Click on the questions below for an explanation
Health Insurance Frequently Asked Questions:
What are the enrollment dates for 2021 health insurance coverage through the ACA Marketplace (Obamacare)?
November 1, 2020: Open Enrollment begins.
December 15, 2020: Open Enrollment ends. After December 15, you can still buy a health plan if you qualify for a Special Enrollment Period.
January 1, 2021: Plans sold during Open Enrollment start date.
Where can I find Marketplace pricing and plans?
On our website, drag the cursor over the Benefits heading and click on “Shop Online for Health Insurance. Once clicked it’s the second from the left.
Who is eligible for coverage?
Individual/ Families coverage Part-time and 1099 contractors
Full-time benefits eligible new hires in a waiting period
Employees that move between full and part-time Early retirees
Medicaid/CHIP eligible options for part-time and full-time COBRA eligible employees
What’s the advantage of using the Silverstein HR’s link to HealthSherpa for Marketplace quoting?
HealthSherpa is a private site that is the first-ever partner of the federal government that offers a more streamlined way to compare and shop for health insurance online. Using any of these platforms will also let you see if you qualify for monetary assistance with your premiums. An enrollment pathway with integrated quoting, enrollment, and servicing. More than 36,000 agents and 4,800 agencies have adopted HealthSherpa’s agency and broker platform.
On December 4, 2018, HealthSherpa announced that it was the first company approved to utilize the Department of Health and Human Services’ innovative new Enhanced Direct Enrollment (EDE) technology, which permits private companies to carry out all enrollment and related activities for on-exchange health coverage.
Faster easier application No identity proofing refilled renewal applications Synched to Healthcare.gov Compare plans to all companies in your area Provider and prescription search
What exactly is Enhanced Direct enrollment (EDE)?
Enhanced Direct Enrollment (EDE) is a provision in the United States that allows certain private entities, including insurance carriers and web-brokers, to directly enroll consumers in Qualified Health Plans through the Health Insurance Marketplace without redirecting consumers to Healthcare.gov. Approved EDE partners may access a suite of APIs which allow them to directly submit and update applications on the federal exchange.
What is an “Off Exchange” Plan?
Instead of purchasing your health insurance on through the ACA Marketplace (Obamacare) or a qualified web broker’s approved website; you could purchase directly from an insurance company or a broker for that insurance company. Several plans are identical and, in some cases, the “Off Exchange pricing may be less expensive. Some plans are offered both on and off exchange. For plans that are offered both on and off exchange must adhere to the same rules except the “off exchange products that aren’t eligible for tax saving incentives couldn’t be surcharged for underreporting income at the end of the year.
Non-ACA, “Off Exchange” products may not be as robust and may be subject to medical evidence, and therefore an applicant may be rejected for coverage. A big plus is that some medically underwritten plans could be substantially more affordable saving insureds 20% or more.
What are some Innovations in this year’s insurance offerings?
Well it seems if almost everyone has added a telehealth product and some companies are now adding Virtual Primary Care and Virtual Urgent Care at a $0 (ZERO) co-pay. Some companies that have on exchange and off exchange products are offering certain off exchange products at a lower price than the “on exchange” pricing. This would only be an advantage if the applicant was not eligible for a premium credit. Technology and smart phone apps are getting better and offering more services. Some companies allow in-home blood draws at $0 (ZERO) copays if directed by the Virtual Primary Care Physician.
What is a Special Enrollment Period?
Once the open enrollment period for 2021 is over starting December 16, 2020, You qualify for a Special Enrollment Period if you’ve had certain life events, including losing health coverage, moving, getting married, having a baby, or adopting a child.
Changes in household
You may qualify for a Special Enrollment Period if you or anyone in your household in the past 60 days: Got Married, Had a baby, adopted a child, or placed a child for foster care, Got divorced or legally separated and lost health insurance, Died,
Changes in residence
Moving to a new home in a new ZIP code or county, moving to the U.S. from a foreign country or United States territory, If you’re a student, moving to or from the place you attend school, If you’re a seasonal worker, moving to or from the place you both live and work, Moving to or from a shelter or other transitional housing.
