This "Im on my spouses plan" thing is getting real annoying

[somarco]

I don't know about TX law but CO does not require a business owner to carry Workman's Comp.

All states have WC laws. The minimum number of employees will vary by state.

Here in GA it is 3.

You count W2 employees, not 1099.

Even if you do not carry WC that does not exclude the employer from liability. If I work for you and I am injured on the job I can still come after you for med payments, LOT and other issues.

If you meet the minimum threshold (3 employees for example) and do not have WC you must purchase a bond to cover your liability. Many large employers will either post a bond or pledge assets and purchase a cover (reinsurance) to take care of claims in excess of the bond.

 

[Crabcake Johnny]

Maybe Sam or others can answer this, but is there any claims review involved regarding participation? If a company currently has a group plan with 10 employees and 6 blow off the plan are they going to get contacted by the carrier?

 

[somarco]

Group carriers review participation on small group on a regular basis if the number of employees drop. Not so much with larger groups.

This is an accounting function, not claims.

If a 10 life group suddenly drops to 6 someone in accounting will probably call them if enrollment does not pick back up within 90 days.

If a 5 life group drops to 2 they will most likely react much quicker. Some carriers will ignore the drop in enrollment until renewal before giving them the boot.

 

[Crabcake Johnny]

Thanks - I feared that. This has always been a small issue when I contact a lead and it's a small employer with say 5 employees. Three are interested in looking at indie plans but I've always pulled away from that knowing it will harm the rest of the group.

I understand the theory behind participation and also employers contributing towards or paying for individual coverage for their employees. In reality that's a doomsday forecast by the state DOIs - that companies would cancel group, just offer money towards indie plans - the healthy make out fine, the sick get screwed.

The problem is a state like MD which is non-underwritten group with high rates. A small employer, say 3 employees, cannot afford group in most cases and also isn't allowed to pay for indie plans. I think the DOIs need special rules for micro-businesses - under 10 employees.

It doesn't need to be said that a lot of micro business owners say screw those rules and put extra money into employees checks anyway.

 

[Guest]

Most carriers have a waiver clause. According to CA law, from what I undersstand. valid waivers are those individuals who have other health care coverage through a spouse, parent or legal guardian, individual coverage, coverage through another employer of coverage provided through a government subsidized health care program.

 

[djs]

All states have WC laws. The minimum number of employees will vary by state.

Here in GA it is 3.

You count W2 employees, not 1099.

Even if you do not carry WC that does not exclude the employer from liability. If I work for you and I am injured on the job I can still come after you for med payments, LOT and other issues.

If you meet the minimum threshold (3 employees for example) and do not have WC you must purchase a bond to cover your liability. Many large employers will either post a bond or pledge assets and purchase a cover (reinsurance) to take care of claims in excess of the bond.

This varies a lot by state. For instance, in California, 1099 employees MAY have to be covered by workers comp. A good example is hair salons. Most hair dressers are 1099, not w-2. They have to be covered by workers comp. They are not eligible to 'make a group' for health insurance, but they can be covered under the group health plan, as long as the salon qualifies with the owner and a W-2 employee.

In most occupations, 1099 contractors do not have to be covered by workers comp. But, as usual, it's difficult to make a blanket statement.

Dan

 

[djs]

Most carriers have a waiver clause. According to CA law, from what I undersstand. valid waivers are those individuals who have other health care coverage through a spouse, parent or legal guardian, individual coverage, coverage through another employer of coverage provided through a government subsidized health care program.

I always get this one wrong. In all of your examples above (except the government plan), they have to have group coverage to be waived, correct? I don't think you can waive 'Dad' when they are on 'Moms' IFP plan, he has to be on 'Moms' group plan.

Obviously, dependents don't count towards waivers. Maybe it's just me though, but in Silicon Valley, I think a lot of companies pay at least something towards dependent medical coverage, so it rarely makes sense to do this.

Dan

 

[arnguy]

Last year for the first time in recent memory, Independence Blue Cross (the 5-County Philadelphia area) did a census by mail of the groups covered by their association plans. I think their purpose was to ascertain if there were any phony groups,ie., not real businesses attempting to get GI coverage for a family. I do not know what the results were. At the time of applying for coverage BX requires documented proof of a legitimate business.