When to contact Gusto vs. your carrier with questions; common scenarios throughout the year and where to start.
Solution
This article covers how admins can set up, manage, and use health insurance benefits through Gusto. As your broker and payroll system, we help with enrollment and deduction questions. For carrier-specific questions about premium payments and coverage details, you can find your carrier's contact information on the Benefits page of your Gusto account.
Set up and add insurance benefits To set up or add benefits to Gusto, you can get started right from your admin account.
Add or change benefits mid-year You can add or change some benefits anytime during the year. Other changes need to wait until your renewal date.
Offer new lines of coverage
If you offer medical insurance with Gusto, you can add more benefits anytime. Click your desired line of coverage below for next steps:
Change your new hire waiting period or company contribution
You can only change the new hire waiting period and company contribution during your annual benefits renewal. This helps to keep your company compliant with anti-discriminatory practices.
Add or change medical plans
Insurance carriers typically do not let you change the plans your company offers until your benefits renewal date.
If you offer PPO or POS plans, new out-of-state employees can likely be covered by your existing plans. You can confirm your current plans' network on your insurance provider's website or by calling them.
Some carriers let you add a new plan mid-year if you hired a Hawaii employee, or if you only offer Health Maintenance Organization (HMO) plans and you added an out-of-state employee.
You may need to request help from a licensed benefits advisor at Gusto. To contact us, sign in to your Gusto account and click the help icon 
in the top-right corner of the page.
Cancel coverage
Learn how to cancel one or more lines of coverage for your company.
Open enrollment Check out our guide to open enrollment to learn about timing, how your team can enroll, required tax forms, and more. There, you can also watch an open enrollment webinar that includes enrollment demonstrations and answers to your most important coverage questions.
Choose or change individual coverage We'll email eligible employees when it's time to choose or waive coverage. Each employee must enroll or waive benefits themselves. You cannot enroll or waive for employees on their behalf.
Open enrollment Check out our guide to open enrollment for answers to frequently asked questions. This includes information on how to enroll in or waive coverage, how admins and owners can enroll, ID card information, and more.
When your company is in open enrollment, you can contact your dedicated onboarding specialist with any questions.
Help new hires enroll Eligible new hires can start choosing benefits while onboarding. If your company has a new hire waiting period, benefits may start up to 90 days after your first day of work. Employees can see their Coverage effective date on their Benefits page.
Share these resources with employees who need help choosing coverage:
Help employees waive coverage Employees can waive coverage during their new hire enrollment, open enrollment, or if they experience a qualifying life event.
The carriers require employees to sign a waiver because it affects your company's eligibility for coverage. Learn more about valid waiver reasons in the Waive coverage section of this article.
Manage qualifying life event changes Insurance carriers only let employees enroll, waive, or change plans when they're newly eligible, during open enrollment, or if they experience a qualifying life event.
If an employee or an eligible dependent experienced a qualifying life event (like losing or gaining other coverage, getting married, or having a baby), they can change their benefits in Gusto.
Handle dismissals and loss of eligibility After an employee leaves the company or changes from full-time eligible to part-time/ineligible, their last day of coverage depends on your company's termination policy. It's often the last day of the month that they left the company or became ineligible. You can find the termination policy on the Benefits page of your admin account.
Note: The insurance carrier may take a couple billing cycles to process someone's termination of benefits. If you see a dismissed employee on your company insurance invoice, continue to pay the full amount. You'll see a credit applied within one or two billing cycles.
Support employees with coverage questions Expand the sections for answers to frequently asked questions about employee coverage.
Member ID cards If employees need their ID cards immediately or have issues accessing them, share this article that explains how to find their member ID number and get care before the physical card arrives.
Benefits education and plan details Share these resources with employees who have questions about insurance terms and what their plan covers:
- Enrollment video: Explains common insurance terms and plan types
- Guide to your medical benefits: Covers finding in-network doctors, reading the Summary of Benefits, and more
- Insurance carrier contact: For specific coverage questions like "Is this covered?" or "What will this cost?" employees should contact their insurance carrier. Once they’re enrolled, they can find their contact info on their Gusto Benefits page or on the back of their member ID card.
Claims support Employees manage all medical, dental, vision, life, and disability claims directly with their insurance carrier. They should sign in to their member portal or call their carrier for filing instructions or any other claims information. The carrier's phone number is on the back of their ID card or on their Gusto Benefits page.
For HSA, FSA, DCFSA, or commuter benefits, employees can use the Gusto Benefits Card Hub for claims.
Manage payroll deductions Once an employee enrolls in benefits through Gusto, we'll automatically collect their contributions through payroll deductions. Deducted funds remain in the company bank account for admins to pay directly to the insurance carrier.
Payroll deductions When employees enroll in benefits, their payroll deductions will begin after the carrier has processed their coverage and once their benefits become effective. Employees can find their enrollment status on the Benefits page of their Gusto account. If the carrier confirms coverage after the benefits are effective, we'll apply deduction corrections.
Employer responsibility throughout the year Benefits admins at your company need to pay your company's insurance carriers on time and keep your employees' employment statuses up-to-date in Gusto. At the end of your plan year, we'll email benefits admins when it's time to start the renewal and open enrollment process.
Pay your insurance carriers Once your company’s benefits are effective, you'll get monthly premium invoices from your carriers for the total cost of your company's coverage. Remember to pay these on time to avoid the carrier terminating your group plan. Each carrier distributes invoices differently, but you can expect them to be sent monthly, either by email or mail.
Check out this article to learn how benefit deductions and premiums move, how to send payments to your carrier, and more.
Maintain your employees' eligibility statuses Keep employee statuses current when their hours or employment change.
- Status changes: If an employee changes from part-time to full-time, or from full-time to part-time, update their employment status in Gusto. If the change affects their benefits eligibility, we'll invite them to enroll or let their carrier know they've become ineligible for coverage.
- Employee departures: When an employee leaves the company, we'll terminate their benefits after their dismissal date.
For details on both scenarios, check out the Handle dismissals and loss of eligibility section.
Choose your company's renewal plans Your company's insurance plans renew once a year. This is when insurance carriers update their plans and rates, benefits admins can change the company offerings (like adding, changing, or removing plans and changing the company contribution or new hire waiting period), and employees go through open enrollment.
Renewal resources:
- Check out the renewal overview for a timeline, including when we'll reach out to start your renewal and how to choose your company's plan offerings in Gusto.
- Refer to the guide to open enrollment for answers to frequently asked enrollment questions and a webinar video.
