Employee Benefits & more!

Frequently Asked Questions

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Yes! Please fax (800-218-9890) or email (support@StraussInsurance.com) the bill in question. If you have the Explanation of Benefits for the date of service from the insurance company please send it as well.
Typically not but there are a few exceptions. If within in the past 60 days you have; lost your health insurance coverage for any other reason than non-payment, had or adopted a new child, were married, were divorced or moved to a new service area.
Most times your major medical policy DOES NOT include dental and vision coverage for adults (over the age of 18). However many policies now automatically include pediatric dental and vision coverage at no extra charge.
Nine out of ten times you will pay less money under an employer sponsored plan when compared to buying your own coverage. This is because the employer is paying a portion, usually about 60%, of the premium on your behalf.
A better way to look at this is "what doesn't go towards my deductible". Under most plans your doctor, prescription, ER and Urgent Care co-pays are the only services that are not subject to deductible. Therefore everything else from inpatient hospital stays to durable medical equipment would be subject to the deductible.
Maybe... It is also possible that the service was subject to your deductible, in which case the money you paid will be subtracted from your total deductible amount. The best way to tell if it was not covered is to look at the bill and see if there was any type of insurance adjustment or insurance write-off subtracted from the total amount charged. If there was not chances are the claim was either not covered or more likely, the insurance company never received the claim.
Usally it does not. Auto insurance deductibles are typically "per occurrence", meaning you pay them every time you have an accident or claim. Where as a health insurance deductible is cumulative, meaning that your claims accumulate during the contract period (typically one year but not necessarily a calendar year).
The plan provided by YOUR employer is typically primary. Your other plan, through your spouse or State/Federally funded programs such as Access, or Medicaid, would then be secondary.
In most cases you do not. As a full-time employee you have the right to be on your employer's plan just like all other full-time employees. However you may want to take a look at Medicare and Medicare supplement plan as they may offer better coverage at a lower cost to you.
The cost of a COBRA policy is nothing more than the your unique premium under your employer/ex-employer's policy. Let's say the premium for your coverage under your employer's policy is $500 per month. While you are working for the employer perhaps he/she pays $400 a month of the premium for you. Then they deduct $25 per week out of your paycheck to make up the other $100 of monthly premium. Once you end employment or if your hours are reduced to part time your employer must offer you COBRA which gives you the ability to stay on the insurance plan. However under COBRA the employer is no longer paying the $400 towards your coverage and you are therefore responsible for the entire $500 monthly premium.
If you are under the age of 45 and relatively healthy it is quite possibly less expensive to get it on your own. However if you have any type of even moderately serious health condition(s) you are probably best to stick with your employer's life insurance plan.
This varies by area but in general our employer groups pay on average 70% of the employee only cost and 30% of the family. Typically these percentages are higher in Schuylkill and Luzerne county and get lower as you move towards the Lehigh Valley.
Amongst our 200 plus small business clients the average deductible is $1700 for single and $3400 for families as of the year 2019.
This is really a questions you want to ask your accountant but in general you need to have a cafeteria plan (Section 125) set-up. This is something most accountants or payroll companies can set up for you for a nominal fee.
Absolutely! Although your rates are usually guaranteed for one year that does not mean you are stuck with that company for that period. Please be aware that some insurance companies require extra notification time when you are cancelling a policy outside of the renewal period.
If your company has under 100 employees there is usually no fees or extra charges for assigning a broker to your account. Brokers, like Strauss Insurance, can provide many excellent services and support that can help you stay in compliance and make your health insurance headaches go away.
Almost certainly yes. Nearly all businesses must offer their former employees the option to stay on their group medical program either through COBRA or mini-COBRA. There are severe penalties for failing to do so.
This is controversial subject. The IRS has released several guidance notifications advising employers against this. However some accountants and administrative TPA's say that it is legal. If you consider making this change the you should talk to your accountant and/or lawyer before moving ahead.
Most certainly they do not. Under the Affordable Care Act health insurance companies must publish their rates and have them approved by the State Insurance Department. Once this approval is given the insurance carrier cannot vary their published rates to attract specific businesses. Therefore all brokers and agents have the same rates.
It really depends on two factors; the insurance company and the number of employees that are on the insurance plan. It the past few years insurance carriers have become much more flexible with regard to multiple plan options.
The Affordable Care Act (ACA), also know as Obamacare, is a set of laws and regulations that fundamentally changed the way health insurance companies did business. Among other changes the ACA; eliminated pre-existing conditions, allowed children to stay on their parent's policies until age 26 regardless of student status and requires that every American, with few exceptions, carry health insurance coverage.
First thing is that Obamacare is not actually insurance. It is a set of laws and regulations. One of the changes implemented by Obamacare was the expansion of Medicaid (State/Federally funded "free" health insurance) and the creation of Advanced Premium Tax Credits (APTC). If you do not qualify for Medicaid you may still qualify for an APTC that will help reduce the cost of your health insurance coverage.
No. Many insurance carriers still offer a paper application option. However you may forfeit your right to get help paying for coverage by choosing the paper application as opposed to the website. Brokers, like Strauss Insurance, can help guide you through Healthcare.gov typically at no extra cost to you.
This depends on the insurance company you choose. Obamacare allows you to choose a commercial insurance company, such as Blue Cross/Blue Shield, Aetna, the Geisinger Health Plan and many others. Check to see if your doctor accepts their insurance instead of asking them if they take Obamacare.
You can sign up for an individual Affordable Care Act policy starting on November 1st and the last day to sign-up is January 31st. However there are certain special events that allow you to sign up at different times of the year. See questions below for more details.
In most cases yes... However there are certain "special enrollment periods" that allow you to purchase an individual health insurance policy at other times of the year. For example if in the past 60 days; you were married, divorced, had or adopted a child, moved to a new service area or if you lost your prior insurance coverage then you may qualify to enroll outside of the open enrollment period (November 1st - January 31st).