Small Group Multiple States Health Questions

GeorgeInGA

New Member
8
Could use some experienced advice.

Have a small group of 40 people spread out over several states. Already have top shelf group major medical with all the bells & whistles (vision, dental, STD, LTD, LTC, & Life), but looking to change because owner wants better plan in his state. He's the only employee in that state, it's not even home office state, and all other employees are happy with existing coverage.

Questions:

1. Can this type of group be written outside of exchange?

2. Which state do you write group policy in? Home office (1 employee), majority rule state (11 employees), or possibly HR directors state (1 employee, but currently licensed here.)?

3. Do you only need to be licensed in state where policy is written?

4. Can you write group policy for the 39 employees who are happy with existing coverage and let owner refuse coverage, go to exchange, and let company reimburse....or increase salary?

Any advice would be appreciated.
 
Group contracts are issued in the state where the corp is domiciled. Agents must be licensed in that state. Group plans have participation requirements and minimum employer contribution. If group is offered and employee declines they usually cannot get subsidies if they want Obamacare instead.

I don't know how many states involved, but I would never try to sell 39 employees individual coverage in multiple states. Not sure I would write the group either. Sure as heck won't catch me driving all over the place to enroll 39 people.

But that's just me.
 
Could use some experienced advice.

Have a small group of 40 people spread out over several states. Already have top shelf group major medical with all the bells & whistles (vision, dental, STD, LTD, LTC, & Life), but looking to change because owner wants better plan in his state. He's the only employee in that state, it's not even home office state, and all other employees are happy with existing coverage.

Questions:

1. Can this type of group be written outside of exchange?

2. Which state do you write group policy in? Home office (1 employee), majority rule state (11 employees), or possibly HR directors state (1 employee, but currently licensed here.)?

3. Do you only need to be licensed in state where policy is written?

4. Can you write group policy for the 39 employees who are happy with existing coverage and let owner refuse coverage, go to exchange, and let company reimburse....or increase salary?

Any advice would be appreciated.

1- I highly doubt it. My state exchange offers one minimum in home state, whereas all other carriers are going to want a minimum of 51% within the home office state.

2- Group is to be written in the home office state.

3- Yes, of course you need to be licensed where the contract is placed.

4- This question requires a little more information but to answer your question, yes depending on participation ratios. You have mentioned the word exchange twice now I want to make clear there's an individual exchange and a group exchange (at least in my state of CA). I believe you're referring to the individual exchange and if that is the case, I wouldn't waste your time or his and just write him IFP direct off-exchange. Secondly, reimbursement for IFP premiums from the company is not allowed and a big "no no". He could increase salary only.

Re-writing this group is going to be a mess from what it appears. Why not just wait till renewal and make a plan change for the owner?
 
Thank you both. It's obviously a complicated case. Only one employee in domiciled state, but that employee is not the owner. There are 19 total states with employees...7 of which only have 1 employee. The owner is the only employee in his/her state..and HR is in another state. Of course the golden rule is...what the owner wants...the owner gets, and this individual wants better coverage for his family. Can't portray the guy as selfish when the co. population and dependents currently have about as good as you can get (0 deductible/$10 co-pay, STD, LTD, Vision, Dental, Life, etc.). Was thinking "majority rule" could apply as one state has more than 10 employees vs "domiciled" state with only 1.

Honestly, other employees would most likely prefer to keep current coverage, hence the question/idea of owner potentially refusing grp coverage and going to individual exchange. Good point on no reimbursement...would need to be looked at through a "raise + taxes".

On question 3, aware that I would need license in state where contract was written, just wasn't sure if would have to be licensed in other state(s). Would potentially get licensed in owner's state as well just to help the guy who signs the agreement.

Obviously don't want to travel to 19 states. Would hope HR could deliver guides, contracts, and issue certificates.

Really appreciate your advice. May need to pass this one on to a nat'l brokerage, but there are add'l referrals at stake as well.
 
Thank you both. It's obviously a complicated case. Only one employee in domiciled state, but that employee is not the owner. There are 19 total states with employees...7 of which only have 1 employee. The owner is the only employee in his/her state..and HR is in another state. Of course the golden rule is...what the owner wants...the owner gets, and this individual wants better coverage for his family. Can't portray the guy as selfish when the co. population and dependents currently have about as good as you can get (0 deductible/$10 co-pay, STD, LTD, Vision, Dental, Life, etc.). Was thinking "majority rule" could apply as one state has more than 10 employees vs "domiciled" state with only 1.

Honestly, other employees would most likely prefer to keep current coverage, hence the question/idea of owner potentially refusing grp coverage and going to individual exchange. Good point on no reimbursement...would need to be looked at through a "raise + taxes".

On question 3, aware that I would need license in state where contract was written, just wasn't sure if would have to be licensed in other state(s). Would potentially get licensed in owner's state as well just to help the guy who signs the agreement.

Obviously don't want to travel to 19 states. Would hope HR could deliver guides, contracts, and issue certificates.

Really appreciate your advice. May need to pass this one on to a nat'l brokerage, but there are add'l referrals at stake as well.

Well since it's written already broker of record it out for a start then when you're inside and see how it's put together you would have a better shot on making changes, imo.

No need for a license outside of the state the contract is in that coincides with your resident license i.e. you don't need a license for additional states just because the employees are there, only where the contract is placed (if that makes sense).

I have to admit I am curious about how an IFP exchange plan can be richer in benefits than his current group plan which from what you have said is pretty rich. Can we see the group plan he is currently on and the proposed IFP plan? I mean there are a ton of reasons why I would never suggest this (in my state) starting with networks. How about coinsurance and OOP? Can't expose this with numbers? 9 times out of 10 this can be done. There's only 10-13k up for grabs here in terms of OOP maybe less.

Sounds like a good case, grab the BOR and work it backwards with his understanding that you're not a magician.
 
As we’ve discussed before, more and more businesses are expanding their
Concept of choice with crossroads spliting in two ways.jpegoperations to other states. Virtual workplaces, better connectivity, and remote technology allow today’s companies to recruit top talent regardless of location—a win-win for businesses and employees.

At the same time, employing workers in multiple states isn’t easy. One of the biggest concerns multistate businesses face is how to provide health benefits to workers scattered across the country. If this sounds like your business, here are five questions to ask when considering your benefits options.
 
Thank you rcduggan. Definitely will back in through BOR route. Great suggestion. Also, you are right...matching current plan will be almost impossible through IFP exchange. Just trying to figure out a way to please the Chief w/o disappointing the Indians. Based on my # of posts, not well enough versed to feel comfortable with posting brokers/insurers plans. Really glad I found this forum. Thx again.
 
Thank you rcduggan. Definitely will back in through BOR route. Great suggestion. Also, you are right...matching current plan will be almost impossible through IFP exchange. Just trying to figure out a way to please the Chief w/o disappointing the Indians. Based on my # of posts, not well enough versed to feel comfortable with posting brokers/insurers plans. Really glad I found this forum. Thx again.

No problem ;)

Like I said; how can his current plan be beat with an IFP exchange plan? Find out really what this guy wants. From review, I'd say the guy probably is just tired of "vanilla" and would like to see some change. Heck, maybe the old broker doesn't do the job, who knows?

Just give me the carrier, plan type (HMO, EPO, PPO, HSA, HRA) deductible, coinsurance and OOP. From there I can do the math but I will need both plans, his current and whatever he thinks he going to purchase on the IFP exchange.
 
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