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Apply for health benefits

Note: Depending on the size of your company, you may not meet carrier underwriting requirements to apply for a group plan. If this is the case, you’ll see a message directing you to contact us for more information.

To apply for new health benefits, follow these steps:

  1. Click the Benefits tab.
  2. In the Add Benefits section, click Get Started in Health Benefits tile.
  3. Select whether or not you have existing benefits.
  4. If you have already have benefits and you’d like to transfer your broker of record, visit this article for help.
  5. If you are setting up health insurance for the first time, click Learn More.
  6. If you are trying to set up deductions for your existing external benefits, click Just Set Up Payroll Deductions.
  7. The following page will give you an estimated cost based on your company’s demographics. When you’re ready to move on, click Let's Get Started.
  8. Set the employment status of each person on your team. If they're eligible for benefits, this status will trigger the system to administer benefits to the employees. If you have any owners who aren’t on payroll but need to enroll, click +Add Owner, then click Save & Continue.
  9. Click Add Plans to begin selecting the medical plans you’d like to offer your team. The following page will give you educational information about metal tiers. When you’re ready to move forward, click Start Choosing Plans.
  10. Select the tier that you’d like to use when you choose your base plan. We’ll recommend a tier based on your company’s demographics, but you’re free to choose any option. If you need more information about choosing your tier, click Learn more about the tiers and how to pick one. Once you’ve decided, click Next: Choose a Base Plan.
  11. You’ll find several plans with your selected tier on the following page. Each plan is offered by a different carrier. Once you’ve chosen your medical plan, click Save & Choose More Plans. Follow the same steps to choose dental and vision plans or leave them blank if you only want to offer medical. There is plenty of educational information offered on this page as well so you can feel confident in your choice. Follow this guide below to learn more about your plan options:
  12. Why this plan?: Click on this arrow and information that is unique to that plan will appear below.
  13. Doctor Visits: Click on this arrow and a table of employee out-of-pocket costs will appear for different types of doctor visits.
  14. Facilities: Click on this arrow and a table of employee out-of-pocket costs will appear for different types of medical facilities and services.
  15. View full details: If you’re interested in reading the Summary of Benefits and Coverage (SBC), this will provide a carrier-generated PDF which includes the fine print of each plan.  Learn how to read SBCs from our Help Center.
  16. ?: Hover over the question marks for glossary definitions of the words they appear beside.
  17.  The next step will ask some additional questions about your company. When you're finished with the questions explained below, click Save & Continue.
  18. New Hires: Select your waiting period which will apply to all newly hired employees who are eligible for benefits from the dropdown menu. Then let us know if you expect to be hiring anyone else before your benefits start so we can keep track of your team as we prepare your open enrollment.
  19. Company Information: Let us know if you have an active workers' compensation policy. If not, get a new policy as soon as possible. If your company files taxes as an S-corp, please indicate that in this section so we can keep your 2% shareholders compliant by taxing them properly. Lastly, your company must be registered with the Secretary of State to be approved for group health insurance. Please check your status to make sure that you've completed that step.
  20. Employed Shareholders:As mentioned above, 2% shareholders have different tax implications than normal employees. If you haven't already, please make sure to designate them here. You have two options for contributing to 2% shareholder-employees' health insurance. Companies can pay for the entire premium for all lines of coverage, including their dependents, or the shareholder can be subject to the company's standard contribution scheme but will pay for insurance with post-tax dollars. If you have questions about how you should set this up, please contact your accountant.
  21. Review your selections on the next page. There will be an estimated company cost of premiums based on your eligible employees, but this doesn't include dependents that your team might enroll during open enrollment. Once you've confirmed your information and you're happy with your benefits package, click Apply for Benefits & Continue.
  22. Note: Once you click Apply for Benefits & Continue, you will not be able to change your selections online. Once submitted, we’ll need to review it before we send it to the carrier for final approval. There is no guarantee that the carrier will approve your application.
  23. The last page will require you to upload a few documents to prove your eligibility. These documents are required when we submit your application to the carrier, so make sure you upload them as soon as possible, but by the deadline provided so we can get your team covered.
  24. Click Upload beside each required document.
  25. Once you’ve uploaded all three, click Submit Documents.

Questions & Answers

Q: I’ve confirmed my benefits package.  What happens next?

A: You’ll get an email summarizing your health benefit selections. We'll contact you in the next few days to verify your information, set up open enrollment dates, and prepare your application to submit to your health insurance carrier. Shortly before open enrollment, we'll reach out to your eligible employees via email to help them enroll in health benefits. If your employees have any questions in the meantime, they can contact us at (415) 918-2371.

Q: Some of my employees have existing coverage that they want to cancel when they join our group coverage.  When can they do that?

A: Because we can't guarantee when or if coverage will be formally approved by a carrier, we always suggest waiting to cancel coverage until we have the formal approval letter in hand. We’ll update you as soon as we have that so your employees can cancel their old coverage then. In the event that the requested effective date is pushed back by the carrier, we don't want your employees to have a lapse in coverage.

Q: Why did I receive a bill? I thought Gusto was taking care of my premiums for me.
A: The first premium payment is submitted with group application, but subsequent payments must be made by the group. Gusto automatically takes payroll deductions from employees, but those deductions remain in your company account so you can pay the carrier in full. Find out how to pay your invoice from our Help Center. There will also be contact information for the billing department of your health insurance company on the invoice. Reach out to the carrier directly if you have questions about paying your bill.

Q: I don't want to enroll. Why do I need to waive benefits in my Gusto account?
A: The Affordable Care Act requires that all full-time eligible employees either enroll in benefits offered to them or sign a waiver to decline benefits. This helps your group be compliant.