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What are the typical requirements to prove eligibility? |
| Typically, to Prove Employer Eligibility:
• The Employer must reside in a state where the plan is approved for sale.
• The Employer must employ between 2 and 50 applicants with 75% of eligible employee participation (see employee eligibility).
• A state quarterly unemployment tax report or some other financial document must be provided to validate the business and the employer/employee relationship.
Typically, to Prove Employee Eligibility:
• The employee must be employed on a permanent full-time basis and works a minimum of 30 (thirty) hours per week for at least 9 (nine) months per year (or as otherwise specified by state law).
• The employee’s name should appear on the company’s state quarterly unemployment tax report. |
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Can independent contractors (1099 employees) be considered for coverage on a group plan? |
| Yes, if they meet the criteria for eligibility such as:
• Is working solely for this employer.
• 100% of earnings are drawn from the participating employer.
• Is required to comply with company policy
• Is engaged in a regular business activity of the firm. |
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Are groups of two, consisting of husband and wife eligible for coverage? |
| No. To be eligible, there must be at least one non-related employee participating in health coverage (unless state law otherwise defines a group of two). |
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Are common-law spouses eligible for dependent coverage? |
| The relationship must be recognized as a common-law marriage by the state in which the couple resided at the time the marriage was entered into. If the relationship is recognized as a common-law marriage, the common-law spouse is eligible for coverage as a dependent of the eligible employee. |
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Are “employee only” groups accepted for new business? |
| Yes, employee groups can be considered. We would require a letter on the employer’s stationery with the owner’s signature requesting that no dependent coverage is desired for the duration of the plan. |
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Are retirees eligible for group health coverage? |
| Only full-time active employees may apply for or maintain insurance. Retiree coverage is not available. |
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Are carve-out groups (groups which offer coverage to one class or category of employees rather than all employees) accepted for new business? |
| No, however, we will consider groups where union negotiated contracts provide coverage for the employer’s union employees. In such instances, all such union employees would be excluded by class and as such deemed ineligible and not subject to participation requirements. |
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Are there Employer groups who may not qualify? |
| Yes, those entities that lease individuals to other employers, are seasonal, or one operating during temporary periods. |
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What are the minimum new business application requirements? |
| In order to be eligible for consideration, an applying employer must submit the following:
• Completed and signed employer application and employee applications. *
• Completed and employee signed waivers (where applicable). *
• State wage and tax report (for the most recent quarter).
• Prior health insurance billing statement.
• First month’s premium (initial deposit made payable to IAC).
• Copy of your proposal (which matches the employer application selections).
*All signatures must be dated within 60 days of requested effective date. |
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Is a photocopy (or fax copy) of an application acceptable? |
| Yes, as long as the original application follows in the mail (preferably within 5 days of receipt of the photocopy or fax copy). |
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How is the employee participation requirement determined? |
| Employee participation is verified at the time of new business underwriting by comparing the total number of eligible employees to the number of employees applying for coverage. Percentage of participation required depends on group size (please refer to respective Employer Application). |
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How is dependent participation determined? |
| Dependent participation is determined at the time of new business underwriting by comparing the total number of applying dependent units (i.e.; spouse or family are counted as one dependent unit) to the total of eligible dependent units. The percentage of participation required depends on group size (please refer to respective Employer Application) or state law. |
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Who needs to complete a waiver section of the application? |
| Any employee who does not wish to take coverage for themselves or their dependents needs to complete a waiver section. |
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Why is other coverage information necessary on waivers? |
| This information is used to determine if a group meets the carrier’s minimum participation requirements and to allow waiving employees to preserve special enrollment rights should they apply in the future. |
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What is the adverse effect to an employee who waives coverage when first eligible and does not have other creditable coverage? |
| Such employee desiring coverage in the future will be deemed a late applicant. Late applicants are subject to a deferral of coverage and a subsequent pre-existing condition limitation period. |
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In a multi-location group, what percentage of employees should be in the home office? |
| At least 50% of insured employees of a multi-location group must be in the home office. Employers not meeting this criterion must first be approved by the Marketing Department prior to applying for coverage. |
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What is the minimum employer contribution toward a group-sponsored health plan? |
| The minimum employer contribution toward a group-sponsored health plan is 50%. The employer may choose to contribute 50% of the employee cost and 0% of the dependent cost or 25% of the employee cost and 25% of the dependent cost to meet this requirement. |
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Does IAC offer deductible credit from a prior health plan? |
| IAC offers deductible credit for group health plans only; deductible credit for individual health plans is not offered. |
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Is child-only coverage available? |
| Yes. The individual health insurance plans support child-only coverage for children 2-17 years of age. Each child is subject to medical underwriting, including additions to the coverage. When a child covered under these policies reaches age 18, they may request coverage under their own individual plans and be charged an adult rate, if they reside in a state where coverage is available. Premium is based on the rates applicable to the state in which the child resides. Children of foreign nationals with legal residency in the United States are not eligible for coverage. |
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What effective dates are available for IAC health plans? |
| Applicants may choose to have their coverage become effective on either the 1st or the 15th of the month. Applicants who choose the 15th of the month for their effective date will have their premium billing pro-rated and they will be billed on the 1st of the month thereafter. |
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When does an application need to be submitted in order to receive the requested effective date? |
| Applications must be received before the requested effective date. Applications for coverage received after the requested effective date, if approved, will be made effective the next available effective date. |
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Will IAC insure groups who do not have a Quarterly Tax and Wage statement (because they are a new business)? |
| Groups who do not have a Quarterly Tax and Wage statement can submit payroll records for the previous two months. In addition, they must submit a Partnership Agreement or Schedule K-1 / Partnership form, a sole proprietor Schedule C or State/City License, a Corporation Schedule E or Articles of Incorporation. A first Quarterly Tax statement will be requested at a later date. |
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