeks of leave during a single twelve-month period to care for a covered service member with a serious injury or illness if the eligible employee is the service member’s spouse, son/daughter, parent or next of kin.
2016 Tax Year Deadlines:
January 31, 2017 – Forms 1095-B & 1095-C due to employees.
February 28, 2017 – Forms 1094-B & 1094-C due to IRS if filing on paper.
March 31, 2017 – Forms 1094-B & 1094-C due to IRS if filing electronically.
By offering a HDHP, employers can give their employees additional options and allow them to be more involved in their healthcare decision making.
- Step 1: Review any contract between your company and your existing benefits advisor to identify any terms that address the termination of the agreement. Usually, benefit brokers are retained via a simple Broker of Record letter, and termination provisions are not addressed.
- Step 2: Notify your existing benefits advisor(s) of your decision with respect to their services. While this is not mandatory, it is the professional thing to do.
- Step 3: Execute a Broker of Record letter for your new benefits advisor. In the letter, address the effective date of the change and identify the actions your new benefits advisor is authorized to take on your behalf. Your dedicated John J Boyd account manager will provide you this template.
- Step 4: Your new benefits advisor should take responsibility for filing the Broker of Record letter with your insurance carriers and service providers. This often requires that you provide the advisor with a comprehensive list of the contracts you have in force.
- Step 5: Your new benefits advisor should be able to obtain copies of contracts and other required data from your plan providers. In certain situations, it may be quicker for you to provide this information.