California Small Group Health Insurance

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Small Group Health Insurance and Employee Benefits in California. How to get started.

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California Small Group Health Insurance:

California Small Group Health Insurance Presented by: Betty J. Lindstrom, FLMI, RHU, FHIAS Lindstrom Insurance Services www.lindstrominsurance.com

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits Betty J. Lindstrom, FLMI, RHU, FHIAS Insurance Industry Experience since 1975 Established agency in 1995 Agency Personnel has combined 50+ Years of insurance experience Find us on Yelp & Linked In, many five star reviews Website: www.lindstrominsurance.com

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits Topics to be covered: What is a small group? Advantages of group coverage vs. individual health plans Available Plans and Benefits Employee Options & Cost Sharing Tax Advantages Getting Started

California Small Group Health Insurance and Employee Benefits:

California Small Group Health Insurance and Employee Benefits

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits What is a Small Group? An employer group with 2-50 eligible employees for more than half of the preceding calendar quarter. Owners and W-2 employees are included in the count. Eligible can be those working at least 30 hours/week or 20 hours/week Documentation will be required to show hours worked / ownership

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits Advantages of Group Insurance “Guaranteed Issue” coverage, with all eligible employees and dependents covered, regardless of health conditions Dental, vision, and Disability benefits may be less expensive to groups than individuals and have stronger benefits Renewals annually Gives more rate stability than individual policies where rates may be adjusted more than once each year Open Enrollment offers flexibility to add dependents and change plans More benefit options than individual plans

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits Available Plans & Benefits Medical HMO, PPO, H.S.A. Qualified Plans Dental HMO, PPO and Indemnity Plans Vision Life Disability Retirement Plans

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits HMO Medical Plans HMO plans offer lowest “out of pocket” expenses for covered employees, but there are rules! Select a primary care physician who will direct your care and refer to specialists All care will be provided in one medical group Easy sharing of medical info with all of your doctors

HMO Benefits Must use Network providers!:

HMO Benefits Must use Network providers! Preventive Care Federally Listed Services using network providers No cost to member Prescription Drugs Copayments for Generic Meds Copayments plus possible Brand Name Drug Deductible for Brands Office Visits Copayments Only Lowest copay Primary Physician, higher for Specialists Hospital, Surgery, Other Copayments or Coinsurance (i.e. 80/20) to Out of Pocket maximum Then 100%

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits PPO Medical Plans No requirement to select Primary Physician Self refer to specialists Better benefits using network providers More out of pocket expenses Deductibles and Coinsurance in addition to Copayments

PPO Benefits Better Benefits when using Network providers:

PPO Benefits Better Benefits when using Network providers Preventive Care Federally Listed Services using network providers No cost to member Prescription Drugs Copayments for Generic Meds Copayments plus possible Brand Name Drug Deductible Office Visits Copayments Only No Deductible Hospital, Surgery, Other Deductible First, $250 to $5000 generally (per year) Coinsurance (i.e. 70/30) to Out of Pocket maximum Then 100% for balance of Calendar year

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits H.S.A. Qualified Plans May be HMO or PPO format, mostly PPO Preventive benefits without deductible Qualifies member to open a Health Savings Account All other benefits subject to plan deductible Most plans double the individual deductible if family members are covered

H.S.A. Qualified Plans Better Benefits when using Network providers:

H.S.A. Qualified Plans Better Benefits when using Network providers Preventive Services On Federal List No cost to member, no deductible Everything Else Deductible First, $1250 to $5000 generally (per year) Coinsurance (i.e. 70/30 or 80/20) to Out of Pocket maximum Then 100% for balance of Calendar year May be copayments for Prescriptions AFTER deductible

Options & Cost Sharing:

Options & Cost Sharing

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits Employee Options & Cost Sharing Employer may pay entire premium or partial premiums (for employees or dependents) Options to offer employees a choice of plans while fixing the employer contribution Flat Dollar Amount Percentage of a specific plan premium Percentage of whichever plan employee selects

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits Tax Advantages Employer Contributions are tax-deductible to Employer and may qualify for additional tax credit Employee contributions may be taken from paycheck on a pre-tax basis through a Section 125 plan, or Premium Only Plan Section 125 plans save Employees on their Federal and State withholding, plus FICA taxes Section 125 plans save Employers on all matching and payroll taxes (i.e. FICA, FUTA, SUI, ETT, etc. ) and lower the covered payroll for calculating Workers Compensation premiums

California Small Group Health Insurance & Employee Benefits Getting Started:

California Small Group Health Insurance & Employee Benefits Getting Started

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits Steps to Start Your Plan Determine Employee eligibility (30 hours/ week or 20 hours/week) Eligibility waiting period (employee has worked for the company for 1 month, 3 months, etc.) What is the purpose for your plan? Attract quality new employees Keep existing employees motivated Provide minimum benefits because owners can’t qualify for individual plans

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits Steps to Start Your Plan (part 2) What is your budget? What benefits do you want to offer? Get Quotes Develop your census ( fillable census form at http:// www.lindstrominsurance.com/files/2012/03/Small-Group-Insurance-Employee-Census-Listing-for-Quote-Fillable.pdf ) or we can email Work with your broker to determine best company and plans to offer

California Small Group Health Insurance & Employee Benefits:

California Small Group Health Insurance & Employee Benefits Steps to Start Your Plan (part 3) Schedule employee meeting to announce plans & explain benefits and contributions Applications – we can help with enrollment process and company documentation Set up payroll deductions Distribute Summaries of Benefits and Coverage (SBC) Work with broker to determine other required notices

Contact us to get started!:

Contact us to get started! Call: 831-335-8200 Toll Free: 877-238-8974 www.LindstromInsurance.com/GetStarted

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