Health Insurance Basics
Health insurance is a way to help pay for health care expenses. Having insurance helps in the event of an accident or illness by paying some of the medical costs when you're injured or sick. Like car insurance or home insurance, you can choose from a variety of plans.
How insurance works
When you have health insurance, the insurance company pays a portion of your medical expenses. The amount the insurance company will pay, and the services that are covered (coverage) varies by plan.
You may have to pay a $20 co-payment for each doctor visit. Or, the plan may not cover anything until you've paid a certain amount (the deductibles ). These deductibles and co-payments , along with any other expenses you may pay, are referred to as out-of-pocket expenses.
Some plans may also have co-insurance , which is the percentage of the bill that you're required to pay, in addition to your deductible and co-payment.
The term cost-sharing is often used to describe the share of costs covered by your insurance that you pay out of your own pocket. This generally includes deductibles, co-insurance, and co-payments, but it doesn't include premiums, balance billing amounts for non-network providers, or the cost of non-covered services.
The amount you pay each month for your coverage is the premium .
Generally, the higher your monthly premium, the lower your deductible will be.
The relationship between premium and deductible
No matter which health insurance plan you choose, you’ll pay a monthly payment (your premium) to keep your health insurance coverage. You may also pay a certain amount (co-payment or co-insurance) each time you receive medical care.
Common Terms used in Health Insurance
Need help with the lingo? You don’t need to learn a whole new language, but here’s a list of some terms you are likely to see as you review health insurance information.
We've got answers.
Generally, you must have between 2 and 50 full-time equivalent employees, one who is working 30 or more hours per week on average. Your part time employee's hours will contribute to the required full time equivalent. This could change depending on specific State regulations, so please contact one of our representatives to discuss this in further detail.
You must offer coverage to all of your full-time employees. Generally this means those working 30 or more hours per week on average. This is different than the number of employees that must enroll.
States have different regulations about how many full time employees must enroll in a plan. Please contact one of our representatives to discuss this in further detail.
Visit our Networks page to see if we cover your area.
No. Businesses with 50 or less full time employees are not required to offer insurance. The government definition of a full time employee is a person who works 30 or more hours a week. However, all your employees must have health insurance in 2015 or pay a maximum fine of $900 (depending on income).
Small Business Tax Credits
(resulting from the Affordable Care Act)
If you are a small business and all of the following apply to you, then there may be a tax credit that will put money back in your pocket.
Have less than 25 full-time equivalent employees?
Pay an average annual wage of less than $50,000 (as adjusted for inflation beginning in 2014)?
Pay at least 50% of your employees health insurance premiums?
To learn more about how to file the required documents, please visit IRS.Gov - Small Business Health Care Tax Credit for Small Employers.
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