Group Health Insurance Tidbits

“I’m considering adding group health insurance for my employees. What do I need to do that the insurance broker won’t do?”

Your HR Survival Tip

It’s great you want to provide health insurance! Adding this benefit can be a big step due to the expense but you should find this will aid in recruitment and retention of employees.

You’ll want your broker to help you sign up for a Premium-Only Plan (POP) so you can take the employee’s share of any premium as a pre-tax deduction. Without a POP in place, any deductions must be made with after-tax dollars. You will always pay the full bill from the carrier and the employee’s share reimburses you.

Your broker will make a recommendation for certain plans but it will be up to you to decide how much of the premium is paid by you versus the employee. Our preference has you paying a percentage (50-100%) of the employee-only cost of the lowest level plan you offer. Employees then pay the remainder of that premium, plus the full cost of covering dependents or choosing a higher level plan. We prefer employees pay at least a small amount to save you money but to also avoid employees electing coverage just because it’s free rather than needed. You will find the amount a company might pay toward benefits will vary greatly based on your industry and ability to pay.

Reconciling the carrier’s bill every month is crucial. Insurance carriers don’t add or terminate employees as quickly as you might expect. You could see a back charge of 2 months of premiums because the bill is catching up on a new employee’s premiums. When someone’s coverage terminates, you submit their termination to the carrier but keep paying the full premium until the carrier pulls them off the plan and reimburses you for any premiums previously charged. If you try to deduct that employee’s premium off the bill, you’ll get a notice from the carrier stating you did not pay the bill in full and are now subject to cancellation. If an employee hasn’t been added or dropped by the end of 2 months, talk with your carrier or broker to ensure they received the change.

Pay stubs must list each deduction separately so the employees can easily see how much it’s costing them for each plan. Deductions on the paycheck are fairly easy to calculate once you know the employee’s premium amount for each plan they have elected and what portion the employee must pay:

  • Semi-monthly payroll (twice per month): Enter half of the employee’s monthly portion for each pay period.
  • Biweekly payroll (every 2 weeks): Multiply the employee’s monthly portion by 12 (months), then divide that amount by 26 (pay periods in a year) and you have the deduction for each pay period.
  • Weekly payroll (every week): Multiply the employee’s monthly portion by 12 (months), then divide that amount by 52 (pay periods in a year) and you have the deduction for each pay period.

When an employee’s employment terminates (voluntary or involuntary), their insurance coverage will end on the last day of the month regardless of when in that month their employment terminated. The employee will owe their share for the full month so let the employee know you will be pulling the remaining deductions from their final paycheck. Regardless of the employee’s plans for future coverage, you are legally obligated to offer COBRA (Consolidated Omnibus Budget Reconciliation Act) within 14 days of their coverage ending. If they elect COBRA, they are continuing the same insurance but paying their full premium for up to 18 months.

As a last step, create a policy that clearly states what happens to the employee’s coverage during leaves of absence. You need to decide how the employee’s share of the premium will be paid when they aren’t receiving a paycheck and how long the employee must be off before you’ll offer COBRA instead of keeping them active on your plan. This step is important because you’re potentially ending the employee’s medical coverage while they may be off work due to medical problems. Also, make sure your policy reflects the legal requirements for certain types of leaves. Having a policy in place, and signed by the employee before they begin a leave, will make this transition easier for both you and the employee.


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