mason and associates faq

FAQ’s

Employer

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.

Employee

Question: Who is a qualified dependent for my insurance?

Your spouse and dependent children (to age 26) are qualified dependents. Some plans allow you to add your domestic partner (same-sex or opposite -sex).

 

Question: Can my dependent children continue on my insurance even if they are not a full time student?

Yes, through the Affordable Care Act, plans and issuers must make the coverage available until the adult child (married or unmarried) reaches the age of 26 regardless of full time student status.  

Question: What options do my dependents have once they are no longer eligible for coverage on my plan?

Once your dependent is no longer eligible for coverage on your plan, they would be eligible to continue coverage through COBRA. The COBRA coverage could last for a maximum of 18 months based on the qualifying event.  You also have the option of purchasing an individual plan for your dependent directly from a carrier or through the Health Insurance Marketplace. We can help you review your options.

 

Question: Can I change my enrollments without having a qualifying event?

Yes, you can change your enrollments during the group’s annual Open Enrollment.  The Open Enrollment is typically during the month before the plan effective date. During this time, you can add or delete a dependent or change plan if you employer offers multiple plans.

Question: Can I change my Primary Care Physician at any time?

Most HMO plans require members to choose a Primary Care Physician. Most carriers allow you to change your Primary Care Physician on a month to month basis. With a PPO plan you do not have to choose a Primary Care Physician and can visit any physician. However, you will receive the richest benefit if you visit a physician who is in the PPO network.

Question: What should I do if I need to see a doctor but don’t have my ID card yet?

If you have been added to your group policy but do not have an ID card yet, you may provide some identifying pieces of information to your doctor’s office and they can contact the carrier to verify benefit coverage. A doctor’s office will typically ask for the employee’s date of birth, social security number and group number. You can ask your benefits administrator for the member services phone number where you can call and get your ID number over the phone. Most carriers offer website access where you can register and print a temporary ID card meanwhile you receive your ID card.

Question: Can I use my coverage while I’m traveling?

Most plans will cover the cost of treatment if the patient is receiving treatment for a life-threatening emergency condition. Before seeking treatment for a non-life threatening emergency, we recommend that the patient first call the insurance provider (member services phone number can be found on the ID card) to inquire about the plan’s provisions for treatment of that emergency outside of the members home region.

Question: Can I get credit for my deductible if my company switches to another carrier in the middle of the year?

Yes. Most carriers allow you to carry over your deductible if you switch carriers in the middle of the year. Each carrier has certain deadlines as to when you can do this. You will need to submit a copy of your current carrier’s Explanation of Benefits with the deductible amount that you have already met along with any forms that your new carrier requires.