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Frequently Asked Questions

If you’re considering providing insurance coverage for your employees, we’re here to help. We’ve shared answers to some of the most common questions small business owners have about coverage below.

To qualify for group coverage as a small business, your company needs between two and 50 full-time employees (including the owner). All full-time, permanent employees of an employer are eligible for insurance under a group policy. And 70% of eligible employees must select health plan coverage.

A full-time employee for group insurance purposes is one who works at least 30 hours in the employer’s normal work week and for whom the employer withholds Income Tax (UW approval required for less than 30 hours; no approval is needed for employees who work more than 30 hours per week).

For guidance on other qualifiers, call 833-923-1785.

Employers must provide UI 3/40 quarterly wage and tax statement for all employees and indicate full time, part time, seasonal, temporary, or terminated status for each employee on the document.

If your company is a new business, you may not have this document. This will require a state filed proof of business, and W-4’s for all W-2 employees.

Partnerships with no other employees require UI 3/40 and state filed proof of business. If they do not claim wages, K-1 documents for all partners of the group are required. If they are listed as stockholders, they do not qualify for coverage.

Yes, however 1099 contractors cannot exceed 10% of the eligible employees. Therefore, 1099 contractors are not eligible on group sizes between 2 and 9 employees.

Partners, proprietors, and members of the firm must meet all requirements applicable to full-time or part-time employees to be eligible.

Only individuals who are insured under a group policy prior to retirement may be insured after retirement. When a Blue Cross and Blue Shield of Texas group policy replaces that of another carrier, under which retired persons were insured, proof that the employees have satisfied the minimum years of service and achieved the limiting age must be submitted for review.

Deductibles, coinsurance, and copays are all mechanisms that allow health insurance companies and individuals to share costs. Deductible is a fixed amount an employee is required to pay before reimbursement by the health plan (coinsurance) begins. Coinsurance is the percentage of the cost of a covered health care service the employee is responsible for paying after they’ve met their deductible. Premium is the monthly amount that must be paid for a health insurance plan. Copay is the fixed dollar amount a member is required to pay for covered services or prescriptions at the time you receive them. Learn more about how insurance works.

This is the most employees have to pay out of their own pocket for expenses under the insurance plan during the year. Learn more about how insurance works.

Doctors, hospitals, or other providers who accept your employees’ health insurance plans are “in-network,” also known as participating providers. Doctors who do not take these plans are “out-of-network.” In-network provider services are paid at a higher benefit level. Learn more about how insurance works.

Our network plan offerings are built to create health insurance coverage options that fit any budget across different metallic coverage tiers. For more detail on the networks available to you, visit our Plan Options page.

A Smart network is a group of providers that encompass a specific geographical area, and is less broad than a standard PPO network. Plans with a smaller network typically have lower premiums. Learn more about how insurance works.

Essential health benefits are included in every health plan, no matter which plan you choose. The Affordable Care Act requires these benefits to be included in all individual, family, and employer-sponsored plans. Visit our Plan Options page to see all essential health benefits included in our plans.

BCBSIL plans provide comprehensive benefits with options to fit your employees’ needs and your organization’s budget. For more detail on the plans available to you, visit our Plan Options page.

Employers offering group coverage are required to pay at least 25% of their employees’ premiums. You may pay a higher percentage if you choose; making insurance more affordable for your employees can increase participation. If you purchase group coverage between November 1 and December 15 for a January 1 or January 15 effective date, the minimum contribution requirement is waived. Learn more about the benefits of offering health insurance.

You can apply for health coverage at any time throughout the year. If you purchase group coverage between November 1 and December 15 for a January 1 or January 15 effective date, the minimum amount you are required to contribute towards your employees’ premium, as well as the number of employees required to participate - are waived.

Each policy has a 12-month contract term. We will reach out to you before the contract term expires to discuss your options for renewing your policy.

You can buy coverage any time during the year and indicate a desired coverage start date. Once your business is approved for coverage, you will receive a notice confirming the date on which your coverage will begin. It will be effective for all enrolled employees starting on that date.

Yes, you may be eligible to take a deduction on the amount you contribute towards the premium cost on your employees behalf. Please contact your tax professional for more details on the tax advantages you may qualify for by offering your employees health insurance.

It is possible. You can take a pre-tax deduction from employees’ paychecks to cover the portion of the total premium that they are required to pay. This deduction reduces their taxable income and the amount of income taxes owed.

Through the Affordable Care Act, individuals may be eligible for subsidies for purchasing coverage through the individual market place if they meet income requirements. If you have additional questions, please contact your tax professional for more information.

Group insurance policies allow employers to offer their employees and their dependents a wider choice of options, with access to more robust plans and larger networks. Monthly premium costs are shared between the employer and the employee.

