Your protections will vary somewhat, depending on whether your plan is a fully insured group health plan or a self-insured group health plan. The plan’s benefits information must indicate whether the plan is self-insured. You have to be eligible for the group health plan. For example, your employer may not give health benefits to all employees. Or, your employer may offer an HMO plan that you cannot join because you live outside of the plan’s service area. You cannot be turned away or charged more because of your health status. Health status means your medical condition or history, genetic information or disability. This protection is called nondiscrimination. Employers may refuse or restrict coverage for other reasons (such as part time employment), as long as these are unrelated to health status and applied consistently. However, if you work for a small employer in Arizona, insurance companies must offer coverage to all eligible employees.
When you begin a new job with health insurance through an HMO, the HMO may require an affiliation period before coverage begins. During this affiliation period, you will not have health insurance coverage. An HMO affiliation period cannot exceed 2 months (3 months for late enrollees), and you cannot be charged a premium during it. If you have to take leave from your job due to illness, the birth or adoption of a child, or to care for a seriously ill family member, you may be able to keep your group health coverage for a limited time. A federal law known as a Family and Medical Leave Act (FMLA) guarantees you up to 12 weeks of job-protected leave in these circumstances. The FMLA applies to you if you work at a company with 50 or more employees.
When you first enroll in a group health plan, the employer or insurance company may ask if you have any pre-existing conditions. Or, if you make a claim during the first year of coverage, the plan may look back to see whether it was for such a condition. If so, it may try to exclude coverage for services related to that condition for a certain length of time. However, federal and state laws protect you by placing limits on these pre-existing condition exclusion periods under group health plans.
A group health plan can count as pre-existing conditions only those for which you actually received (or were recommended to receive) a diagnosis, treatment or medical advice within the 6 months immediately before you joined that plan. This period is also called the look back period. (If you are enrolling in an individual health plan or if you are self-employed, the definition of pre-existing condition is different).
Small Employer or Self Employed Health Insurance
Arizona has enacted reforms to expand some health insurance protections. Some of these reforms apply to groups of different sizes. Generally, small employers are those that employ 1-50 employees. Self-employed persons count as small employers in Arizona, but have somewhat different protections. Please note that the definitions of small employer and employee are somewhat different under federal and state law.
With few exceptions, small employers cannot be turned down. This is called guaranteed issue. If you employ no more than 50 people, health insurance companies must sell you any small group health plan they sell to other small employers. However, they can require that a minimum percentage of your workers participate in your group health plan. They can also require you to contribute a minimum percentage of your workers’ premiums. If you are buying a large group health plan for 51 or more employees, your group can be turned down. Your insurance cannot be canceled because someone in your group becomes sick.This is called guaranteed renewability and it applies to group plans of all sizes. Insurers can impose other conditions, however. They can require you to meet minimum participation and contribution rates in order to renew your coverage. Additionally, they can refuse to renew your coverage for nonpayment of premiums or if you commit fraud.
If you are self-employed with no other workers, you are considered to be a group of one. Insurers are required to accept your application for the standard plan or basic plan in August of each year to make coverage effective on October 1, of that year. They can refuse to sell you other plans, however. Further, the rules for pre-existing condition exclusion periods are somewhat different.
For groups of one, pregnancy can be counted as a pre-existing condition. If you are a group of one and you have had no prior coverage, the group health plan can exclude coverage for your pre-existing condition for up to 2 years. The plan can count as pre-existing any condition for which you received, or – in your insurer’s judgment, for which you should have sought – a diagnosis, treatment or medical advice in the 2 years prior to enrolling in the plan. This is called the prudent person rule. If you had prior coverage, you will receive credit toward your pre-existing condition exclusion period for any time you satisfied under your prior coverage.
Health Maintenance Organizations (HMO)
A HMO is the most affordable kind of group health insurance available in Arizona. HMO health insurance requires you and your employees to give up some flexibility. In order for those on your business health insurance to receive medical services at a discounted rate, they must use the primary care doctors, specialists, hospitals, and other providers within the HMO health insurance plan’s network. If you use a provider that isn’t in their network, you’ll have to pay full price. With this type of employee health insurance, they will also have to see a primary care physician for referrals to a specialist. HMO networks vary in size among your options for small group health insurance.
When buying group health insurance, VitalOne can help you select the most cost-effective HMO plan solution for your business.
Preferred Provider Organizations (PPO Plan)
PPO group health insurance plans are similar to HMOs, but they allow your employees more freedom. This type of employer health insurance consists of a comprehensive health care network of medical providers that are covered by the PPO plan, and a lower reimbursement rate for out-of-network providers. A preferred provider organization does not require your employees to select a primary care physician or receive a referral to see a specialist. This means that you will have a more efficient, healthier workforce. Employee co-payments are higher than other varieties of health insurance for small business. Some PPO plans also require that those covered pay an annual deductible. PPOs can be a great way to provide health insurance employers can afford, as well as a solution for those in search of self employed health insurance in Arizona.
At VitalOne, we can provide you with group health insurance quotes from multiple providers.
Point of Service Plans (POS)
Where business health insurance is concerned, a point of service plan gives your employees the best of both worlds; it includes aspects from HMOs and a PPOs. Similar to a HMO individual health insurance plan, this type of employee health insurance requires them to pick an in-network primary care physician. Then, their PCP can refer them to any in- or out-of-network specialist they wish. Like PPOs, POS plans allow you and your employees an unlimited choice of Arizona medical providers. However, going outside the network will result in higher out-of-pocket costs and the responsibility for filing claims to recieve partial reimbursement. Point of service plans are usually cheaper than PPO plans, making them suitable health insurance for self employed professionals.