Loss of health insurance
You must prove you had qualifying health coverage for one or more days during the 60 days before your move. You don’t need to provide proof if you’re moving from a foreign country or United States territory.
Losing job-based coverage, Losing individual health coverage for a plan or policy you bought yourself, Losing eligibility for Medicaid or CHIP, Losing eligibility for Medicare, Losing coverage through a family member.
An employer offer to help with the cost of coverage
You may qualify for a Special Enrollment Period if you or anyone in your household newly gained access to an individual coverage HRA or a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) in the past 60 days OR expects to in the next 60 days. If you qualify to enroll in Marketplace coverage through this Special Enrollment Period, call the Marketplace Call Center to complete your enrollment. You can’t do this online.
More qualifying changes
Other life circumstances that may qualify you for a Special Enrollment Period:
Gaining membership in a federally recognized tribe or status as an Alaska Native Claims Settlement Act (ANCSA) Corporation shareholder, Becoming newly eligible for Marketplace coverage because you became a U.S. citizen, Leaving incarceration, Starting or ending service as an AmeriCorps State and National, VISTA, or NCCC member.
What if I’m turned down for a Special Enrollment Period, but I think I qualify?
The Marketplace Appeals Center can review these types of issues:
Not eligible for advance payments of the premium tax credit (APTC)
Eligible for APTC, but the amount is wrong
Not eligible for a Special Enrollment Period
Not eligible to buy a Marketplace plan
Not eligible to choose a Catastrophic plan
Not eligible for an exemption from the requirement to have health insurance
What’s the latest on cost-sharing for Covid-19?
Federal protections prevent most people from paying out-of-pocket for COVID-19 testing, patients may face substantial costs if hospitalized for treatment because there are no provisions that require private insurance plans to waive cost-sharing for COVID-19 treatment. Some insurance companies are waiving telehealth co-pays, but not hospital or co-insurance charges. Many insurers of fully-insured group plans that waived cost-sharing, may not be waiving these charges going forward.
PEO Frequently Asked Questions:
How can I know that my PEO is financially sound?
Most insurance agencies are rated by financial organizations, but what about PEOs? Ensuring compliance with industry organizations and trusting that they are financially responsible isn’t always evident. Silverstein HR vets all of our PEO partners to ensure they are financially sound, and we endeavor to work with PEOs who are accredited by ESAC or the IRS. ESAC Accredited PEOs are backed by assurance bonds of $15 million to protect their clients.
Certification as a Certified Professional Employer Organization (CPEO) affects the employment tax liabilities of both the CPEO and its customers. To become and remain certified under the CPEO program, CPEOs must meet tax status, background, experience, business location, financial reporting, bonding and other requirements described in the statute and regulations.
You can learn more about them here:
ESAC – https://www.esac.org/
https://www.irs.gov/tax-professionals/about-certified-professional-employer-organization
What is our role when it comes to taxes and regulatory compliance?
When you partner with a PEO, they handle your tax payments and manage complex tax systems. Some of these taxes include FICA taxes, Medicare and Social Security taxes, State Unemployment tax, Federal Unemployment tax and other state and local taxes, to improve your efficiency and ensure your organization remains compliant. As a co-employer of your employees, the PEO assumes responsibility and liability for managing your payroll and unemployment taxes.
Can I work with a PEO AND a Financial Advisor?
Just like independent insurance agencies that quote your business insurance we have many PEOs to choose from.
Howard Silverstein, CEO of Silverstein HR Inc. has 35+ years of experience providing employee benefits, payroll, insurance, PEO, HR and compliance services in New York, Florida and throughout the United States. We have the expertise and understanding of how PEOs work and when it’s best to use them. Our negotiation skills are unparalleled and we continually strive to provide the best fit and PEO services for our customers. Most benefit brokers and PEO direct sales personnel don’t have the experience we have to offer.
