NJ Small Business Health Insurance Employers’ Guide

This guide is intended to assist employers when shopping and getting quotes for health insurance in New Jersey. Please contact us if you have any questions.

Am I eligible to have group health insurance in NJ?

You must meet the definition of a small employer, meet participation requirements, and meet employer contribution requirements.

What is a small employer?

Employ at least two eligible employees, but no more than 50 employees.

You must also have a majority of eligible employees working in New Jersey.

What is the participation requirement?

At least 75 percent of your employees must participate in coverage as a condition of obtaining a small group health benefits plan.

Employees waiving for spousal coverage, another group health plan offered by the same employer or another employer, Medicare, Medicaid, or NJ Family Care are considered to be participating in your plan.

What is the employer contribution requirement?

A small employer must contribute 10 percent of the total cost of health benefits plan. This is calculated as the annual premium for the employee and dependents.

What information do I need to provide you to prepare a quote?

• We will need your company name and zip code.

• A complete census with each employee’s date of birth, gender, and insurance coverage status. Such as single, husband/wife, parent/child, or family.

• The effective date of when you want the insurance to start.

• Residential zip codes for each employee will be helpful to provide.

You do not need to provide any personal information for employees such as names or social security numbers. You may refer to them on the census provided by their initials or last name.

What paperwork or documentation do I need to start a plan?

• Master application for your company that includes a small employer certification form.

• Check for the first month’s premium on your business checking account made out to the insurance carrier.

• Each employee must fill out an enrollment form or a waiver depending on if they plan on electing the insurance.

• A copy of your quarterly wage and tax report (WR-30)-Any employees not listed on the WR-30 will need to be shown on your monthly payroll. Owners not on the payroll must be on the Schedule C or K1. Newly formed businesses can provide other documentation to prove employee eligibility.

• If your company has prior health insurance, then you will be required to provide a copy of your last bill.

• HSA plans will require documents to be filled out by the employer and employee.

What waiting periods can I have for employees?

An employer can have a waiting period of up to 6 months. You may have a different waiting periods for current employees and new hires.

When can employees enroll in my group health insurance plan?

As an employee of a company that has a group health insurance plan, you are only allowed to enroll during specified times. You are initially allowed to enroll when you are first hired. If your company has a waiting period for new hires, then you may have to wait 30 days or more to enroll.

What types of plans are available?

PPO, POS and HMO plans are available. HSA compatible POS and HMO plans are also a popular cost effective way to insure your company.

What are the main differences between plan types?

HMO plans offer in-network benefits only. PPO and POS plans offer in-network and out-of-network benefits. Employees receive greater benefits when using in-network providers. PPO and POS plans are generally more expensive than similar HMO plans. Deductibles and co-insurance for major medical services can be added to lower your premium.

HSA compatible plans have a high deductible that must be satisfied for all services, except for preventive care. The health insurance plan may be used with a savings account that can be obtained from the insurance carrier or from another financial institution.

Will the plans in my quote cover employees outside of NJ?

Yes, after requesting a quote you will speak directly to a state licensed insurance broker who specializes in group health insurance. Provide zip codes of current employees and let the broker know if you intend on having employees outside of NJ. Only select plans will work in specific states. This varies for each plan type and insurance carrier presented in your quote.

When are referrals required?

Some plans require referrals from your Primary Care Physician before seeing a specialist. All of our quotes provided do not require referrals since a majority of employees prefer it that way.

Do I need to select a primary care physician?

Plans that have separate co-pays for your primary care physician (PCP) and specialist visits require you to choose a PCP. If you do not choose a PCP the insurance carrier will charge you the higher specialist co-pay when visit your PCP.

What is a deductible?

A deductible is a specified dollar amount that must be satisfied before the insurance carrier pays anything toward the member’s charges.

What is coinsurance?

The coinsurance is the percentage of the allowed charges that are shared by the carrier and the covered person, usually after a deductible. Quotes list a percentage, such as 80 percent that commonly refers to the insurance carrier paying 80 percent of your bill and the employee is responsible for the remaining 20 percent.

What is a co-pay?

A co-pay is a defined amount of money that is used by the insurance company to charge you for utilizing a service. Commonly you are charged a co-pay for doctor, specialist, and hospital visits. Typical co-pays can range from fifteen Dollars for a doctor visit to one hundred and fifty Dollars per day for a hospital visit.

What is the Maximum Out-of-Pocket?

The maximum of out of pocket (MOOP) is used to refer to the total amount of covered services that an employee is expected to pay in a calendar year. After the MOOP is met, the insurance carrier pays 100% of the employee’s bill.

How are rates determined for NJ small business health insurance?

Rates in the small business health insurance market in NJ are based entirely on your employee demographics or census, zip code of your office, and effective date of your new health insurance plan. Co-pays, deductibles, and plan types all change your insurance premium. Negotiating on price is not available in the small group employer market in NJ.

Do all insurance brokers and agents have the same rates?

If the exact census and other details are used for two quotes from different brokers or agents, then the quotes will be exactly the same price. Agents and brokers vary heavily on the strategy they use to insure your company, so no two brokers or agents will present the same plans to you. We recommend having an in-depth discussion with a broker about your company’s health insurance needs.

Contact us now to get a free no obligation health insurance quote. We quote all insurers available to your company in one easy to understand proposal.