FAQs

Understanding Dental And Health Insurance for Your Small Business

Understanding health insurance

Why should I offer health insurance to my employees?

Everyone is aware of the rising cost of health care. But not taking care of your health has its own costs. As a small business owner, the biggest investment you've made in your business is yourself and your employees.

Health insurance offers your employees protection from financial worries

Health insurance helps protect the personal health of you and your employees and the financial health of your business. With coverage for routine health care, employees are better able to stay healthy, while catastrophic coverage insurance relieves some of the financial fears of getting sick.

Just like you have insurance coverage for auto and home, health insurance helps protect you from unexpected expenses that might otherwise devastate your finances. Unprotected from medical costs, the uninsured are at risk of being unable to pay off medical debt.

Health insurance helps you retain talent and keep them working

Globally, health insurance can be a top benefit factor in attracting and retaining top talent. And you're probably aware of the hidden costs in time and effort when it comes to recruiting and training new employees.

Health insurance can also help reduce absenteeism due to illness. When your employees feel able to see a doctor when they need to, they not only stay healthier, but can help you save in terms of improved productivity and less absenteeism.

What are the tax benefits of offering health insurance?

Tax-advantaged HSAs - If you opt for an HSA plan, the Health Savings Account that accompanies it has tax-advantages. Employers can deduct any amounts contributed to employees' HSAs and the employee will also enjoy tax-free contributions, tax-free growth of assets and tax-free withdrawals from the account - triple tax advantages. Visit irs.gov for current tax information.

What's the difference between a group plan and individual coverage?

If you have a business that employs 2 or more people, you're eligible to purchase group insurance for your business. By pooling employees together, premiums for group plans can be less expensive than buying individual plans for your employees.

Group Plan
Individual plan
Groups
Individual
  • Uses the power of averages to spread risk across the group (some people are high risk, some are low risk)
  • Lower premiums than those found in individual plans
  • Premiums paid are tax-deductible
  • Premiums are deducted pre-tax for employees
  • Individual premiums are determined by their individual risk
  • Individuals must reach 7.5% of their adjusted gross income in medical expenses in order to deduct from taxes.

Purchasing a group plan can benefit your business's bottom line as well. Employer paid premiums are generally 100% tax deductible and your employees' contributions to their premiums are paid from pre-tax dollars, which lowers your employees' taxable income.

North Carolina requires small businesses to pay at least 50% of an employee's individual premium. If an employee wants to extend coverage to a spouse or dependent, some employers will help cover that cost, but they're not required to do so.

Does Blue Cross and Blue Shield of North Carolina offer dental insurance plans?

Yes. BCBSNC offers a suite of flexible dental plans designed to fit your business needs.

Why should I offer dental insurance plans to my employees?

Providing dental coverage is important to your employees' overall health. Research shows that there's a connection between gum disease and health conditions such as diabetes, stroke and heart disease.1 With our Dental Blue® and Dental Blue Select plans you'll find a wide range of options to help improve the overall health of your employees and their productivity.

All Dental Blue plans also give employees the freedom to choose their preferred dentist or access to the BCBSNC dental network.

Choosing a health plan

How can I determine what type of plan I need?

Finding the plan that works best for both you and your employees is a matter of determining the type of coverage you need, balanced with your budget.

Some insurance plans provide copayment coverage for most routine needs: annual physicals or monitoring a health condition. A plan with copayments covers doctors visits and prescriptions with a known copayment. The premiums for these plans reflect this level of coverage.

Other insurance plans offer a higher deductible, which results in a lower premium, but have higher out-of-pocket costs until the deductible and any coinsurance requirements are met. This type of plan provides coverage for significant medical expenses and can be right for people who don't anticipate needing to see the doctor frequently. There are two ways that individual policy-holders can control how much they pay for health insurance, and health care.

  • The first is to weigh the plan features that affect the price (premium) of the plan
  • The second is to use the health insurance coverage in a way that maximizes health care while controlling costs
What are the typical features of a health insurance plan and how do they affect its price?

As you work with BCBSNC to find the plan that fits your needs, you will make decisions about factors which affect how much you and your employees will pay (the premium). From the factors with the highest impact to those with less of an effect on the premiums of a plan, the factors are:

Plan deductible

Like any insurance deductible, this is how much you will pay before the insurer will cover expenses.

The lower the plan deductible, the higher the premium.

In some health care plans, some services, like an annual physical and certain preventive care tests, like mammograms and prostate screenings, are covered from day one, either entirely or with a copay.

