frequently asked question for mason and associates



Question: Can different insurance agents give me different rates?

No, all agents are given the same rates if your group is under 50 lives. If your group is over 50 lives, there is some room for negotiation. The main difference between agents is their level of service. Mason and Associates has other lines of business we can offer that make us unique in the marketplace. We believe in offering a personalized approach in answering any question or concern you may have.

Question: How much of the premium must an employer contribute to a group plan towards employee cost?

It depends on the carrier. Most require that the employer contribute at least 50% of the employee premium.

Question: How long do my employees have to wait until they are eligible for health insurance?

Under the Affordable Care Act, and in California, employers are required to provide coverage by the 60th day of the waiting period. This provision will apply to groups effective January 1st, 2014 or at renewal.

Question: Does my company have to offer COBRA or Cal COBRA?

Employers who had 20 or more full-time employees during at least half of the preceding year must offer COBRA benefits. If you have under 20 employees, your company must offer Cal-COBRA; typically the carrier is responsible for administering this benefit.

Question: What is the Health Insurance Portability Accountability and Access Act (HIPAA)?

HIPAA provides the ability to transfer and continue health insurance coverage for individuals and their families when they change or lose their jobs.  HIPAA also requires the protection and confidential handling of protected health information.

Question: If a member is enrolled with Medicare and group coverage, is Medicare primary or secondary?

If the group has 20 or more employees, the group benefits are primary and Medicare is secondary. If the group has 19 or fewer employees, Medicare benefits are primary and the group benefits are secondary.

Question: What is a Health Care Flexible Spending Account (FSA)?

The Healthcare FSA allows employees to be reimbursed for medical expenses not covered or reimbursed by other insurance plans. In order for expenses to qualify for reimbursement, they must be for medical care. All expenses must be qualified medical, vision, pharmacy or dental benefit expenses as defined in Section 213(d) of the Internal Revenue Code.  Mason and Associates works with several companies who administer FSA’s and can work with you to set one up.

Question: What is a Section 125 Premium Only Plan (POP)?

Section 125 Premium Only Plan is a plan that allows employees to pay their portion of medical insurance premiums on a pre-tax basis.

Under a Section 125 program, employers may choose to pay for qualified benefit premiums before any taxes are deducted from employee paychecks.  We work with expert companies who can set up this plan for you.

Question: What type of expenses can employees pay through my flexible spending account?

Unreimbursed medical, dental and vision expense, as well as dependent care, and non employer sponsored health insurance premiums can be paid through your account. The employee, their spouse, or their children can incur these expenses.