Justworks partners with Aetna for nationwide coverage for health, dental, and vision insurance.

FAQs for Employers

Am I required to offer access to health insurance to my employees?

Once your company has 50 employees working at least 30 hours a week, you’ll be required to offer benefits.

When can I decide to offer access to health insurance to my employees?

With Justworks, you can set up access to health insurance for your team at any time. Once you set up the plan, your employees will be presented with an enrollment opportunity during which they'll be able to sign up for benefits.

Benefits for employees will begin on the first of the month following their date of hire or eligibility date. For example, if a full-time employee begins on June 15, their benefits will start on July 1. If a full-time employee begins on July 1, their benefits will start on August 1.

I’m an employer selecting plans to offer my employees. How do I select plans?

Reach out to your Account Manager or support@justworks.com to learn more about our plans and how you can make a selection on what you’d like to offer your employees.

What is the minimum I am required to cover for health insurance?

Companies are required to pay a minimum of at least 50% of the least expensive plan they offer to employees.

Am I required to contribute any amount for dental insurance? 

Companies are required to pay a minimum of at least 50% of the least expensive plan they offer to employees for dental coverage.

Am I required to contribute any amount for vision insurance?

No, companies are not required to contribute towards vision plans.

How can I see the total health insurance costs for my company?

You can see the total monthly cost of your health insurance by navigating to “Benefits” on the left navigation bar. Here, you’ll be able to see the total costs to both your company and your employees.

How does insurance billing work?

Great question. We actually have an article all about this and you can find it here.

I got billed for more than I cover for health insurance. What happened?

Justworks will bill your company the entire premium one month prior to coverage. This occurs on the first billing cycle of the month. Your employees will then pay back their portion during the actual month of coverage. You can learn more about how insurance billing works here.

Why are medical plans offered in groups?

Justworks provides access to medical plans in predetermined groups in order to make great options available to employees without overwhelming them. All Justworks plans cover the same set of conditions, treatments, and facilities. They differ in the amount of coverage for each item, the networks they offer access to, and how costs are divided among premium, copays, and coinsurance. Each group offers a diverse set of a options within a given price range, allowing employers to take great care of their teams within their budget.

FAQs for Employees

What is open enrollment and how does it affect me?

Open enrollment is the designated time each year when you can enroll in benefits. This period is based on when your company offers benefits to your team. Employees have two open enrollment opportunity each year: 1) when they join the company and can select their initial plan and 2) when the company’s Aetna policy renews in November. Unless a qualifying event occurs, open enrollment is the only time an employee can enroll in benefits.

What is a qualifying life event?

A qualifying life event is a time when employee can enroll in benefits outside of open enrollment. A qualifying life event would include one of the following situations: 1) marriage / domestic partnership, 2) divorce or separation, 3) birth or adoption of a child, 4) loss of previous coverage, 5) moving (this is not a guaranteed event, please contact support@justworks.com for more information on what qualifies).

When you have a qualifying life event, you can make updates to your benefits coverage by submitting proof of the QLE within 31 days of the event.

I want to add a dependent to my coverage. How can I do that?

Dependents must be added to your plan during open enrollment unless there is a qualifying event. If a qualifying event does occur, simply navigate to your Benefits and select the “Change coverage” button to signal that you need to add a dependent to your plan.

I want to change my plan selection. How can I do that?

You can change your plan if you’re still in open enrollment or if you have a qualifying life event. In either of these cases, navigate to your Benefits and select “Change coverage”.

I missed my open enrollment period, but now would like to enroll. Can I sign-up at any time?

You can only enroll in benefits during open enrollment or if you have a qualifying life event, otherwise you’ll need to wait until the next open enrollment period.

I want to cancel my coverage. How can I do that?

In order to cancel your benefits outside of the open enrollment time, you will need a qualifying life event.

I have to file a claim with Aetna. How can I get started?

You can file a claim directly through your Aetna profile. Navigate to aetna.com and register an account. From there, you can click “claims” or “Ask Ann” to get more information. When filing a claim with Aetna, you can use the Justworks mailing address in order to expedite claims.

Justworks

130 7th avenue #249

New York, NY 10011

How can I find out if my doctor is available on aetna?

You can check this on Aetna’s website. Here are step by step instructions on how to do so:

  1. Visit aetna.com and click on the “Individuals and Families” tab at the top of the screen.
  2. Under Why Choose Us, select “Find a Doctor.”
  3. Under the “Start your search” section, select “Search our public directory”
  4. Select “A plan offered by my employer or organization (includes small group plans purchased on exchange in Maryland, Delaware, and District of Columbia).”
  5. Enter your doctor’s full name, and if possible, the zip code of the location where you normally see them.
  6. From the dropdown of plans, you can select either “Elect Choice EPO” or “Managed Choice POS,” depending on the plan you are enrolled or hope to be enrolled in.

The results will show you whether a doctor is currently accepting Aetna. If for any reason you cannot find your doctor, please feel free to reach out to us at support@justworks.com. Alternatively, you can also reach out to your provider directly.

How can I best reach Aetna?

You can reach out to Aetna Member Services at the following numbers:

Aetna Medical / Vision - 1-800-704-7287

Aetna Dental - 1-877-238-6200

Aetna Pharmacy - 1-888-792-3862

How can I learn of the details of my plan?

To learn more about your plan, navigate to Benefits on the left navigation bar. From there, you’ll be able to see your various plans (medical, dental, vision, etc) and you can click “view plans” to find more details on each plan.

Where can I see my Aetna ID?

Directly in your Justworks account. Your Aetna ID is prominently displayed in your Benefits center.

How do I find out how much I’m paying for health insurance each month?

To find your monthly insurance cost, navigate to your Benefits. You’ll then be presented with each benefit for which you’re enrolled as well as each monthly cost.

Can I make changes to my coverage throughout the year?

Once you select a plan and coverage begins, you cannot make changes unless it is due to a qualifying life event occurs. 

I did not get an opportunity to enroll in health insurance, but I think I’m eligible. What do I do?

If you believe your company should be offering you benefits, give us a call or email support@justworks.com. We’ll do what we can to make sure you’re all set and covered.

What are eligibility requirements for health insurance?

An employee must be classified as “full-time” or “part-time” working 30+ hours in order to be eligible for health insurance in Justworks. Contractors are not eligible for health insurance.

When will I have a chance to change my plan selection?

You can change your plan if you have a qualifying life event or when open enrollment occurs for your company.

What is an out of pocket maximum?

An out of pocket maximum is the most you’d pay for services in a year.

What is co-insurance?

Co-insurance is the percentage of health insurance expenses you pay after you’ve met your deductible.

What is a deductible?

A deductible is the amount you must spend before your insurance begins to pay claims. Member cost sharing for certain services, as indicated in the plan, are excluded from charges to meet the deductible. Pharmacy expenses do not apply towards your deductible.

What is a co-pay?

A co-pay is the amount you’ll pay at a doctor’s visit after you’ve met your deductible.

Disclaimer

This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.

5194bbb68780b2513b9ef8f6f7614015@justworks.desk-mail.com
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