Out-of-Pocket Limit

The out-of-pocket limit is the maximum annual amount your insurer will require you to contribute out-of-pocket towards the cost of your care After the out-of-pocket is met, the plan will pay 100% of the allowed amount for covered expenses.

The lower the out-of-pocket limit, the higher the premium.

Coinsurance level Coinsurance is the percent of the allowed amounts for covered services that BCBSNC will pay after you meet your deductible. Plans range from 100% (BCBSNC covers all expenses for covered services after the deductible has been met) to 50%. (The member pays 50%, and BCBSNC pays 50% of the allowed amounts.)2
Copayment for services

A copayment is a fixed-dollar amount which is due and payable by the member at the time a covered service is provided. Usually this is all the member will pay for the provided service(s). Copayments mean the plan covers a large part of the costs of services.

Controlling costs

How can we effectively use our health plan to reduce costs while maximizing benefits?

Making sure you understand the parameters of your health insurance coverage can help you get the most value from your plan. BCBSNC provides Quick Start Guides to members to help them understand the best way to use their health coverage to minimize out-of-pocket expenses. And be sure to talk to your employees about the value of their health insurance. Talking about the benefits you offer helps employees understand and appreciate the benefit you are providing.

  • Tip #1 Choose an in-network provider
    The BCBSNC network of doctors and hospitals is extensive. You can visit any provider in our network and you'll be covered by your plan. You can visit out-of-network providers, but coverage levels will vary by plan.
  • Tip #2 See your primary care doctor first
    Primary care doctors can provide many of the health care services you need on a regular basis. And you'll typically pay less when you visit a primary care doctor than if you visit a specialist.
  • Tip #3 Know before you go
    Know what type of facility you're visiting before you go. You may pay more for services provided by outpatient clinics and by providers who are affiliated with certain hospitals in certain locations than when you visit your primary care provider in an office setting.2 When you understand what, how and where your plan provides coverage, you are better able to plan your health care choices.

Additional benefits

What health and wellness benefits does BCBSNC offer?

From our website bcbsnc.com, all members can find a doctor, get more information about prescription drugs and coverage, and review benefits and claims.

Blue 365 brings you exclusive member discounts from top retailers on fitness gear, gym memberships, family activities, healthy eating options and much more.3

BCBSNC also offers wellness programs to members of most plans which can help lower medical costs, reduce employee absenteeism, reduce disability claims, improve productivity and transform your corporate culture by offering your employees real incentives for healthier living.4

What other types of insurance are available through Blue Cross and Blue Shield of North Carolina?

Life insurance as well as short-term and long-term disability are offered by Mosaic Group, an authorized agency of Blue Cross and Blue Shield of North Carolina. Mosaic Group offers a variety of insurance options that can help you create an attractive benefit offering for your employees.

Can't afford to fund additional benefits? Let your employees choose. Mosaic Group also offers voluntary products that add value to employee benefit packages at little to no cost to you. Plans such as short-term and long-term disability, life, supplemental hospital coverage, cancer, accident and critical illness policies can all be offered on a voluntary basis.

Note: All specialty products, except dental, are offered by Mosaic Group through USAble Life. USAble Life does not offer Blue Cross and/or Blue Shield products or services. BCBSNC and USAble Life are not affiliated companies.

Why should I use BCBSNC to facilitate all my benefit offerings?

When you work with BCBSNC for your insurance, you can simplify your administration. You'll have one point of contact for your benefits. If you add life insurance and/or disability coverage offered by Mosaic Group through USAble Life, you still pay only one bill. How easy is that?

Note: All ancillary products, except dental, are offered by Mosaic Group through USAble Life. USAble Life does not offer Blue Cross and/or Blue Shield products or services. BCBSNC and USAble Life are not affiliated companies.

1. "The Health Perils of Gum Disease." Joanne Baker, Reviewed by Steve Drescher, DDS (Accessed June 2013).

2. Some services and supplies received by members in an office setting or in connection with an office visit are in fact outpatient hospital-based services provided by hospital-owned or operated practices. These services and supplies may be subject to your deductible and coinsurance. The coinsurance displayed in the Benefit Booklet shows member responsibility.

3. Blue365 offers access to savings on items that Members may purchase directly from independent vendors, which are different from items that are covered under the policies with BCBSNC. Blue Cross and Blue Shield Association (BCBSA) may receive payments from Blue365 vendors. Neither BCBSNC nor BCBSA recommends, endorses, warrants or guarantees any specific Blue365 vendor or item. This program may be modified or discontinued at any time without prior notice.

4. BCBSNC contracts with Alere Health Improvement Company, an independent third party vendor, for the provision of certain aspects of Healthy Outcomes programs.

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