Group Health Insurance FAQ

Medicare Insurance FAQ

Individual Health Insurance FAQ

Why should I offer group health insurance to my employees?

Offering health insurance as a part of your benefit package will more likely attract and retain better employees.  Employees who have insurance are more likely to go to the doctor when they get sick vs. employees without insurance; this helps for loss time at work.   It helps to promote wellness; a healthy workforce is a positive thing for an employer.

What do I have to contribute to my employee’s health insurance?

Most insurance carriers require that employers contribute at least 50% toward the employee’s premium.  It is up to the employer if they choose to contribute more than 50% or if they choose to contribute toward the employee’s spouse or dependents.  Under PPACA (Affordable Care Act), it is required for employers who offer coverage, to also offer coverage to dependents however it is not a requirement to offer coverage to spouses.  The employer is not required to contribute toward dependent coverage.

If I want to add a group health plan, where do I start?

Call Creekside Insurance Advisors, Inc. and we will walk you through the process, virtually handling every aspect of the enrollment process.  Here are a few steps we take in getting your group health plan set up.

  • Gather the information on your company and the employees
  • Analyze your group census
  • Determine approximate health risk of group to determine if self insured plan options may be suitable
  • Shop your group among several insurance carriers and/or self insured TPAs
  • Educate the employer on the options available and cost-savings strategies
  • One-on-One or Group Benefits Counseling to employees-we want to make sure all of your employees understand their benefits.  Each employee is able to contact us directly for questions.

What is a census?

A census is what insurance carriers require in order to get preliminary rates.  A census consists of each employee’s name, date of birth, type of coverage (employee only, family, etc), and zip code.
*See Forms tab to find a Census Form to send to us if you are interested in getting a quote*

What are standard rates vs. underwritten rates?

Standard rates conform to PPACA (Affordable Care Act) where insurance companies will charge the same rate for each employer group regardless of medical risks that exist with employees of that group.  Standard rates will vary by zip code, age, tobacco use, family structure, and plan design choice.  Underwritten rates are only available via self insured plans for groups of 10 or more employees.  Contact one of our group health specialists for explanation of the advantages of either strategy.

What is the difference between PPO and HMO?

Preferred Provider Organizations (PPO) generally permit your employee to choose in-network providers at a lower co-payment for services or the flexibility to use out-of-network providers at a higher co-payment.  Health Maintenance Organizations (HMO) generally do not permit out-of-network benefits except for urgent or emergency care.  Employers may be able to save on premiums by using an HMO product however it is important to review medical provider choices within the areas of your employee zip codes.  We are more than happy to assist with this process.


What value added services can Creekside Insurance Advisors offer my company?

Creekside Insurance Advisors provides many value added services so that the process of getting a group health insurance plan is not a time consuming process.  We do individualized benefit counseling, fast turn-key transitions, personalized service with regular follow up, automatic re-evaluation at renewal, voluntary benefits, and conformity to the new ACA law.   We believe in the value of a relationship and strive to establish strong and lasting partnerships with our clients.

Do all brokers have access to the same plans?

As long as your broker is appointed with a given insurance company, then he/she will have access to all the plans offered by that insurance carrier.  Creekside Insurance Advisors utilizes multiple companies as well as self-insured TPAs to find the best balance of benefits and cost for our clients.  We are presenting plans to some of our employers that many brokers are choosing not to.  These innovative plan designs are a definite advantage for groups with a better than average health risk profile.    We find that doing the right thing by our clients helps create and maintain their trust.

What are voluntary benefits?  What enrollment technology do you utilize?

Voluntary benefits are a supplement to the core insurance; they can offer added financial security the employees, with no direct cost incurred by the employer.  And when employees choose to enroll in a voluntary plan option, the employer may also be able to save on payroll taxes with a Section 125 established.  We have teamed with AFLAC and other companies to offer voluntary products such as:

  • Short-term disability
  • Cancer Plans
  • Accident Insurance
  • Critical Illness Plans
  • Life Insurance
  • Dental & Vision

We provide one-on-one benefits counseling where the employee can sit down with a benefit counselor and learn about their health insurance and other products made available to them by their employer.  During this one-on-one counseling, the employee can choose any voluntary products they want; additionally they will be able to review the cost of each product and see the total amount that will be payroll deducted from their check.

How does Creekside Insurance Advisors, Inc. handle renewal time?

We usually receive your renewal rates about 60 days prior to your renewal.  At that time, we analyze your census to review any changes you have had since your last enrollment.  Then, we automatically shop your plan out again to make sure you are still getting the most competitive rates.  During this time, we also contact you to let you know that we have your rates and that we are looking at other carriers.  We also use this time to talk with you to see if your goals for the group insurance plan have changed.  Once all the rates proposals are received, we will meet with you and go through the entire process as we did when we set up your original insurance plan.  We will review your renewal rates with you and show you other plans that may be a better fit.

