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Answers to the most common health insurance questions

Tis the season… to shop for Health Insurance! Human Resources professionals are often thought to be Health Insurance experts, but that's unfortunately a little too much for us to put on our plates. So we defer the tough questions and how to choose what plans are best to the specialists. One of those Health Insurance experts in Northern Colorado is Nora Cook of Sage Benefits. Nora has been with Sage for 4 years, and works with individuals, families, and business owners. We were lucky enough to sit down with Nora and have her answer a handful of questions we hear consistently from our clients, and we are happy to share her expertise with you. So without further ado, here's our Q&A session with Nora Cook.

Q: What the heck do the following terms mean?

Premium: The premium is the monthly cost of your health insurance plan.

Copay: A copay is a fixed amount that you pay for certain healthcare services, such as a doctor visit.

Out of Pocket Maximum: This is the most you can pay for medical expenses within a calendar year. If you meet your out of pocket max, you'd be covered at 100% for any additional expenses.

Deductible: For services for which the plan does not offer a copay, you'd need to meet the deductible before the insurance company would start to contribute. For example, if your deductible is $2000, you'd pay that amount before the insurance company would pay a portion of expenses for a something like a surgery.

Q: How do you advise families or individuals choose between a very comprehensive high premium plan or a catastrophic plan with lower premiums?

My recommendations are based upon a variety of factors. We consider the most likely scenario for the upcoming year. The health of the family is important, and whether anyone takes prescriptions regularly. Also, especially if the client is a business owner, it's important to look at whether an HSA might make sense to help lower their taxable income.

Q: Are there any significant changes to Health Insurance anticipated for the 2017 year?

In 2017, group health insurance (a health policy offered through an employer) is going to be hard to ignore. Premiums for group coverage will be equal to or more affordable than individual premiums next year, which hasn't been the case for quite some time. Chiropractic visits, bariatric surgery and fertility treatments have also been added as essential health benefits on all 2017 plans.

Q: For business owners considering forming a "group," what constitutes or defines a group, and what would the savings be to those participating?

To start a group plan, at least 1 employee who receives a W2 must be enrolled on the plan. Owner only and husband-wife only policies are no longer allowed. The cost is often split between the employer and the employee, and both employer and employee contributions to group health insurance premium are tax deductible. If you are able to offer group insurance, this is a great time to explore your options. If you are wondering if this is an option for your business, please reach out to me for a free analysis and quote.

Q: Why are you passionate about working in the benefits field and what can you help small business owners with?

Unlike most brokers, at Sage Benefit Advisors, we don’t just sell health insurance. Our service goes way beyond the sale from annual policy reviews, to claims assistance, enrollment support, and more. I take something complex and make it easy to understand and implement.

Q: Before contacting you to set up a group plan, what can a business owner have prepared to make your meeting most efficient?

It's pretty simple. To prepare quotes I just need minimal business information and the ages of employees and their dependents. Here at Sage Benefit Advisors, we take great care of our clients and walk you through each step in the process.

Q: When not working at Sage Benefits, what do you like to do in your spare time?

I enjoy going out to the awesome restaurants and breweries in Northern CO with family and friends. I also love taking advantage of all the outdoor activities we have including snowboarding, hiking and camping.

Q: How can small business owners contact you to set an appointment?

If you are interested in connecting with me, please give me a call at 970.484.1250 or feel free to book a phone or in person appointment through this link: https://noracook.youcanbook.me/

Nikki Larchar, Nora Cook, Tina Todd

(From left to right, Nikki Larchar, Nora Cook, & Tina Todd)

simplyHR is an HR consulting firm located in Fort Collins, CO providing partnerships to companies in all 50 states. Our goal at simplyHR is to provide training, education, partnership, and resources to make Human Resources simple for small businesses.


The content of this website provides practical and HR best practice information and is not legal advice. simplyHR LLC does not provide legal advice or other professional services. While every effort is made to provide accurate and current information, laws change regularly and may vary depending on the state and/or the municipality your business operates in. The information provided from simplyHR is provided for informational purposes and is not a substitute for legal advice or your professional judgement. You should review applicable federal, state and municipality laws in your jurisdiction and consult with legal counsel as you deem necessary.