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Common Questions about the GAWDA Health Insurance Program

Thursday, October 15, 2015
Common Questions about the GAWDA Health Insurance Program
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Can I join the GAWDA program at any time?

Yes, with appropriate notice to your current carrier (typically 30 days), you can move into the GAWDA program at any time. Rates are guaranteed through January 1, 2017.

When should I submit information for a quote?

As soon and as early as possible.  The process from submission to formal quote to enrollment to effective date normally takes around 45 days.

What information do you need so I can get a quote?

A simple employee census, completion of a short questionnaire by phone, and basic information on what health benefits you offer and the costs you have currently.

What health benefit plans are offered in the GAWDA program?

Five United Healthcare PPO plans are offered, three traditional first-dollar co-pay PPO plans and two Health Savings Account options, along with voluntary dental and voluntary vision options.  Employees can choose any of the five medical plans they want, and there is no minimum enrollment required in any one plan.

Is there a minimum employer contribution to this program?

Yes.  The ACA law requires that an employee be able to purchase single only health insurance, based on the lowest cost plan offered, not to exceed 9.5% of their W-2 income.  As an example, for a 40-hour employee making $10 per hour, this would limit the employee only pre-tax cost to no more than $164 per month, or around $38 per week.  If the employee wishes to buy a better health plan, cover dependents, or purchase dental or vision coverage through their own pre-tax contributions, it is at the sole discretion of their employer if they wish to subsidize any of those added costs.

Can I keep my medical plans and just offer Dental or Vision through GAWDA?

No, a member firm must offer and enroll employees for medical coverage through GAWDA’s program to be able to access the voluntary Dental and Vision options.

Why is this more advantageous than buy health insurance on my own?

Small group and individual coverage is now based on individual ages of participants, including each dependent, making costs much higher for most working members.  Additionally, the risk pool used to set rates has worse experience than larger employers would see.  By pooling all GAWDA membership together, a unique and separate risk pool is created, which will offer competitive initial rates and long-term stable costs.

How good is the access to discounted providers in the United Healthcare PPO?

United Healthcare is the largest, seamless national healthcare provider across the country.  The UHC Choice Plus PPO network covers more hospitals, outpatient facilities, and physicians across the entire country than any other national health carrier.  More than 66,000 pharmacies accept the United Healthcare prescription program.  For those GAWDA firms that have joined the program, none have reported any disruption in continuing care with current providers.

Are medical underwriting questions from employees required?

No, there is no medical underwriting required other than a general employer statement of knowledge.  There are also no pre-existing condition limitations.

For information about the GAWDA Health Insurance Program, contact Sharon Spiese at 708-845-3154 or at sharon.spiese@thehortongroup.com.

Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.

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