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Group Health Insurance Employer Responsibilities

As an employer, you have responsibilities when it comes to your Group Health Insurance.

  1. Giving notices to eligible employees who will or will not become eligible to join the group health plan.
  2. Obtaining and submitting complete enrollment information for eligible employees to enroll in the group health plan. It is the employers responsibility to make sure applications contain all requested information.
  3. Sending the Health insurance company all notices, written information or inquires from eligible employees.
  4. Distributing Carriers communications to employees on group health insurance.
  5. Paying premiums for the group health insurance plan on or before the due dates.
  6. Maintaining a benefit records on each employee application. This information should include any changes, benefit amounts, or other details. The insurance company may request such information.
  7. Reporting changes to the Health Insurance company.
  8. Change in employee classification
  9. Change in earning
  10. Change in dependent status
  11. Change in employee name
  12. Change of employee address
  13. Termination of employee and the reason.
  14. Change in employer information.
  15. Assisting covered employees in filing claims if applicable.
  16. Notifying employees about Cobra or the continuation coverage. It is better to use a third party administrator to admin your Cobra.
  17. Reporting to the health insurance company any qualified medical child support.
  18. Notifying employees of any conversion eligibility upon termination. This aspect used to be much more important before guaranteed issue was available in the Health insurance market. You may still have employees that want to take advantage of this because they have already met their out of pocket.
  19. Notifying the insurance company of any changes in group size. Federal Law does impact the health insurance depending on the size of the employer. This can have a huge impact on rates and plan design. For example, if your Health Insurance plan is under 50 employees, there is a guaranteed issue. If the group goes over 50 employees, then you are subject to underwriting guidelines. The underwriting can be a good thing in certain situations.
  20. Notifying the insurance company if an employee no longer meets eligibility. If you have a full time employee on the group health plan and they drop down to part time, this would be a situation where that employee is no longer eligible for that group health plan.
  21. Notifying the insurance company that an employee is no longer actively at work. One would want to review the certificate of coverage for the group health insurance contract.
  22. Tracking Cobra and establishing who is no longer eligible for the continuation of coverage. It is much more effective to hire a third party to admin this aspect of the health plan.