Utah Group Health Insurance Options for Owners and Employees of Utah Businesses

What is group health insurance?

Group insurance is insurance specifically designed to cover groups of business owners and their employees.

How group health insurance works in Utah

Utah is a unique state when it comes to group insurance. Insurance company options include local insurers such as; Regence Blue Cross Blue Shield of Utah, Altius Health Plans, and SelectHealth, and national insurers such as; Humana and United Healthcare. The Utah market is full of plan options for Utah employers.

Does my business qualify for group health insurance in Utah?

Businesses in Utah typically qualify for a group plan if they meet the following conditions:

  • They employ two or more employees (paid on a W-2)
  • Their business is based in the state of Utah
  • The majority of their employees are based in Utah
  • The employees to be covered work at least 30 hours per week
  • The employees to be covered are permanent and non-seasonal

If a Utah employer group meets these basic requirements, they should qualify for a group health plan.

There are two markets for group health plans

  1. The traditional market offers employees and owners the ability to choose from one or more plans offered by the same insurance company (depending on the size of the group). In Utah, the employer is typically required to pay at least 50{b8199d4e76d5c4c4a9fa89ec04f495f77a40e6e04d2b7b455e3b26e8fd6a6d2e} of the employee’s monthly (not including spouses, children, or other dependents.)
  2. The defined contribution market offers each employee the ability to choose their own specific plan from the insurance company of their choice. In addition, this market allows the employer to pay a predetermined dollar amount toward each employee’s monthly plan premium.

There are advantages to both markets. It’s worth discussing both options with a local insurance agent.

Applying for group health insurance in Utah

In the state of Utah, employer groups cannot be denied coverage due to current health conditions or the health history of the group. However, the state of Utah allows health insurance companies to raise their published health insurance rates from 0{b8199d4e76d5c4c4a9fa89ec04f495f77a40e6e04d2b7b455e3b26e8fd6a6d2e} to 85{b8199d4e76d5c4c4a9fa89ec04f495f77a40e6e04d2b7b455e3b26e8fd6a6d2e} to cover the existing risk in any group.

When a group applies for a health plan in Utah, they submit the following documents:

  • A group master application
  • Their most recent quarterly wage list, as filed with the Department of Workforce Services
  • A copy of their current health insurance benefits (if previous coverage existed)
  • Applications or waivers (opting out of coverage) for each eligible employee

Businesses that are just opening their doors are required to provide different documentation, such as articles of incorporation and a promissory letter agreeing to submit their first quarterly tax and wage list when it becomes available.

Once submitted, the insurance company reviews the application and determines the group’s rate structure. If the group accepts the rates, the plan is enrolled and the coverage begins on the chosen effective date.

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