- I am a sole proprietor. Can I participate? Yes, as long as your chamber membership is a business membership under your business name, then you have access to this coverage.
- What is my financial responsibility as a participating employer? Because this health plan is 100% ACA compliant, you are only required to contribute half of the most economical single option offered toward your employees premium. For example, if an employee chooses one of the family options, the employer is still only federally required to pay half of the most economical single option toward that family premium.
- Are the premiums tax deductible? Yes, they sure are.
- Can the employee portion be withheld from their paycheck? Yes, if you so choose.
- Will I get my own invoice for my participating employees? Yes. Each month you will receive an invoice for your participating employees. You can pay that premium with cash, check, EFT, ACH, etc.
- What about Medicare eligible individuals (65+ years)? Will they have the ability to participate? The Newton community representatives who are overseeing this plan have decided to decline anyone who is eligible for medicare. Medicare eligible individuals have the opportunity to take medicare, which is more affordable and covers virtually everything. The youth of the community do not have the ability to participate in medicare.
- Will my provider be in network? We are working along the Newton Medical Center to put together a primary contract with them, meaning more affordability for everyone involved. However, that doesn’t mean you can’t continue seeing your PCP if they aren’t part of Newton Med. You can search the ProviDrs Care Network by going to their website and utilizing their search tool (www.providrscare.net). You can also search your provider using the First Health Network (www.firsthealth.com), which is the nationwide network the plan will be contracted with.
- The Chamber plan is starting July 1. What if my current plan renewal is January 1 (or any other time)? You can still come onto the chamber plan at your renewal. You and your employees will need to submit health questionnaires no sooner than 3 months from your renewal, and no later than 2 months. Please keep in mind, coming onto the chamber plan mid year like that will result in renewing with the totality of the group again at the chamber plan renewal of July 1. Your renewal will align with the chamber plan at this point.
- How many employees need to participate for the employer to offer this plan to them? The participation percentage is 65%. Meaning, 65% of the full time, (30+ hours per week) eligible employees have to participate for the employer to be able to offer it. Please keep in mind that waivers do not count against your participation total. Waivers such as: they are on their spouse, parent’s, the marketplace, etc. If the employee has coverage anywhere else, and they elect not to participate, they do not count against your total participation percentage. We recommend you have all of your employees complete the questionnaire so they will have the option to participate if they so choose. However, if they decline to provide health information initially, they will not be able to participate until open enrollment for next year.
- Will there also be a dental and vision plan? Yes. The chamber plan includes a voluntary dental and vision plan (meaning the employee is responsible for all dental and vision premiums). Dental and vision cannot be taken without taking the health plan.
- How much is this going to cost? The strategy that we are moving forward with takes into consideration many different things that contribute to the overall risk and cost of the group. Therefore, we will not know what the rates are for our plans until we get through the health questionnaire and underwriting process. Don’t worry, you are not obligated to any of this process until you sign the dotted line at enrollment.
- What about pre-existing conditions? Will they be covered? Yes, per the ACA federal requirement, individuals with pre-existing conditions cannot be denied coverage.
- What about preventative care? Well-woman check ups? Man checks? Yes, again, per the ACA federal requirement, preventative care will be covered 100%.
- Will I be able to continue using the local pharmacy? Yes, of course! This effort is to try to use as many local resources as possible.
- What about the dental and vision network? Will my eye doctor/dentist be in network? With the dental and vision plan, there will be no network, so all dental and vision providers will be considered in network.
- I am not a Chamber member. Can I still participate and have access to coverage? You can participate and including yourself in all of the underwriting process. However, if you enroll in the coverage, you will be required to be current on your Chamber business membership prior to the coverage start date.
- Am I limited by the amount of office visits I can have? No. You can see your doctor as many times as you need to make sure your health is taken care of.
- When is open enrollment for the Chamber plan? Open enrollment is from 5/1 – 6/30 of each year.
Still have questions?
Contact Joshua Sapp, President/CEO of Heartland Benefits Group
(316) 670 – 2856