Group Quote Questions for California
Q: I just printed out a group health insurance quote from your website, but I do not understand lots of these things. I have a small business with only 6 employees in California. What does OOP and OOP Fam mean? What does it mean where it says RAF for 6-50 life group is .90? Under the quote prices with the names of each employee, it has EE Cont and ER Cont, what are those totals from?
A: You must have printed these group health quotes from a different website. We are an consumer directory and resource website, but do not provide online quotes or sell health insurance directly through our agency. We provided you with links to many other websites, some of which provide online quotes. So, you probably received the quotes from one of the websites listed on our California small business health insurance directory. However, we can help you define the parts of the quote that are confusing for you.
OOP refers to “out-of-pocket” maximum. This is the maximum coinsurance per year, per person. Once you have reached this amount, you are covered in full for the remainder of the year. OOP Fam is the “out-of-pocket” maximum for a family, which is usually twice the out-of-pocket maximum for a single person. Once two family members reach this amount in coinsurance, all family members are covered in full for the remainder of the calendar year. RAF stands for rate adjustment factor. The .90 references a percentage of the standard premium as 90%. This means that the rates that are displayed on the quote are calculated at 90% of the standard rate because your company has 6 or more employees on the quote. This is not a guarantee of what your rates will actually be. The final decision on your rate is made by the insurance company. This is just the best possible rate for your group.
EE Cont means employee contribution. That is the amount of the premium that the employee is responsible for paying. ER Cont displays that employer’s portion of that employee’s premium. Somewhere on the quote you should see a percentage that is associated with the employer contribution. In California, the employer must pay at least 50% of the employee only premium. Further questions regarding your group health insurance quote should be directed to the broker that produced this quote for you. They will have a copy for reference. You should find their name and phone number somewhere on the printed quote. You probably also received an email from them, also providing you the option to contact them directly with questions about the quote.
I did not get an email because I used a fake email address. I do not see any contact information on this quote.
Comment by Brad — December 13, 2006 @ 9:54 am
We would have no way of tracking which site you visited to get your quote. Try looking at the bottom of your print out. It might reference a website address. If that does not work, here is a link to the California Group Health Insurance directory. Perhaps you can recognize the listing.
Comment by admin — December 13, 2006 @ 9:56 am