Health Insurance FAQs

  1. What do the words deductible, coinsurance, and out-of-pocket maximum mean?Deductible:  The amount you must pay each year – with your own money – before your health insurance plan begins paying benefits.
    Coinsurance:  The percentage of care costs you are responsible for paying – usually after you have paid your plan’s deductible.
    Out-of-Pocket Maximum:  The most you will pay out of your own pocket for health care expenses in a year. 
  2. What is a High Deductible Health Plan (HDHP)?This is a health insurance plan that typically has no copays and a somewhat higher deductible as defined by the IRS. This, along with other qualifications, determine if the plan can be paired with a Health Savings Account (HSA).
  3. What is a Health Savings Account (HSA)?An HSA is a special bank account that you own that allows you to use pre-tax dollars to pay for qualified health care expenses. You put dollars in pre-tax, earnings grow tax free, and you can spend them tax free on qualified health care expenses. In most cases you must also be enrolled in a qualifying High Deductible Health Plan to take advantage of an HSA
  4. What is the Affordable Care Act (ACA) tax penalty for not having individual health insurance coverage?As of January 1, 2019 the ACA Tax penalty for the individual mandate was taken to $0.
  5. Does the Affordable Care Act still require large employers to offer health insurance to employees?Even though the individual tax penalty is eliminated, all of the other ACA regulations still apply to employer groups. Larger employers with 50 or more full time equivalent employees can face substantial financial penalties if they are not in compliance.
  6. How many employees does an employer have to have to qualify for group coverage?Group qualifications can vary by state and by insurance carrier. Often the minimum size is just two full-time employees enrolled, with at least one of those being a W-2 type employee.
  7. Can group health insurance cost be deducted on a pre-tax basis from employee pay?In most cases it can, which is a great financial advantage to employees and the employer. The proper documents, often referred to as a Premium Conversion or POP Plan, have to be established to allow pre-tax deductions.
  8. What should I look for when choosing a broker/advisor to work with on my group’s employee benefits package?Finding a broker that is experienced and knowledgeable can be key to the success of an employee benefits program. Look for a broker that will help you map out both short and long-term strategies that keep your benefits affordable and competitive. Your benefits broker should provide expert assistance with cost control, compliance, communication, customer service, and more.
  9. Where can I get individual health insurance?For individual coverage many states use the federally run Marketplace at Some states operate their own exchange for individual plans. Depending on your age and circumstances other options may include Medicaid, Medicare, or short term coverage.
  10. When is the open enrollment period for individual health coverage on the Marketplace?For the federal marketplace the open enrollment period typically runs from November 1 through December 15, but this can vary from year to year. You may also be granted a Special Enrollment Period during the year if you have a Qualifying Life Event.