Frequently Asked Questions
Group Benefits
1. How is Zenith Benefit different from a traditional broker or a PEO?
We act as your company’s "Culture Architects." We bridge the gap between the two models by providing the dedicated, personalized strategy of a traditional broker alongside the premium, large-scale benefits usually only accessible through a Professional Employer Organization (PEO). You get tailored guidance without sacrificing elite group perks.
2. How do you help midsize businesses manage rising healthcare costs?
We don't just shop for the cheapest spreadsheet; we architect sustainable long-term strategies. By leveraging our vast carrier networks and PEO-level perks, we identify creative funding solutions, alternative plan designs, and gap strategies that control your bottom line while keeping your benefits package highly competitive for recruiting.
3. Will you help our HR team with the day-to-day administration?
Absolutely. We know HR teams at growing companies wear many hats. We act as a direct extension of your team, handling everything from streamlining open enrollment and conducting employee education to managing complex claims and carrier communications.
4. Are we locked into rigid group plans, or can we customize our offerings?
Customization is our specialty. We don't believe in one-size-fits-all. We conduct a comprehensive workforce assessment to build a custom portfolio—including health, dental, vision, life, and wellness perks—that perfectly reflects your unique company culture and appeals to your specific employee demographics.
5. How do you help us stay compliant with changing healthcare laws?
Staying compliant with ACA, ERISA, and state regulations is a major burden for growing businesses. As your dedicated partner, we provide proactive compliance reviews, regulatory updates, and strategic guidance to keep your business protected, penalty-free, and ahead of the curve.
6. How do you support our employees when they have claims or billing issues?
Your employees shouldn't have to battle endless 1-800 numbers during a medical crisis. We provide dedicated, hands-on advocacy for your team. When an employee faces a complex claim or billing dispute, we step in to resolve it directly with the carrier, ensuring they feel supported in the moments that matter most.
Individuals & Families
1. Can I get health insurance outside of the annual Open Enrollment Period?
Yes, if you experience a qualifying life event—such as losing job-based coverage, getting married, having a baby, or moving—you qualify for a Special Enrollment Period (SEP), typically giving you 60 days to select a plan.
2. How do I know if I qualify for a subsidy or tax credit?
Eligibility for Advanced Premium Tax Credits (APTC) depends on your household income and size relative to the federal poverty level. We evaluate your situation during consultation to ensure you receive any financial assistance you qualify for.
3. What is the difference between a deductible, copay, and coinsurance?
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Deductible: The amount you pay out-of-pocket for covered healthcare services before your insurance starts to pay.
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Copay: A fixed flat fee you pay for a specific service (e.g., $30 for a primary care visit).
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Coinsurance: Your percentage share of the costs of a covered healthcare service after meeting your deductible (e.g., 80% covered by insurance, 20% by you).
Medicare
1. When should I start applying for Medicare?
Your Initial Enrollment Period (IEP) spans 7 months: 3 months before the month you turn 65, the month you turn 65, and 3 months after. Enrolling on time prevents late-enrollment penalties for Parts B and D.
2. What is the difference between Medicare Supplement (Medigap) and Medicare Advantage?
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Medigap: Works alongside Original Medicare (Parts A & B) to pay out-of-pocket costs like copays and deductibles.
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Medicare Advantage (Part C): An all-in-one alternative bundled through private insurers that replaces Original Medicare and often includes drug, dental, and vision coverage.
3. Can I keep my personal doctor if I transition to Medicare?
With Original Medicare and Medigap, you can see any doctor nationwide who accepts Medicare. With Medicare Advantage, coverage depends on whether your doctor participates in that specific plan's network (HMO or PPO).
Life Insurance
1. How do Term Life and Permanent Life Insurance differ?
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Term Life: Provides coverage for a specific period (e.g., 10, 20, or 30 years) with fixed payments, offering straightforward protection at a lower cost.
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Permanent Life (Whole/Universal): Covers you for your entire lifetime and includes a cash value savings component that grows over time.
2. How much life insurance coverage do I actually need?
A common benchmark is 10 to 12 times your annual income. However, exact needs depend on outstanding debt (like a mortgage), income replacement goals, family size, and future education expenses.
Dental & Vision
1. Do standalone Dental and Vision plans cover pre-existing conditions or major procedures immediately?
Preventive services (cleanings, routine eye exams) are typically covered right away. Major dental procedures (crowns, bridges, oral surgery) may have a waiting period (often 6 to 12 months) unless you had prior continuous dental coverage.
2. Can Dental and Vision plans be offered as voluntary benefits for employees?
Yes. Employers can offer dental and vision coverage as voluntary (100% employee-paid) or employer-sponsored benefits, giving staff access to lower group rates at little to no cost to the company.
Ancillary Products
1. What are ancillary benefits, and why should a company offer them?
Ancillary benefits are supplemental coverages—such as Short-Term/Long-Term Disability, Critical Illness, Accident, and Hospital Indemnity insurance. They protect employees against unexpected financial burdens while helping employers build a competitive benefits package for recruitment and retention.
2. How do Accident and Critical Illness policies pay out benefits?
Unlike traditional health insurance that pays hospitals or doctors directly, these policies pay cash benefits directly to the covered individual upon a diagnosed covered illness or injury. The funds can be used for medical bills, rent, or daily living expenses.