04 Jan Benefits Questions & Answers
Q. Our company is a small group, do you have options for me to avoid member-level (age-rated) health insurance premium rates?
A. Yes, our DynamicHR group health program has a tiered (single, two person, and family) rating and regardless of if you are a 10 person or 500 person group, you can participate with the same tiered rating options.
Q. What if we want to offer more than one plan to our employees in order to give them options to pick what works best for them?
A. The DynamicHR group health plan options include a number of plans, all with different deductible levels. A number of these plans can be offered to eligible employees.
Q. Aside from health insurance, other benefits such as dental, vision, disability, and life are important to us. Can you provide those types of benefits as well?
A. Yes, DynamicHR can provide medical, dental, vision, and ancillary products to groups and their employees.
Q. When will I pay for services that apply towards deductible?
A. The most common deductible expenses are those incurred within a hospital such as procedures, x-rays, and other tests. However, deductible expenses could also be incurred in a doctor’s office if bloodwork, x-rays, or other tests are sent out to a hospital or a lab for results.
Q. What is a total out of pocket maximum?
A. A total out of pocket maximum is the total in expenses that a member will pay in a given plan or calendar year for in-network services. In most cases deductibles, copays, and coinsurance apply toward out-of-pocket maximums. You will want to refer to your group health plan documents to confirm this.
Q. When am I responsible for paying a copay?
A. In most traditional group health plan designs, copay responsibilities are for primary care office visits, specialist office visits, urgent care visits, emergency room visits, and prescriptions. Depending on the situation surrounding the copay along with the group health plan design, some copays may be waived.
Q. For 2015, will my group be subject to the Affordable Care Act employer mandate penalty?
A. This will depend on the size of your group. For employers with 99 or fewer full-time employees and full-time equivalents (FTEs), the employer mandate penalty will not apply until 2016. However, for groups with 100 and more full-time employees and FTEs, the employer mandate penalty applies for 2015.
Q. What is the individual penalty if I do not have healthcare in 2015?
A. For potential fees and also exemptions to this penalty, you can visit https://www.healthcare.gov/fees-exemptions/fee-for-not-being-covered/.
Q. How can I learn about this DynamicHR group health program?
A. Please contact us here to find out more!