Group Health

Group Health insurance is employer sponsored health coverage. This means that the employer of a company is contributing a dollar amount or a percentage to the employee's medical premium. Here at Stone Hill National, we offer a variety of carriers that you can present to your clients. Depending on each carrier's structure, determines the minimum contribution amount that the employer is required to contribute.  

FAQ section

Employer Group Q&A

What classifies as an employer group?
An employer group is 2 or more employees working for a bona fide company. Most carriers will not write owners-only policies, so at least one of the employees must be receiving W-2 income.
Are there requirements for a business to provide a group plan?
ACA (Affordable Care Act) requires businesses providing health benefits to employees to contribute a minimum of 50% of the employee-only premium for the lowest-cost plan offered. Employers are free to increase the contribution or provide for dependents also as a means enrich benefit offerings.
How do I know if my group is small employer or large employer?
Small Employer (SE) is a group of 2-50 full-time FT employees. Large employer (LE has a workforce of 51+ FT employees. SE groups are based on ACA community rated premiums and there is no health underwriting. LE groups are rated on the overall health and size of the employee census and allows for more custom plan design.
What is needed for a small or large employer quote?
For both group sizes, the Stone Hill National (SHN) census spreadsheet is required to be completed with all full time eligible employees, spouses and dependents. For Large employers (Tab 2), please also see the included checklist of materials needed. For Alternative funding quotes we will need the census and health statements (these are also available in a secure link). The EMI form attached is accepted by all carriers.
How soon can I expect my group health quote?
For small employers ACA quotes, expected turnaround is 2-3 business days based on when received and completeness of the census. During Open Enrollment (November to December), turnaround time may be longer as this is the busiest season for group renewals. For Large Employers (Or alternate funding plans) it can take 5-10 business days for underwriting to review and return quotes as these require being submitted directly to the carrier.
Does Stone Hill work with groups outside of Utah?
Yes! We are licensed to sell insurance in all 50 states. Out-of-state quotes can take additional time to generate.
Are there options for groups outside the ACA community Rating?
SHN has many options available to group clients. Many small groups with 10 or more enrolling employees can qualify to be underwritten with pooled or level-funded products, often times at lower premiums and an actual return based on the operating health and claims history of the group.
Stone Hill National can also assist in pairing traditional insurance with gap coverage, which allows group employees to save money on premiums without sacrificing benefits.
Call or email us for more information!

FAQ section

Ancillary

How soon can I expect my group ancillary quotes to be returned to me?
How soon can I expect my group ancillary quotes to be returned to me? Turn- around time is generally 7 business days from date received as most lines of coverage require underwriting and are submitted to the carrier.
What is the difference between contributory and voluntary?
Contributory- The group contributes a percentage to the cost of the premium for the employee.
Voluntary- The group does not contribute any percentage of the premium and it is 100% paid by the employee
What information do I need to provide for an Ancillary quote?
Stone Hill Quote Request Form that has all the required information marked with an asterisk* completed. If the group has current benefits please provide the following: Current Benefit Summary, Current/ Renewal Rates, Current Invoice and if the is a group over 100, carriers will need claims experience.
Does Stone Hill work with groups in multiple states or completely outside of Utah?
Yes, SHN is licensed in all 50 states and work with multiple national ancillary carriers.
FAQ section

New Business

What is the deadline to submit new groups?
Please submit new business to us at least 7 business days before the effective date. Best practice is to submit everything before the 15th ( if this falls on a weekend the last business day before) so we have time to get members their cards before their effective date. Regence requires all new business to be complete by the 15th of the month before the requested effective date. However, we will accept new business up until the last business day of the month for the other medical carriers.
What are the participation requirements?
  • Select Health - 75% with eligible waivers
  • Regence - 75% with eligible waivers
  • UHC - 50% of the group no matter the waivers
  • Aetna - 60% with eligible waivers
  • Humana - No requirement
Some carriers may have additional requirements.
What are the premium contribution requirements?
The employer must contribute at least 50% of the employee-only premium on the lowest-cost plan offered. Some carriers may have additional requirements.
What if my group will not meet participation or contribution requirements?
Most carriers waive these requirements for January 1 effective dates. Please email us in November if your group would like to take advantage of this.
Can I bundle major medical with ancillary products?
Yes! Just let us know!

FAQ section

Servicing

Can Stone Hill help me with servicing (e.g. terminations, adding members, etc.)?
Yes! We can help you with all aspects of your business, from initial installment, servicing, and ending the group contract.
What qualifies as a special enrollment period (SEP) for group members to enroll?
  • Losing qualifying health coverage through no fault of the member (cancelling or not paying your premium does not count)
  • Marriage
  • Having or adopting a baby or child
  • Moving out of your service area
  • There could be other special circumstances, email us with specific questions
Please note: Divorce or turning 26 are not SEPs on their own. The member must have a loss of coverage.
How soon do I have to add a baby to the group plan?
New baby adds are due within 30 days of the birth.

Group Quotes/New Business

David Oberle

Phone: 801-428-1521

Group Quotes/New Business

Amy Roberts

Phone: 801-428-1528

Group Servicing

Stephanie Mora

Phone: 801-428-1511

Group Servicing

Matti Yeomans

Phone: 801-428-1531

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