Employer FAQ

How many employees are required for group coverage?


You need at least two full-time eligible employees or owners. The two eligible employees can be an owner and an employee, two partners of a partnership, or two officers of a corporation (but they cannot be a husband and a wife)




Which employees are eligible for benefits?


Any full-time W-2 employee who works at least 30 hours per week is eligible to enroll in benefits. Those not eligible for benefits inclue part-time (less than 30 hours a week), seasonal or temporary employees. Usually sub-contractors are not eligible for benefits, although some insurance companies offer flexibility in this area.




How many employees need to enroll in the benefits program?


A minimum of two employees need to enroll in your plan to qualify as a group. Most insurance companies require at least 50% of eligible employees to enroll in the plan, although some insurance companies will allow exceptions. The number of eligible employees can be reduced by those who have other qualifed coverage, such as benefits through a spouse, parent, Medicare, VA, second employer, or other government program. In some cases, employees covered under an individual policy might also qualify as a valid waiver.




How much is the business required to pay toward benefits?


As a general rule, most insurance companies require the employer pay at least 50% of the employee health insurance premium. The employer is not required to contribute any toward the cost of dependent coverage. The employer is also not required to pay for any non-medical products such as dental, vision, life, and/or disability insurance, etc.




How much do group benefits usually cost?


The cost of health insurance varies depending on a number of factors including business industry, size, claims history, plan design and provider network. The average cost for health insurance is +/- $500 per month for an employee. Costs can be higher or lower based on the factors listed above. Bailey Risk Management negotiates the best possible rate for your business. The average dental insurance cost is about $35/month per employee. The average vision insurance cost is about $6/month per employee.




Is one insurance company better than another?


There can be big differences in rate competitiveness, benefit choices, network access, administrative services, and financial stability. We will conduct a comprehensive review of the market and provide recommendations to best meet your needs and budget.




Will I pay less premium if I buy directly from an insurance company?


No. The rates are the same regardless of which broker you have or even if you have the services of a broker at all. Insurance companies prefer that you work with a qualified professional benefits agency like Bailey Risk Management. Brokers help employers select the right plans and help employees enroll and manage their benefits year-round. Our services are available at no additional cost to you.




Can a group health insurance application be denied?


For a business with less than 50 employees: Insurance companies must offer ACA quotes if they work in that segment. However, your business must comply with contribution and participation requirements to be eligible for coverage. For a businesses with more than 50 employees: Insurance companies can decline to quote based on a number of factors, including claims experience. Employees at any size business: Once group coverage has been issued to the business, all employees (and dependents) are approved. Pre-existing conditions are covered.




What types of insurance are available through Bailey Risk Management?


We offer employee benefits including health, dental, vision, life, disability, critical illness, cancer, long-term care and accident plans. We are an independent brokerage licensed to offer any insurance company. We will conduct a comprehenive market review and recommend the best plans for your needs. We also specialize in individual life, disability and long-term care insurance.




What can our business do to reduce annual insurance increases?


Bailey Risk Management communicates directly with your employees to help lower costs. We provide education and resources on everything from wellness discounts to prescription coupons. We help employees get the most out of their benefits wihile keeping your renewal increases as low as possible. We also continually monitor insurance company trends, available programs and coverages to ensure that you’re consistently getting the best value available in the market.




Are pre-existing conditions excluded?


Since the passage of the Affordable Care Act, all pre-existing conditions are now covered on group health insurance plans.




Does my business qualify for COBRA continuation of benefits?


COBRA applies to employers with 20 or more employees, on average, during the prior calendar year. COBRA gives workers and their families who lose their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events. COBRA requires employers and plans to provide notice. We provide COBRA services through a third-party administration and legal company.




Is my business required to offer health insurance because of the ACA law?


For a business with less than 50 full-time equivalent (FTE) employees: You are not required to offer health insurance to your employees. For a business with more than 50 FTEs: You are required to offer affordable health insurance to your employees, or you could be subject to a penalty. The ACA law mandates that applicable large employers (ALEs) provide affordable health insurance coverage to its employees or pay a penalty. An ALE is a business with at least 50 full-time eqivalent employees on average during the prior calendar year. ALEs are also required to provide reporting on the health plan to the IRS and its employees on an annual basis. If the health plan does not pass the affordablity test for a particular employee, the business could be subject to a penalty if that employee qualified for a tax subsidy through the exchange for individual health coverage.

Bailey Risk Management's free HR technology takes all the guess work out of ACA. Our technology will track variable hours, conduct real-time affordability testing, populate all the ACA Reporting, and e-file to the IRS.




Is my business required to file a 5500 form?


Businesses offering health plans that cover more than 100 participants are subject to filing the ERISA Form 5500, and it must be done electronically. (Also businesses who offer quialified retirement plans are required to file a 5500 Form.) We provide this service by outsourcing to a third-party legal company.