The FAQs below are for the small group health insurance commercial market: Oregon (1-50) employees, and Washington (1-50) employees.
Exact definitions and answers will vary with each insurance company and each kind of insurance.
Why do I need an insurance agent?
An agent can assess your needs, explain state and federal rules and laws, and do all the work for you to gather rates, available options, and benefit information.
Are my rates higher if I have an insurance agent?
In Oregon for groups (1-50) and in Washington for groups (1-50) the medical and dental rates are the same with, or without an agent. Most insurance companies prefer that clients work with agents who can help answer questions and communicate contract changes, etc.
How many employees do I need to have a group plan?
In Oregon you need one employee who is eligible for insurance; however, the one employee who is eligible has to be someone other than the owner or the owner’s spouse.
In Washington, you need one employee who is eligible for insurance, and at least one needs to enroll.
Is the owner of a company considered an employee?
Yes, the owner is considered an employee for insurance purposes. But someone other than the owner or the owner’s spouse must enroll.
Is the owner of a company required to enroll?
Yes, the owner of a company is required to enroll, unless they have other medical/dental insurance
Do I have to pay my employees’ premiums on a group plan?
Most insurance companies require the employer to contribute a minimum of 50% of the employees’ premium. The employer is not required to contribute any portion of the employees’ spouse and dependent premium.
How long will it take to get health insurance rates for a group plan?
A normal turn-around time would be five to ten working days. However, sometimes rates can be obtained within 48 hours when you are working to meet a deadline.
Do I have to offer insurance to all my employees?
You need to offer insurance to all eligible, full-time employees. However, employees who have other insurance are usually allowed to decline and do not have to enroll.
Who are eligible employees?
Eligible employees are those employees who have been hired as full-time, work 17.5 - 40 hours or more per week, and have satisfied their waiting period.
Do all eligible employees need to enroll?
All eligible employees need to enroll, unless they have other medical coverage; i.e., coverage through their spouse, Medicare, Medicaid, OHP, WBHP, etc.
Will I be denied on a group plan if I have pre-existing conditions?
On a small group plan in Oregon (1-50) and Washington (1-50), health statements are not required. You may not be excluded because of health reasons.
How long do I need to be in business to have a group plan?
This varies with insurance companies in Oregon and Washington. Depending on the insurance company; you can be a brand new business, or are required to have been in business anywhere from two months to one full year. An agent can help direct you to the plan(s) available depending on how long you have been in business.
Do I need to offer Federal COBRA to my employees?
Yes, if you have twenty (20) or more employees on payroll, regardless of whether-or-not those employees are eligible for the group health plan. Full-time employees are counted as one employee; however, part-time employees are counted, for example, as ½ employee or ¼ employee, depending on how many hours per week the employee works.
Do I need to offer state continuation?
In Oregon, if you have fewer than 20 full-time equivalent employees, you are required to offer nine months of medical state continuation. Washington does not have a state continuation requirement.