In the individual market place, there may be fewer options to choose from, plans typically have a higher deductible and smaller networks, and employees are responsible for 100% of the monthly premium.

Yes, coverage can be extended to spouses and/or children of any employees who enroll in coverage. You can decide if you want to contribute to the cost of their coverage.

We offer plans that include out-of-state coverage. If you have employees that reside out of state, you should consider including one of these plans. To find out which plans offer out-of-state coverage, review our 2023 Small Group Plans. pdf link

Health insurance includes coverage for a wide range of medical care. However, health care plans only include pediatric dental coverage. Dental insurance can help you and your employees access quality dental care.

Dental insurance includes coverage for oral care, such as regular check-ups, orthodontics, oral surgery, and other dental services. Like health insurance, dental insurance includes networks, coinsurance, deductibles, and annual out-of-pocket maximums.

All health care plans include pediatric dental coverage. However, coverage for adults is only available through a dental insurance plan.

Combining health and dental coverage through BCBSIL streamlines the administration of both programs, helping you manage your overall benefit costs. Employees with both BCBSIL health and dental plans have access to BlueCare Dental ConnectionSM, which includes educational information and outreach to help your employees make important decisions about their dental care.

Members who have health and dental insurance have experienced:
• 24% reduction in medical costs
• 41% fewer hospital admissions
• 34% fewer ER visits

You can choose to offer a contributory or voluntary dental plan to your employees. If you choose a contributory dental plan, you must contribute at least 50% towards your employees’ dental insurance premiums. For voluntary plans, you are not required to contribute towards your employees’ premiums, but you have the option to contribute up to 49%.

Life insurance is a way to provide for loved ones in the event of death. It can be one of the wisest decisions a person can make to financially protect those who depend on them.

We provide both employer-paid and voluntary plans. Employees can also obtain coverage for their spouses and dependent children.

Major reasons given for owning life insurance include:
• Replace lost income • Cover burial or other final expenses • Pay off mortgage

Most group life policies offer a certain amount of guaranteed coverage. Under certain circumstances employees and family members might have to go through the Evidence of Insurability (EOI) process to be considered for coverage. EOI may be required if:

  • an employee applies for an amount of coverage higher than the guarantee issue amount
  • an employee is currently enrolled and wants to increase his or her insurance amount
  • an employee declines coverage during his or her initial eligibility period and then wants coverage at a later date

EOI is an application process where employees provide information on the condition of their health or their dependent’s health to be considered for certain types of insurance coverage.

Online EOI submission eliminates or reduces the processing of paper applications for coverage requests, increases accuracy and confidentiality, and speeds up the overall application process.

Step-by-step instructions lead the employee through the application process, which usually takes about 15 to 30 minutes and can be submitted 24 hours a day, 7 days a week. Our system will provide confirmation to the employee that the application has been received. Once all the required information is received, a decision will be made, and a letter will be sent to you and the employee. Premium should not be deducted until you receive notification of our approval.

Most EOI applications are processed using only the information provided. However, in some cases, we may require medical records from the applicant’s physician or a physical examination which is at our expense.

For additional information please contact your Group Administrator or call 1-800-721-7987.

An accident or illness can endanger an individual’s most important asset: the ability to earn a living. Our short-term disability (STD) plans pay benefits when sickness or injury prevents an employee from working full time. We offer STD programs tailored to meet the needs and cost expectations of both employers and employees.

  • Affordable premiums
  • Evidence of Insurability not required on most plans
  • Coverage for pregnancy, as well as disabilities caused by accidents or illnesses
  • Benefits paid for total or partial disability
  • Seamless claim transition from STD to LTD

Many voluntary short-term disability (VSTD) claims end with the employees being able to go back to work. Some, however, will turn into long-term disability claims. Employers who also have voluntary long-term disability (VLTD) coverage benefit from having the same team manage both VSTD and VLTD claims. This means that no time is lost in the move from a VSTD to a VLTD claim, and the team’s purpose is to bring the claimant back to gainful employment, whenever possible.

  • Benefits for total or partial disability
  • Return-to-work incentives for employees who can work on a partial or part-time basis
  • Rehabilitation incentive income—unique in the industry—for those claimants who cannot return to their job but have skills that can transfer to a new occupation
  • Social Security assistance services for employees who are totally disabled and eligible for Social Security benefits

Life and disability insurance products issued by Dearborn Life Insurance Company, 701 E 22nd St. Suite 300, Lombard, IL 60148. Blue Cross and Blue Shield of (State) is the trade name of Dearborn Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

For additional information please contact your Group Administrator or call 1-800-721-7987.

To get a quote for your health insurance, simply give us a call at 833-923-1785 or you can get a quote online Leaving Site Icon.

Our insurance specialists can answer any additional questions you may have as you consider your group health insurance options. Call us at 833-923-1785.

Healthier Employees. Healthier Business.

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