Question 1

Why do I need an insurance agent?

Accepted Answer

An agent can assess your needs, explain state and federal rules and laws, and do all the work for you to gather rates, available options, and benefit information.

Question 2

Are my rates higher if I have an insurance agent?

Accepted Answer

In Oregon, for groups (1-50), the medical and dental rates are the same with or without an agent. Most insurance companies prefer that clients work with agents who can help answer questions and communicate contract changes, etc.

Question 3

How many employees do I need to have a group plan?

Accepted Answer

You need one employee who is eligible for insurance; however, the one employee who is eligible has to be someone other than the owner or the owner’s spouse.

Question 4

How long do I need to be in business to have a group plan?

Accepted Answer

This varies with insurance companies. Depending on the insurance carrier; it can vary between a brand new business, in business 2 months, or in business a full year. An agent can help direct you to the plan(s) available depending on how long you have been in business.

Question 5

Is the owner of a company considered an employee?

Accepted Answer

Yes, the owner is considered an employee for insurance purposes. However, someone other than the owner or the owner’s spouse must enroll.

Question 6

Is the owner of a company required to enroll?

Accepted Answer

Yes, the owner of a company is required to enroll, unless they have other medical/dental insurance.

Question 7

Do I have to pay my employees’ premiums on a group plan?

Accepted Answer

Most insurance companies require the employer to contribute a minimum of 50% of the employees’ premium. The employer is not required to contribute any portion of the employees’ spouse and dependent premium.

Question 8

How long will it take to get health insurance rates for a group plan?

Accepted Answer

A normal turn-around time would be 5 to 10 business days. However, sometimes rates can be obtained within 48 hours when you are working to meet a deadline, just let us know.

Question 9

Do I have to offer insurance to all my employees?

Accepted Answer

You need to offer insurance to all eligible, full-time employees. However, employees who have other insurance are usually allowed to decline and do not have to enroll.

Question 10

Who are eligible employees?

Accepted Answer

Eligible employees are those employees who have been hired as full-time, work 17.5 - 40 hours or more per week, and have satisfied their waiting period.

Question 11

Do all eligible employees need to enroll?

Accepted Answer

All eligible employees need to enroll, unless they have other medical coverage; i.e., coverage through their spouse, Medicare, Medicaid, OHP, WBHP, etc.

Question 12

Do I need to offer Federal COBRA to my employees?

Accepted Answer

Yes, if you have twenty (20) or more employees on payroll, regardless of whether-or-not those employees are eligible for the group health plan. Full-time employees are counted as one employee; however, part-time employees are counted, for example, as ½ employee or ¼ employee, depending on how many hours per week the employee works.

Question 13

What is considered a qualifying event?

Accepted Answer

You may qualify to enroll in an individual plan outside the annual Open Enrollment window if you experience any of the following:
Involuntarily lose group/employer coverage
Turn 26 and age out of your parents’ plan
Exhaust your COBRA coverage
Permanently move out of your previous service area
Have a birth or adoption in your family

Question 14

Will I be denied on a group plan if I have pre-existing conditions?

Accepted Answer

On a small group plan in Oregon (1-50), health statements are not required. You may not be excluded because of health reasons.

Question 15

Do I need to offer state continuation?

Accepted Answer

In Oregon, if you have fewer than 20 full-time equivalent employees, you are required to offer nine months of medical state continuation.

Frequently Asked Questions

FAQs