Insurance Agent Forum

[al3]

Maybe one of the 'old hands' can give a brief description or definition of the various health policy types as relate to the work place. Here is what I know.... but I am not 100% sure about so if you are NEW HERE, DON'T TAKE THIS AS GOSPEL UNTIL SOMEONE WHO KNOWS THEY ARE TALKING ABOUT POSTS TO THIS THREAD!!!!!

1. Group: Full-bore major medical, business gets cert. of insurance for employees who are enrolled and premiums can be split between employer and employee. Employee can take COBRA if they leave or are laid off (and pay full premium). This is what they teach us in insurance school in Calif.

2. Workplace sups - voluntary benefits, usually accident or dreaded disease or disability, usually paid for entirely by the employee through payroll deduction. Benefits are usually paid direct to employee. (AFLAC, Colonial, etc.)

3. Mini-med: no idea.

4. Section 125 (?) Cafeteria plan: often used for independent contractors. No idea how this works.

Thanks,

Al

[somarco]

Major medical (employer based) may be changing after the State of the Union . . . just depends. Of course Ahhnald also has his eye on revamping a lot of things out there.

COBRA is not always available. Depends on the size of the group and the way state laws are written. Normally only good for 18 months but can be longer. After that it depends on what is available in your state.

WSM (worksite marketing) plans are always employee paid via payroll deduction. Since these are individual policies you dont want employer money involved.

Mini-meds are mostly HIP (hospital indemnity plans) that are also known as defined benefit. They pay $x per day for every day of hospital confinement, $x for doc visit, $x for ER and so forth. Many are guaranteed issue; rest are simplified issue.

Section 125 covers an array of issues as does Section 105. Good resources here

http://www.coredocuments.com/

http://www.baseonline.com/105hra.html

http://www.crbenefits.com/125.htm

http://www.cbiz.com/page.asp?pid=3183

[salpro22]

A great book I recently picked up that discusses health insurance options for individuals/families and businesses is entitled, "The New Health Insurance Solution" written by Paul Zane Pilzer. Check your local library to see if they have the book or here http://www.amazon.com/New-Health-Ins...e=UTF8&s=books

-J.R.

[arnguy]

COBRA is federally mandated for groups of 20 or more, thus, small groups are eliminated.

[arnguy]

COBRA is federally mandated for groups of 20 or more, thus, small groups are eliminated.

[al3]

Originally Posted by arnguy

COBRA is federally mandated for groups of 20 or more, thus, small groups are eliminated.

In CA we have CalCOBRA which covers groups of 2 to 19.

As I understand it, in Calif. if you work for a large company you MUST TAKE federal COBRA for 18 months AND then CalCOBRA for another 18 months before you can apply for HIPAA.

However, if you work for a small firm (< 20 people) you only GET the CalCOBRA for 18 months which makes you eligible for HIPAA much sooner.

Does not seem fair... but maybe I've got it wrong. Anyone know for sure?

Al

[somarco]

Most states have small group laws and their own version of COBRA. In GA 2 or more must offer COBRA (GA style) with a 3 month benefit.

Insurance is regulated at the state level except for ERISA plans that are self funded. Each state is required to pass their own laws that are at least patterned after federal law. The state laws can be broader but cannot be more stringent than federal law.

[arnguy]

Wow! That's great that CA and GA have state mandated COBRA laws. Here in Pennsylvania only the Federal mandate exists.