If you’re considering health insurance for your small business, you may find there are many forms and documents used in the process. Some of these you are probably already familiar with – like those used by the Internal Revenue Service (IRS) and the State of California. Others may be less familiar. Here, we’ll take a quick look at the some of the most-common documents and how you and your employees may use them in connection with employee benefits.
State of California DE 9C: Quarterly Contribution Return and Report of Wages
Under California law, employers are required to report specific information periodically, including quarterly wage reporting. The quarterly wage report form (DE 9C) is used bypaper rain many carriers in connection with your employer application for employee health benefits.
The quarterly report is available in both print and electronic format. Right now, employers with 10 or more employees are required to electronically file this form. Beginning January 1, 2018, all employers will be required to file electronically. More information about how you can file and manage payroll tax accounts online is available at www.edd.ca.gov/e-Services_for_Business. Information on the state’s e-file mandate is available at www.edd.ca.gov/EfileMandate or in the California Employer’s Guide (state form DE 44).
Employer Application
An employer application is the first document you’ll complete with the help of your broker. It provides the information needed to qualify your business to offer employee health insurance benefits. All health insurance carriers, including CaliforniaChoice (see the sample CaliforniaChoice employer application here), require you to complete the form, which asks for information, including:
- Employer name, address, company structure (corporation, sole proprietorship, partnership, S Corporation, LLC, or other), and workers’ comp carrier (and policy ID)
- Enrollment and eligibility (requested effective date, pay periods annually, employee count, current coverage (if any), waiting period, etc.)
- Selected Affordable Care Act Metal Tier (Bronze, Silver, Gold, Platinum, or a combination) for the next year
- Premium Contribution (percentage of cost or fixed dollar amount)
- Statement of Compliance
Some applications also include the option to provide benefits like Dental, Vision, Chiro, and Life Insurance or a Section 125/Premium Only Plan (POP), which will allow employees to pay for their health insurance with pre-tax dollars from their paychecks. (A POP also reduces your payroll taxes. Your broker can give you all of the details.)
Explanation of Coverage (EOC)
This document, provided by the insurance carrier or administrator, offers a complete explanation of all of your health plan’s benefits. (It is sometimes also called a Summary of Benefits and Coverage or SBC.) While it is not your actual insurance policy, the EOC/SBC is a useful easy-to-read summary of plan benefits. It outlines what’s covered and what is not included. It also has examples of what you might pay for certain health services, keeping in mind any deductible, co-payments, and other out-of-pocket costs. All EOCs/SBCs must follow a standard format, including a glossary of terms. That makes it easier for you to compare plans and costs.
Explanation of Benefits (EOB)
Once you and your employees are enrolled in a health plan, you’ll receive an Explanation of Benefits (EOB) from your insurance carrier after each visit to a health care provider. The EOB is an overview of the total charges for your visit and a summary of how much you and your health plan will pay. Your EOB is not a bill; it’s provided to tell you know how you (and your covered dependents) are using your coverage. If you have co-pays or co-insurance due as part of your visit to a doctor, hospital, or other health care service provider you may get a bill.
If you have questions about your EOB, you should contact your health plan. If you think you’re being charged for tests or services covered by your plan, you may be able to file an appeal. The insurance carrier will review your request and provide a written response.
Employer Administrative Guide
During the coverage year, it’s inevitable that you’ll be presented with a question or situation that needs clarification. Some may come from your employees, asking about the benefits of their specific health plan. Others may come from you or someone who helps you manage your staff about how to apply administrative procedures or policies.
An administrative handbook is designed to help guide you through different procedures and answer general questions about your benefits program.
If you choose CaliforniaChoice for your employee benefits, the CaliforniaChoice Employer Administrative Guide is a great resource with information on:
- Benefits administration basics
- Frequently asked questions
- How to make changes to your policy
- Billing basics
- And more
Employee Enrollment Guide
All carriers and private exchanges provide an enrollment guide for employees. This is the piece your employees will be most interested in, since it summarizes their available health plan options and provides information about costs and how to enroll. It’s very useful in helping employees understand their available benefits, and a great resource before they make their benefits selection. (You can see the CaliforniaChoice employee guide here.)
Change Request Form
When you need to add or cancel coverage or add a dependent to an employee’s existing coverage, this is the form you’ll need. It may sometimes also be used to add or change voluntary or optional benefits, like Dental, Vision, and Life Insurance.
IRS Form 1095-C: Employer-Provided Health Insurance Offer and Coverage
If you’re an employer with 50 or more full-time or full-time equivalent employees and you currently provide health insurance benefits, you’re probably familiar with this IRS form. (To learn about how the IRS defines full-time and full-time equivalent employees, visit the IRS website.)
If you have fewer than 50 full-time or full-time equivalent employees or you do not currently offer employee health benefits, you may not know about this form. It’s used by employers to give notice to employees each year about their eligibility for health benefits. The form summarizes health coverage offered to employees and, in some cases, includes information about whether an employee or dependent is enrolled in this coverage.
Employees are not required to file Form 1095-C with their tax returns; however, the form is useful to employees in determining the months in which they or their dependents are covered by a health plan for purposes of determining any individual shared responsibility penalty due to the IRS, as a part of the Affordable Care Act.
If you are interested in learning more about any of the above-described health insurance and related forms, or if you’d like a health insurance quote for employees at your small business, we can help you find a CaliforniaChoice broker.
