Offer health benefits to your team

Gusto currently supports the following benefits in the following states. 

Supported benefits	Supported states
Medical insurance Dental insurance Vision insurance Employer-paid life insurance Short-term disability insurance Long-term disability insurance Health flexible spending account (FSA) Dependent care flexible spending account (DCFSA) Health savings account (HSA) Commuter benefits	Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico New York North Carolina Oklahoma Ohio Oregon Pennsylvania South Carolina Tennessee Texas Utah Vermont Virginia Washington Washington D.C. Wisconsin

 

Admins can add new lines of coverage anytime in Gusto. If you want to offer dental, vision, life, or disability insurance, you must first offer Gusto-brokered medical coverage.

Step 1: Get started 

You can start reviewing plans and quotes right from Gusto.

1. Sign in to your admin account.
2. Go to the Benefits section. 
3. Click Medical, Dental & Vision.  
   • You must offer medical benefits through Gusto in order to offer any other lines of coverage. 
4. Choose No, we want to offer new benefits, then click Next.
   • If you already offer benefits, click Yes — we currently offer this benefit. You’ll be able to integrate your current benefits with Gusto on the following page. 
5. Click See Price Quotes.

Step 2: Tell us about your team

In order to generate quotes, let us know who will be eligible for benefits.

1. Decide whether you're offering benefits to all full time employees, or to all full time and part time employees. The ACA defines a full time employee as anyone working 30+ hours/week.
   
   • If you want to offer benefits to all part time employees: click edit next to "Employees eligible for benefits."
2. Under "Employment status," select each employee's status. 
3. Next, tell us about your company's owners:
   • If there are owners or officers in your company who aren’t on payroll but may want to enroll in benefits, click Add an owner. We'll create an employee account for them so they can participate in open enrollment.
   • Indicate whether any employees listed above are owners in the company. If yes, select them from the list below.
   • Let us know if your company has any employees who are married to an owner (and are not an owner themselves). 
4. Click Save & continue. 

Step 3: Build your benefits package

After you choose medical plans, you can view quotes for dental, vision, life, and disability coverage. We partner with multiple nationwide carriers and our licensed benefits advisors are available to help you select the best options for your team. You'll also have the option to offer tax-advantaged benefits like a Health Savings Account, Flexible Spending Account, and commuter benefits. 

1. Take a look at the "Coverage start date." This is the earliest start date available based on the insurance carriers' application deadlines.
2. On the Medical tile, click See Plans.
3. Click Start Choosing Plans.
4. Select your preferred metal tier. On the next page we'll recommend options in this tier from different carriers.
   • Here's a guide to understanding the differences between the metal tiers.
   • The monthly "Cost to Company" is based on the company contribution that you can adjust above the tier information—click edit if you want to change it. 
5. Click Next: Choose a Base Plan. 
6. Review the plan options and premiums to choose your base plan. 
   • To adjust the company contribution, click edit under "Your company information." 
   • To help you predict costs, under "Eligible employees" you can add the number of eligible employees, business owners, and dependents that your team might have.
   • Click View full details to review the Summary of Benefits and Coverage (SBC) of each plan. Check out our guide to reading an SBC.
7. When you’ve found a base plan you like, click Choose this plan. 
8. Click Save & Choose More Plans.
9. Decide if you want to offer more metal tiers to your team. Click Remove plan or Add this plan to make changes.
   • Having a base plan means your company costs will stay the same regardless of which plans your employees enroll in. For example: you chose the Silver tier for your base plan and set the company contribution as 75%. If an employee enrolls in the higher-cost Gold plan, the company will only pay 75% of what their Silver premium would be, and the employee will pay the difference. If an employee enrolls in a Bronze plan, the company contribution of 75% of their Silver premium will go further toward the lower-cost Bronze premium. 
10. Click Save & continue.
    • On the next page, scroll to Download employee cost breakdown for a PDF with employee and company costs for each plan you chose. 
11. To see quotes for other benefits, click Add Plan for the coverage you're interested in.
12. When you're finished selecting plans, click Save & continue.

Step 4: Add company info

Next,  you'll choose a waiting period and provide some more company information for your application. 

