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The Role of the Professional Health Insurance Agent:
Advisor, Advocate, and
Consumer Confidant
Aita & Associates
Insurance Marketing, Inc.
7005 Hazel Cotter Court #G3
Sebastopol, CA 95472
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Tel:
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707-829-8606
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888-829-8606
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Fax:
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707-829-8924
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CA License #0649963
Email Us
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| Q. |
How and when should I add new employees? |
| A. |
New employees MUST be added within 31 days of their eligibility. What does this mean?
If you have a 90-day waiting period for new employees, then you would have to add them
between the 90th and 121st day of their employment.
Example:
An employee is hired on December 11, 2000. If you have a 90-day
elimination period for new hires, this person would have to come on
the plan on April 1, 2001, as the eligibility is "First of the month
following 90 days", or whatever elimination plan you have.
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| Q. |
If an employee gets married and wants to put their spouse on the plan, how and when do I need to do that?
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| A. |
When an employee marries, the spouse must be added within 31 days
of the event.
Example:
An employee marries on December 24, 2000. Their spouse has to be
added by January 24, 2001. In reality, the coverage would begin on
February 1, 2001, but the carrier must have the paperwork by
January 24, 2001.
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| Q. |
An employee either has naturally or adopts a child, when do I have to put the child on the insurance?
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| A. |
The same rules apply for a dependent child as for a spouse, regarding the 31-day time frame of the enrollment. However, with the child the effective date will go back to the birth of the child. Under the HMO's the child is covered for the first 31 days, and then must be enrolled.
IF THE EMPLOYEE REFUSES COVERAGE, EITHER FOR HIM/
HERSELF OR FOR DEPENDENTS, HAVE HIM/HER SIGN A
WAIVER OR DECLINATION OF COVERAGE FORM, STATING WHY
S/HE IS DECLINING. THIS IS A SAFEGUARD BOTH FOR YOU
AND FOR THE EMPLOYEE.
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| Q. |
How do I terminate an employee?
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| A. |
If you are doing your own billing, you mark the employee off the
current billing, noting the date of termination. The employee is
covered through the end of the month in which they were terminated.
Continue to monitor your bills to verify that they have removed the
particular employee. If we do your billing, just let us know by sending
us back the Action Form.
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| Q. |
How do I deal with COBRA?
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| A. |
If you have less than 20 employees, make sure you're aware of
who has to be counted and who can be left off. Once the carrier is
notified, they will send the COBRA information to the insured, and bill
them directly, if they choose the coverage. If this is your situation,
you are under to guidelines of Cal-COBRA, the under 20 employees
plan. The employee can be charged up to 10% administration fee.
If, however, you have more than 20 employees, you are subject to
Federal COBRA and the rules and regulations apply to you, the
employer. We strongly suggest that you send someone from your
staff to attend a COBRA Compliance Systems "COBRA Alert™"
Seminar (click this link to see a list of COBRA Compliance Systems'
upcoming seminar dates and locations). The IRS, who now oversees
COBRA compliance, requires that someone on staff be trained in
COBRA compliance. We will let you know when the next COBRA
seminar is in the area. In the meantime, please call us with any
questions regarding COBRA. If we don't know the answer, we will get
it for you. The fines for COBRA "misconduct" are onerous. We agree
strongly with COBRA Compliance: "Keep the IRS out of your business,
and keep your business out of court". In addition to the COBRA
Qualifying Event Notice, which is sent out when an employee
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| Q. |
What is Open Enrollment, and what do I have to do?
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| A. |
Open Enrollment is the period of time (usually one month before the
effective date of your policy period) during which dependents can be
added, if they were not added during the initial enrollment. If you
have more than one plan, it is the time during which employees can
make plan changes. It is also the time to add different coverages, or
change the plan design that you currently have. You can also add
riders at this time, such as Chiropractic and/or Acupuncture, life
insurance, etc.
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| Q. |
What are the deductibility limits for health insurance for the self-employed?
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| A. |
Self-employed individuals can deduct some to all of their health
insurance premiums as business expenses. These deductions are
limited, however, to amounts less than an individual's earned income.
Partners and 2 percent S corporation shareholders are also
considered to be self-employed individuals. If you fit the criteria of a
self-employed individual, you can deduct the following percentages of
premiums for insuring yourself, your spouse, and your dependents:
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2002: 70%
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2003 (and beyond): 100%
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| Q. |
Do I need additional medical insurance when traveling abroad?
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| A. |
That depends on your insurer and your coverage. Some major
medical plans have limitations when traveling abroad, and Medicare
and some Medicare supplements won't cover you while outside the
US. If your plan does not offer full coverage, there are several
options available. Temporary travel insurance plans require no proof
of insurability, but exclude coverage for pre-existing conditions.
"Global insurance" is also available - this provides comprehensive
medical insurance for frequent travelers and individuals with multiple
countries of residence. In addition to health coverage, travel
insurance plans include an accidental death benefit, medical
evacuation provisions, lost baggage, trip cancellation insurance
options, and global 24-hour assistance. Contact us with questions
about the extent of your coverage, and for further information on our
travel insurance plans.
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| Q. |
I'm in the process of applying for health insurance, but will not
have coverage for six months. Are there any plans available
that will cover me until my permanent coverage kicks in?
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| A. |
If you are between jobs, coming off family coverage, retiring early, or
uninsured and applying for permanent coverage, short term insurance
can provide you virtually immediate coverage and protect you until a
permanent plan is in place.
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| Q. |
I have a pre-existing medical condition, and have not been able to get coverage. Are there any plans I can qualify for?
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| A. |
Federal law (specifically, the Health Insurance Portability & Accountability Act of 1996, or HIPAA) guarantees that individuals coming off of COBRA coverage can obtain individual health insurance regardless of medical history. Additionally, California's Major Risk
Program provides coverage to the uninsurable redardless of their past
insurance (or lack thereof). If you know of someone who is uninsured
and/or thinks they can't get individual insurance because of their
health problems, have them call us immediately to see if they qualify
for these guaranteed plans.
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If you have any further questions,
please contact Nancy Aita
for questions about your existing Aita and Associates policy,
or Tam Nedbal to receive a quote.
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