Who is the typical BDS Corp client?

A business with at least 2 full time employees and up to 1000 employees

What are the requirements for my business to apply for a group health plan?

Each carrier has its own requirements, but some general guidelines include:

• You must be actively engaged in a legal business.
• You must have at least 1 non-relative employee eligible for coverage.
• You must be headquartered in New York State.
• Your insurance must not have been cancelled due to non-payment during the last 12 months.
• Be prepared to provide documentation such as Federal EIN, tax returns, and NYS-45.

Can I apply for insurance as a Sole Proprietor with no employees?

Yes, but your choices are limited to individual plans, and premiums are more costly.

Do all of my employees have to enroll in a health plan?

Not necessarily, but some carriers have participation requirements.

If I offer my employees a health insurance plan, do I have to contribute to the premium?

Generally, no,  but it’s also a good incentive to help you hire and retain good employees!

If I change insurance carriers mid-year, can I get credit for amounts that I’ve already paid towards my deductible?

For experience-rated groups (50+ employees), a deductible credit can be negotiated with the new carrier.  For community-rated groups (up to 50 employees), unfortunately carriers do not recognize out-of-pocket expenses that you’ve paid while enrolled in other health plans.

COBRA

• Employee Questions about COBRA

I’ve just lost my job and want to continue my health insurance coverage.   Can I do that?

Yes, you have the right to continue the same coverage that you had when you were employed if you experience a “qualifying event.”  Your employer will provide you with information about COBRA (Consolidated Omnibus Budget Reconciliation Act).

What is a qualifying event?

A qualifying event is the loss of health insurance coverage because of one of the following events:

• The death of the covered employee
• The termination of a covered employee’s employment (except for gross misconduct)
• Reduction in a covered employee’s hours of employment
• Divorce or legal separation of a covered employee from the employee’s spouse
• A covered employee becoming entitled to Medicare benefits
• Loss of “dependent child” status under the terms of the group health plan
• For some retirees and their dependents, bankruptcy proceedings of an employer under Title 11 of the U.S. Code

My employer went out of business. Can I get COBRA coverage?

No. You can only get coverage from an existing plan.

My employer has fewer than 20 employees.  Can I still get COBRA coverage?

Yes. Employers with 20 or more employees are subject to Federal COBRA laws. Employers with 2-19 employees are subject to NYS “mini COBRA” laws.

How long does COBRA coverage last for those covered under Federal law?

Federal COBRA law provides for up to 18 months of coverage for employees who lose coverage due to termination or reduction in hours, 29 months for disability, and 36 months for dependents.

How long does COBRA coverage last for those covered under New York law?

A New York State law passed in 2009 extends COBRA coverage from 18 months to 36 months.  This includes coverage for those who have exhausted the 18 months of Federal COBRA coverage.  The new law takes effect as of July 1, 2009 and applies to all policies and contracts issued, renewed, modified, altered or amended on or after that date.

Who administers COBRA?

The employer can administer COBRA internally or outsource to a TPA (Third Party Administrator). The TPA will provide notices, collect premiums, and submit them to the carrier.  However, the employer has the ultimate responsibility for COBRA.

Who pays the premium for COBRA coverage?

You the subscriber are responsible for paying the full cost of the premium.  Your employer can add a fee of 2% of the premium to cover administrative costs.

• Employer Questions about COBRA

I only have one employee besides myself.  Do I have to provide information about COBRA?

Yes.

Do I have to provide information about COBRA to employees who quit without notice?

Yes.

How long do I have to notify terminated employees about COBRA election?

Employers must notify their plan administrators within 30 days after an employee’s termination or after a reduction in hours that causes an employee to lose health coverage.  The plan administrator must provide notice to individual employees of their right to elect COBRA coverage within 14 days after receiving notice from the employer. It is the employer’s responsibility to provide COBRA information to employees both when they enroll in a health plan and at the time of termination.

How long do terminated employees have to respond to the notice?

Terminated employees must respond and elect COBRA coverage by the 60th day after the written notice is sent or the day health care coverage ceased, whichever is later.

What if a COBRA enrollee doesn’t pay the premium on time?

You must allow 45 days from election for payment of the initial premium.  Thereafter, you should establish premium due dates but provide a 30 day grace period for each payment.  Your premium payment policy should be clearly outlined in the COBRA Election Notice.

Check with your insurance carrier for assistance with COBRA procedures.