1. Select the waiting period for new hires. 
   • The drop-down includes every option that your carrier offers.
2. Choose if you want to waive the waiting period for this open enrollment period.
   • Selecting "Yes" means that if there are any recent hires, they can enroll in the new coverage at the same time as the rest of your team. 
3. Indicate if you have worker’s compensation insurance. If you don’t, click here to start one. 
4. Identify whether your company files taxes as an S-Corporation. 
   • If yes, select if you want to enable 100% company contributions for the premiums of 2%+ shareholders and their dependents. This setting is available because there are tax implications for S-Corp shareholders' benefit premiums. Contact your accountant for advice. 
5. Let us know the status of your company under your state’s Secretary of State.
6. Select the date that your business was established.
7. Click Save & continue. 

Step 5: Review and sign forms

1. Review your entire benefits package to make sure you’ve selected the right offering for your team.
2. Click Submit plan selections. Once you submit the application, you will not be able to change your selections. 
3. Click Sign Form beside each document listed.
4. Click Submit Documents.

Our team will review your application and reach out to you with next steps. You’ll be partnered with a specialist to help your team through open enrollment and take care of all the paperwork behind the scenes. Keep an eye on your email as the insurance carriers may request additional info to process your application. 

Note: There's no guarantee the insurance carriers will approve your application, but we’ll keep you posted throughout the process.

Submit documents

If the carriers request more info, we'll email you and you’ll also see a red alert in the Benefits section of your account. Click View documents to see what’s needed.

Upload or resubmit required documents

1. Click Upload document.
2. Click Select File to upload the document, or drag and drop your file.
   • You can upload a .jpeg, .jpg, or .png up to a maximum file size of 20 MB.
3. Click Upload.

Document upload status definitions

• Requested: We’re waiting on you to upload the document.
• Pending review: We’re taking a look to make sure the document meets the carrier’s requirements.
• Accepted: The document is good to go.
• Rejected: The document doesn’t meet the carrier’s requirements. Take a look at the notes and re-submit. 

Once you offer benefits with Gusto, here are a few things to know about your benefits management going forward.

Check your mailbox for your ID card

The insurance carriers send ID cards directly to each enrolled person. They typically arrive 7-10 business days after the benefits start date, though some carriers take longer. Head here for other options to find ID numbers and what to do if you need to go to the doctor before your card arrives. 

Pay your carriers on time

Pay your invoice directly to your insurance carrier(s). Gusto does not make invoice payments on your behalf. Read about how the funds move with payroll deductions and check out our carrier-specific steps to pay your carrier. 

Gusto handles all of your enrollments and deductions

All you need to do is keep your teams' employment details up to date in Gusto. Whenever you make changes (such as hiring and dismissing employees, or changing them from part time to full time), Gusto automatically takes care of their benefits and payroll deduction changes. What to expect:

• New hires: After their new hire waiting period is complete, Gusto emails eligible new hires when it's time to sign in to their account and enroll in benefits. You can estimate your new hire's benefits cost even before their coverage starts. 
• Employment changes: If someone's employment changes, be sure to update their employment status. If they're newly eligible for benefits (e.g. if you change their status from part time to full time), they're invited to enroll in coverage after their benefits waiting period is complete. If the change makes them ineligible for benefits (e.g. they went from full time to part time), Gusto lets the carrier know to remove them from coverage. Read more on eligibility here.
• Class changes: If you offer different company contributions to different types of employees, and an employee changes classes, update their class in Gusto:
  • Go to the Team members section and choose the employee.
  • Then go to their Job & pay tab.
  • Under "Employment status," click Edit to set or change their class.
    • If this changes the company contribution they can receive, we'll send them an email with next steps to make any plan changes, if desired.
    • If their class changes from a benefits-eligible class to a benefits-ineligible class, their coverage will be canceled.
    • If they're newly benefits eligible with this change, we'll email them inviting them to enroll if desired. 
• Dismissals: When you dismiss an employee, their benefits are terminated and we'll send them COBRA information. Here’s more info on termination payrolls and how final deductions work.
• Qualifying life events: If an employee experiences a life event that qualifies them to change their coverage, they can submit enrollment changes in Gusto. They must submit their request within 30 days of the event.

Find benefit information

To find details about your company benefits package, download a Summary of Benefits, add new lines of coverage, or view deductions, contributions, enrollment, and more, head to the Benefits section of your admin account.

For questions about claims and coverage, contact your carrier directly.

When to expect renewal and open enrollment 

When your company benefits are up for renewal (a year after they begin), Gusto will reach out to you to understand how the plans worked for you and help you choose your benefits package for the next year. Then we'll run a new open enrollment for your team.