Q: I only have 1 employee. Do I still qualify?
A: Yes, as long as they are a documented W-2 employee who is not an owner or a family member of the owner residing in the same home.
Q: I already have coverage for my full-time employees, but not my part time. Can I enroll only my part time employees in the program?
A: Yes. You have the freedom to establish different employee groups within your business. As long as they have not been offered coverage for the last 12 months, they work at least 15.5 hours per week, and the group's median wage is $19.33/hour or less, they are eligible.
Q: I already have existing health coverage for my employees. Can I drop my current health coverage and enroll in HealthShare™?
A: No. HealthShare™ is for small businesses who currently do not offer health coverage. You cannot have offered health coverage for 12 months prior to enrolling in HealthShare™.
Q: I just started a new business. Can I enroll in HealthShare™?
A: Yes, as long as you do not currently have or offer health insurance.
Q: Are employees with pre-existing conditions eligible for the HealthShare™ Program?
A: Yes. There is no pre-screening for pre-existing conditions. HealthShare™'s Care Manager helps members with current health conditions get proper care and education to maintain their health.
Q: What's the catch? How can this be done so inexpensively?
A: There is no catch. HealthShare™ is a unique community based health coverage program that actively coordinates community services to make health coverage affordable. There are only a handful of programs like this throughout the country. Costs for the program are shared by you the employer, the employee, and the community. By keeping the costs within the community and utilizing our local network of providers, HealthShare™ is able to offer affordable health coverage to small businesses.
Q: Am I obligated to cover dependents?
A: Yes. However, you are not required to contribute towards the dependents' monthly cost. You may contribute any amount or percent if you choose, but if you do for one employee's dependents, then you must for all.
Q: Will you collect the monthly costs from my employees?
A: No. It is the employer's responsibility to collect monthly costs from employees. Payments are due on the 15th of the month prior to the month of coverage. (Example: Payment for December 1st coverage is due by November 15th.
Q: Is hospitalization and emergency care covered?
A: Yes. HealthShare™ is designed to provide hospitalization and ER services when appropriate. However, part of what makes HealthShare™ affordable is utilization of preventive care. Each member will be required to choose a primary care provider and we encourage members to become active participants in their healthcare through our Wellness Option.
Q: Does HealthShare™ offer prescription coverage?
A: Yes. Like most prescription plans, HealthShare™ has a listing of covered drugs (generic and branded) with varying co-pays. HealthShare™ will pay up to $3000 per person/per year for prescriptions for those enrolled in the Wellness Option and $2000 per person/per year for those who choose the Standard Option.
Q: Will HealthShare™ cover pregnancy?
A: HealthShare™ will work with your employees to find programs they are eligible for. In the case of pregnancy, it is usually more cost effective for the employee to utilize a state funded program. If you have an employee that is pregnant, or becomes pregnant, we will work with them to attain the best care available and assist them to enroll in available programs. Once they no longer qualify for the state programs, they can return to utilizing the HealthShare™ program.
Q: If I or my employees enroll in the Wellness Option, do we absolutely have to participate in educational wellness courses?
A: Yes. However, it is the member's choice to enroll in either the Standard or Wellness Option. The Standard Option does not require members to meet with HealthShare™'s Care Manager or participate in wellness courses. (2 wellness courses/year). HealthShare™ will provide your employees with listings of courses offered on the HealthShare™ website. Most courses are 1 hour and free.
Q: What if I am out of the Duluth area and need to utilize medical services. Will HealthShare™ cover the costs?
A: No. All members enrolled in the HealthShare™ Program must utilize the services of local participating providers to have the service paid for. Please see the participating provider list.
Q: What if my primary physician is based in Duluth, but they are available at a different location outside of Duluth (satellite clinic). Will my services still be covered?
A: No. Only participating physicians located in Carlton, Cook, Lake or St. Louis counties are covered. Any services outside of these four counties will not be covered. Please see the participating provider list.
Q: Can I offer to pay the employee portion of HealthShare™ coverage?
A: Yes. You can pay the employee portion, however if you offer to pay for one employee, you must offer to pay for all employees within that group.
Q: If I offer my employee's HealthShare™ coverage, do they all have to enroll for my business to be eligible?
A: No. Only those employees interested and eligible can participate in the HealthShare™ Program. However, if an existing employee declines coverage, they will need to wait 30 days after the one year anniversary of the date upon which he or she declined participation in HealthShare™ before they can opt to enroll again.
Q: What if I have an employee that carries their own private health insurance. Can they discontinue their private insurance and enroll in HealthShare™?
A: No, employees cannot drop health insurance to enroll in HealthShare™. HealthShare™ was created to provide health coverage to people who have no health insurance. State rules prohibit HealthShare™ from enrolling people who have dropped coverage in order to qualify for HealthShare™. However, there are a few exception to this rule which include:
1. Loss of insurance coverage through no fault of their own (aka: Qualifying Event or Life Change)
2. COBRA Continuation Coverage may be dropped to enroll in HealthShare™.
3. Individual Catastrophic Policies may be carried in addition to HealthShare™ coverage. HealthShare™ defines an Individual Catastrophic Policy as a policy purchased and maintained by an individual, not through an employer, that has deductible limits equal to or in excess of $3,000 for an individual and $5,000 for families and does NOT provide for preventative care, office visits, or pharmacy benefits.
Q: Once I enter into an agreement with HealthShare™, how long am I obligated to participate in the program?
A: The initial term of the agreement is one year commencing on the effective date of coverage. If you decide to not renew, you must notify HealthShare™ 30 days prior to the one year anniversary of your coverage taking effect. Example: if you coverage became effective on December 1, 2008, you must notify HealthShare™ by November 1, 2009 that you wish to discontinue coverage. See employer contract for further details if there is a change in business ownership.
Q: What if I terminate an employee or they quit?
A: Notice of any change in covered employee's status must be received by HealthShare™ no later than the 5th day of the month preceding the following month's coverage. Example: If an employee quits on November 1st, the employer must notify HealthShare™ by November 5th to avoid being charged for December.
Q: What if I have an employee that dropped their health coverage less than 12 months ago, (private, state or federally funded) because they either could not afford their private coverage, or they no longer qualify for coverage funded by the state. Do they qualify for HealthShare™?
A: Yes. As long as they are uninsured at the time of application and enrollment in HealthShare™, they qualify. There are no time limits placed on individuals. However, if an individual is insured at the time of application and enrollment in HealthShare™, they cannot drop their current coverage to enroll in HealthShare™. HealthShare™ is specifically designed for individuals that are currently uninsured. See above for details regarding re-enrollment in HealthShare™ at the one year anniversary date.
Q: Can I or my employees have pre-tax dollars deducted to pay for HealthShare™ coverage?
A: Yes. Consult with your HealthShare™ Employer Representative for guidance on how to accomplish this.
Q: If I have an employee that is covered by their spouse, can they drop that coverage and enroll in HealthShare™?
A: Yes. This is one of the only times a person may drop existing coverage to enroll in HealthShare.
Q: What if I have an employee that is injured at work. Will HealthShare™ cover the costs?
A: No. Workers Compensation will need to be utilized to cover any medical costs for injuries occurring at work.
Q: Can domestic partners qualify as dependents under the HealthShare™ Program?
A: No. Only spouses and children qualify as covered dependents under the HealthShare™ Program.