Most employee benefit brokers only use the services of a PEO Advisor (sometimes referred to as a PEO broker) when in fear that they will lose their existing group health insurance account. They don’t have the expertise and full understanding of how a PEO works, nor the background in workers compensation, payroll, HR and affiliated services.
Similarly, PEO direct sales people know the platform for the company where they work, but not most of the other 400+ PEOs. Once in their system and for renewals you won’t have an advisor like us negotiating for you.
What are the costs associated with working with a PEO?
Professional Employer Organizations’ fees can vary and they may charge a percentage of the employee’s salary or a flat rate per employee. Some PEOs charge additional that may include training, consulting and workers’ compensation safety programs. When comparing PEO costs, you need to consider not only the monthly administrative cost, but group health insurance and workers compensation premiums, 401(k) administrative fees and fund charges, SUTA, setup fees, and possible training fees.
What kind of service should you expect working with a PEO to handle your payroll, HR, workers’ compensation and benefits? How many choices of group health insurance plans is the PEO willing to offer your size group? What types of supplemental benefits do the offer? What is PEO’s role when it comes to taxes and regulatory compliance? Do you offer a workers’ compensation safety program? What type of technology does the PEO offer? Is your point of contact a credentialed HR manager? How do you know what you’re paying for? These are some of the reasons you need transparent pricing.
Use a PEO to grow your company?
A PEO will typically provide comprehensive human resources-related services (HR), including payroll and administration, assistance with hiring and training, employee benefits and rewards packages, insurance policies to protect your organization, as well as help with state and federal compliance issues.
By partnering with a PEO, your organization will be able to adopt some of the most beneficial and desirable products and services normally reserved for much larger companies. Furthermore, the added efficiency achieved by hiring a PEO will greatly streamline all things HR-related, which, aside from helping your company to run more seamlessly, will also likely save your business a substantial amount of money over the long term. Thus allowing the management and valuable personnel more time to concentrate on selling the products and/or services that help grow and contribute to the success of their business.
Can I work with a PEO Advisor and my insurance or financial advisor?
Yes! While Financial Advisors can help with your 401(k) and other investments, working with a PEO advisor and a financial/insurance agent, together, they may be able to provide additional benefits and solutions. Some PEOs allow the group health insurance and/or the 401(k) to be administered separately. In most cases because of the economy of scale the PEO’s group health insurance premiums can be significantly less and the cost to administer the 401(k) also less expensive to administer. It would be an advantage if the PEO Advisory firm has experience with the insurance products offered.
What is the staff support ratio?
When comparing PEO companies, understanding the number of team members that will be assigned to your account is important. The level of support will vary greatly if you have 1 representative for 50 employees versus 1 representative for 500 employees. Set clear expectations when negotiating the level of staff support.
Do PEOs offer Employment Practices Liability Insurance?
We are seeing an increase in the number of employment-related lawsuits, which necessitates the need for Employment Practices Liability Insurance, or EPLI, which provides coverage for legal defense of employment-related issues. This type of insurance coverage can be obtained through a PEO who will present options of coverage depending on the risk.
Do you offer a Workers’ Compensation safety program?
Workplace accidents cost nearly $250 billion per year. Therefore, your PEO will not only recommend risk management and workers’ compensation insurance but also provide safety programs to reduce costs associated with workplace injuries and downtime. Some of these programs include drug testing, loss control, safety procedures, safety training and more.
Is my point of contact a credentialed HR manager?
When just starting out, or when you’re a growing SMB, hiring a dedicated HR manager may not be feasible. A PEO can help eliminate your HR burdens of payroll, benefits, workers compensation, and full-service human resources from hire to retire and everything in-between; and at a substantial savings. This includes guidance and advice about government compliance issues, pandemic issues as we are experiencing currently and about growth strategies as it relates to human resources. Your contact in a PEO may be a credentialed HR manager and depending on the size and/or structure of the PEO, they may have a separate benefits manager.