Who do I contact if I need to add or remove someone to our group health insurance plan?

You can contact Kati Ritter with Creekside Insurance Advisors and she can handle that process for you.

Will I have multiple people that I will be working with or will there be one point of contact for my group?

The entire staff at Creekside Insurance Advisors will be happy to assist you in anything that you need, however your main point of contact will be your agent, Kati Ritter.  She provides each of her clients with her direct line at the office and cell phone number so that you can reach her at anytime.

Why should I use Creekside Insurance Advisors over any other insurance broker?

We only do health insurance.   We don’t try to be your banker or your liability carrier.  Because we specialize in health insurance and conformity to the new ACA law, you can be sure an expert is in your corner.  Another main reason to work with Creekside Insurance Advisors is that we are using strategies and plan designs that many other brokers have yet to implement.  Plus, our Medicare team will make the transition easy for your employees who age in to Medicare at age 65 or younger due to disability.  This is extremely important now that one carrier is excluding claim benefits from group coverage if someone is eligible for Medicare when Medicare is their primary coverage!

When does Medicare coverage begin?

Medicare begins the first day of the month in which you turn age 65 or when you have been determined as permanently disabled for 24 months at any age.  If your birthday falls on the first of a month, your coverage will actually begin the first of the preceding month instead.  It is possible to delay your Medicare coverage without penalty if you are eligible for other creditable coverage through an employer.

What do the different parts of Medicare cover?

Part A covers Hospital and Skilled Nursing Facility – think “inpatient.”  Part B covers Medical, such as physician visits, labs, etc – think “outpatient.” Part D covers outpatient Prescription Drugs.  And Part C, is a private insurance option that replaces benefits payable under Parts A, B and D, also known as Medicare Advantage.

What is a Medicare Supplement policy?

A Medicare Supplement policy is offered through a private insurance company and pays for some or all of the coverage gaps left by approved services under Medicare Parts A and B.  There are 10 modernized plan designs with Plan F being the most comprehensive and also most popular plan choice.  All companies must offer the same benefits for each plan design in order to make the consumer shopping process much easier.

How do I shop for the best rate on Medicare Supplement?

If you are a VA or WV resident, Creekside Insurance Advisors is appointed with most of the relevant Medicare Supplement insurance companies and can do your shopping for you!  We can help you understand the plan differences, find a company with the lowest rate for your preferred plan, and make the enrollment process a snap.

What is the Affordable Care Act (aka Obama Care)?

ACA was passed in March, 2010 and has forever changed the environment in which individuals and employers can purchase health insurance coverage, what benefits are payable, who may qualify for subsidized premium rates and/or benefits, and who may have to pay a penalty for not owning coverage. There are no options outside of ACA that are available to individuals besides temporary coverage from limited sources called “short option plans.”  Exchanges are set up in each state where citizens can shop and enroll in coverage on their own, or through the free assistance of an insurance professional who is certified by the Marketplace.

Can I be turned down for health insurance due to a pre-existing medical condition?

One feature of ACA is that pre-existing medical conditions will no longer be permitted in the availability or premium rating of individual health insurance.  Therefore, regardless of your medical condition, you will no be turned down for coverage and all pre-existing conditions will be covered by the new plan with no waiting period for such conditions.

When can I purchase coverage?

Enrollment in individual or family coverage may only take place during the Annual Enrollment Period each year (November 15, 2014 – February, 2015) unless a Special Enrollment Period (SEP) is available to you for a qualifying event, such as birth of a child, loss of coverage, divorce, etc.  If you are not sure whether you may qualify for SEP, give us a call.

What determines my cost for coverage?

Cost of coverage is determined by each insuring company based on age, geography, family status and tobacco use.  Also, those households under 400% of federal poverty level (FPL) may qualify for lower, subsidized premium rates.  Those below 250% of FPL may qualify for additional subsidies to lower deductible, coinsurance and out-of-pocket maximum. Children in households below 200% FPL may qualify for the FAMIS (CHIP) program and families below 100% FPL (133% in some states) may qualify for Medicaid coverage.

Can I see any doctor of my choice?

Your plan choice will determine what flexibility you will have in provider choice.  PPO plans generally allow out-of-network coverage at a higher cost, but HMO coverage typically only allows out-of-network in urgent or emergency situations.

Where can I get a quote?

VA & WV residents may contact us at Creekside Insurance Advisors for a free, no obligation quote.  We will need your estimated household income and family size in order to estimate your potential subsidy, if eligible.  We can also assist in completing your enrollment both on or off exchange.