Apply for health benefits
When you’ve decided to offer health insurance to your team, we’ll help you get started. If you have questions at any point, our contact information is at the bottom of each page.
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, we'll let you know and one of our benefits advisors will reach out to you to discuss your options.
Follow these steps:
- Click the Benefits tab.
- Click +Add below Health Benefits.
- Select whether or not you have existing benefits. If you have benefits and you’d like to transfer your broker of record, visit this article for help. If you are setting up health insurance for the first time, check the box that says “No — we want to offer new benefits” and click Next.
- 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.
- Check the boxes next to the names of employees who are eligible to enroll in your new benefits. Anyone who works 30+ hours per week on average is eligible. Make sure to include them, even if they plan on waiving coverage. If you have any owners who aren’t on payroll but need to enroll, click +Add Owner, then click Save & Continue.
- 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.
- 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.
- 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:
- Why this plan?: Click on this arrow and information that is unique to that plan will appear below.
- Doctor Visits: Click on this arrow and a table of employee out-of-pocket costs will appear for different types of doctor visits.
- Facilities: Click on this arrow and a table of employee out-of-pocket costs will appear for different types of medical facilities and services.
- 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.
- ?: Hover over the question marks for glossary definitions of the words they appear beside.
Note: Once you submit your application, 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.
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.