Guarino Insurance offers individual/family and small group health insurance through the major carriers in California including Anthem Blue Cross, Blue Shield, Health Net, Aetna, Kaiser and Pacificare (United Healthcare).

Individual and Family Health Insurance

Below are some brief descriptions of the plan types available.

PPOs - (Preferred Provider Organization)
A health care organization composed of physicians, hospitals, or other providers which provides health care services at a reduced fee. A PPO is similar to an HMO (Health Maintenance Organization), but care is paid for as it is received instead of in advance in the form of a scheduled fee. PPOs may also offer more flexibility by allowing for visits to out-of-network professionals (though at a greater expense to the policy holder). Office visits within the network often require only the payment of a small fee. There is often a deductible for major services and tests.  A policy holder will have a primary physician within the network who will handle referrals to specialists that will be covered by the PPO, though it is advised that this be verified by the subscriber when making an appointment. After any visit, the policy holder must submit a claim (unless submitted by the provider's staff, which is typical these days).  The policy holder is responsible for co-payments and may also pay for the services if they haven't met their deductible or are subject to co-insurance.

HMOs - (Health Maintenance Organization)
A group of doctors and other medical professionals offer care through the HMO for a flat monthly rate with no (or small) deductible and nominal office visit co-payments. However, only visits to professionals within the HMO network are covered by the policy. All specialist visits, prescriptions and other care must be authorized first by the HMO in order to be covered. A primary physician within the HMO handles referrals.

HSAs - (Health Savings Account)
The health savings account, or HSA, was created recently by federal legislation. There are two elements to an HSA, a HSA compatible high-deductible health insurance plan and a HSA savings account.  An HSA lets you set aside pre-tax dollars for future medical expenses.  HSA savings account contributions can be invested by the owner.  The HSA bank selected by the HSA account owner has a list of investment options.  These funds are drawn upon for qualified medical expenses.  Unused funds roll over from year to year.

Small Group Health Insurance

Sole Proprietorship Companies

Generally, a sole proprietorship will need at least one active employee in addition to the owner to qualify as a group.  The employee must appear on W-2 payroll reporting form DE-6 (filed with the State of California's Employment Development Department {EDD} each quarter). For many small businesses, this is a difficult hurdle to overcome. If the employee is a family member who is also going to be covered, it may make more sense setting up a partnership. In other cases, if payroll is not handled properly, or the sole proprietorship only uses 1099 independent contractors it will be difficult for the business entity to qualify for guaranteed issue group health insurance.   A copy of the most recent quarterly certified DE-6 filing with the state showing the employee(s) to be covered is often required when applying for group health coverage. 

Partnership Companies

Partnerships have several advantages over other business entities for the purposes of establishing group health insurance for their members. If you do not have another business entity already formed, a partnership may be the least expensive option. The expenses of forming a partnership will include, a city business license, setting up a business checking account, and getting the partnership agreement notarized. 

Many small businesses do not realize, as long as all parties to the partnership appear on all of the required supporting documentation, partnerships avoid having the expense of maintaining payroll, DE-6’s, and W-2’s.  A EIN number from the IRS is still required for a business entity seeking group health insurance.

Limited Liability Companies, LLC's

LLC’s can be formed through the California Secretary of State’s office. An LLC is usually more expensive to establish than a partnership or sole proprietorship. Also an LLC must pay an annual $800 tax to the state of California to remain active. This is a large expense to many of smaller business clients.

Some groups may already have an existing LLC established. LLC’s do not usually have officers like corporations. Instead, they have members similar to partners in a partnership. For insurance purposes, it is best if all prospective partners to be insured in the group plan appear as LLC members.  If they are not listed, then they may be required to be on payroll as a W-2 employee and the most recent calendar quarters DE-6 filing will be required. 

If you do not already have your LLC established, there are some increased costs, and delays associated with establishing an LLC for insurance purposes. The Articles of organization showing all members, stamped and filed with the Secretary of State’s office must be submitted with the group health insurance application. It is not uncommon for new Limited Liability Company’s in California to wait for 2-6 weeks to get back a stamped copy of their filing back from the Secretary of States office.

Also, many businesses choose to form their LLC out of state to avoid paying the franchise tax board the $800 dollar annual tax. For example, you may have your LLC formed as a Delaware company. This adds an additional requirement imposed by the insurance carriers. If your LLC is organized in another state besides California, you must establish a California business address, and get a certificate of good standing from the California Secretary of State’s office before you can qualify for guaranteed issue group health insurance coverage. Again, as with many other transactions handled through the California Secretary of State’s office, to get the certificate of good standing can take as long as 6 week.

To cut down the processing time, there are now many 3rd party vendors available to "walk-in" requests to the Secretary of State’s office in Sacramento.

S-Corporations and C-Corporations

Corporations fall into two catagories, S-Corp's and C-Corps. Most small business prefer to avoid the double taxation of a C-Corp and take advantage of an S-Corp's tax liability pass through.

To qualify your corporation as a bonified group to purchase group health insurance you will need the "Statement of Information" from the state in which the corporation is established. If that state is not California, then you need a letter of good standing on file with the State of California's Secretary of State's Office. You will also need proof of payroll of any W-2 employees (reporting form DE-6).

For more information, and assistance on establishing group health insurance for your company, contact us at 408-248-0909.  You may also want to discuss with your accountant and/or attorney on the best business structure to meet your business needs. We work with companies with up to 50 employees.  In order to get a quote for you, we will need a census of employees, their dates of birth and home zip codes.  We can email or fax a census form upon request.  As an employer, you can reduce employee turnover through increased employee morale simply by adding a group health insurance plan as a benefit for your employees.