In some ways, POS plans are the best of both worlds when it comes to health insurance for individuals. Wondering if a POS plan is right for you? VitalOne has an individual health insurance quote for almost any POS provider in Arizona. They can help you decide which business health insurance plan is appropriate.
Health Savings Accounts (HSA)
Many small business group health insurance policies in Arizona now include health savings accounts. HSA plans transfer more control and responsibility for health care to the employees themselves. Pre-tax dollars (usually a portion of salary) are deposited into an HSA plan, as opposed to being paid out in taxable income. Some employers choose to match health savings account contributions, though doing so is not required. The balance can only be spent on qualified medical products and services: doctor visits, hospitalizations, prescription co-payments, and over-the-counter medications are among the approved expenses. Your business and employees can save money with the tax breaks.
In most cases, HSAs are offered with a high deductible individual health insurance plan. The group health insurance premiums are lower with these plans, since the deductibles reach up to several thousand dollars per year. This means that your business’ health insurance costs will decrease. HSA group health insurance is best for a relatively young and healthy workforce, because their increased out of pocket expenses will most likely be less than their savings on premiums. It is the often the right choice for small business health insurance, as well as for self employed health insurance. Ask VitalOne to help you select the best health savings account and high-deductible individual health insurance plan for you.
Guaranteed Issue Health Insurance
If you or any of your employees suffers from a pre-existing medical condition, you may think that self employed or small group health insurance is out of reach. Guaranteed issue business health insurance plans may be the solution for your company, because such plans must take anyone who applies, regardless of health status. People with cancer, diabetes, high blood pressure, or currently pregnant are among those who can benefit from employee health insurance with pre-existing conditions. Premiums are typically more expensive, since for-profit individual health insurance providers do not want to cover someone who is already sick. However, VitalOne can still help you find affordable group health insurance in Arizona.
Guaranteed issue business health insurance plans are available in Arizona. They allow your employees to take advantage of comprehensive PPO networks like Multiplan, which costs less when in-network health care providers are used. Compare guaranteed issue group health insurance quotes with us today.
Life Insurance
Life insurance allows you and your employees to care for your families after their passing. It pays out a specified lump sum upon their death. You may also want to buy a small group policy for your employees, with the company as the beneficiary. The loss of a valuable employee is both tragic and expensive. Eventually, you will need to find and retrain a replacement for your business. The main types of life insurance sold in Arizona are term life, whole life, variable life, and universal life. Term life insurance is the most affordable; it includes coverage for a set time period, usually anywhere from one to 30 years. Face value amounts for term life insurance policies begin at $5,000 and can reach millions of dollars.
How much life insurance do you and your firm need? Several factors should be taken into consideration. A life insurance policy should cover at least several years of your annual income. Higher incomes mean greater impact on your loved ones’ financial well-being after they stop coming in. If you have many outstanding debts, including mortgages, leases, or business loans, you may want to take those into account when deciding on the amount of your life insurance policy. When you are self employed, there are often many people depending on you and your business for their livelihood. It is also important that the cost of monthly premiums for the policy is affordable. VitalOne and our licensed Arizona insurance brokers are here to help you select the right life insurance plan for you or your business.
Critical Illness Insurance
Critical illness insurance pays out a lump sum if you or an employee experience a major medical condition covered in the policy. Diseases, surgeries, and injuries included in typical critical illness insurance policies range from cancer, heart attacks, organ transplants and strokes to severe burns, paraplegia, blindness, or deafness. Sometimes, Arizona group health insurance doesn’t pay for all of the costs associated with a critical illness. For example, patients are sometimes transported to distant hospitals that specialize in certain types of treatment. The payout from critical health insurance could pay for their family and friends to stay with them during their hospitalization. The money can also be used for mortgage payments, or anything else that would help reduce stress and allow you or your employees to focus on your recovery and return to work sooner.
Several conditions can be bundled together in one business critical illness insurance policy. A certain percentage of the coverage can be paid out upon initial diagnosis, while more can be paid in the case of a recurrence or developing another condition. Critical illness insurance is most affordable for younger, healthier self employed professionals or small business groups. You also need to be careful to know what conditions are excluded, and how long the waiting period before receiving payment is. Similar to buying a life insurance policy, the amount of coverage you get depends your income and outstanding debts. VitalOne can help you decide which critical illness insurance policy is right for your business.
Accident Insurance
There are two main types of accident insurance available in Arizona: accidental death and accidental death and dismemberment (AD&D). The former is similar to life insurance, except that it only covers a person’s death that directly results from an accident (such as a car crash) as opposed to health-related deaths. On the other hand, AD&D coverage also pays out upon serious injuries that are specified in the policy. Although most businesses already have a workers’ compensation policy, it only covers on-the-job injuries or deaths. An accident that occurs outside of work can have a detrimental impact on that person’s employer and/or employees. Group accident insurance is available in higher amounts for less standard life insurance because there is a smaller chance that you will die or be severely injured from an accident. Therefore, insurance companies are less likely to need to actually pay out on many of those claims. However, you must be extremely careful when selecting a policy; they do not apply to any medical illnesses, drug overdoses, surgical errors that result in severe injury or death.
