Group Health Insurance

Health insurance is a key component of almost every employer-provided benefit packages. Many Americans have Group Health insurance coverage through their employer or a family member’s employer.

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Group Health Insurance

Plan Types

There are a few different types of plans, including Indemnity, PPO, HSA, and so on. Each type differs in flexibility, potential co-pays, deductibles, and out-of-pocket maximums.


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Group Categories

When it comes to Group insurance, there are two different categories: Small and Large. A group is considered a Small group if it consists of 50 or fewer employees.

Large groups, those consisting of 51 or more employees, enjoy the benefits of more flexibility in plan design, more potential carriers in the market, flexibility of premiums (as these plans are underwritten), and methods of funding those premiums.

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Group Categories

Affordable Care Act Impact

The Affordable Care Act (ACA) affects these plans in different ways, and has had several provisions delayed and/or changed since its enactment in 2010.
For example, the ACA mandates certain coverage inclusions for individuals and small businesses. This coverage falls into one of four categories—Bronze, Silver, Gold, and Platinum. The more precious the metal in its description, the greater the premiums and the lower the out-of-pocket costs are when receiving care. This is a basic, cookie-cutter approach to health insurance; the rates are calculated on a modified community method, and will differ only minimally from carrier to carrier based on the claims experiences of the carriers.
Smaller businesses may also qualify for a Health Care Tax Credit in some instances, to offset the cost of insurance. We can help determine if your business qualifies.
These provisions may or may not affect plans now or in the future, and we can help you understand the ACA’s impact on your plan as we move forward.

 

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Insurance Funding

Funding

Many employer-sponsored plans—especially for smaller groups—have fully insured health plans. In other words, the employer pays the entire premium and any underwriting losses are borne by the insurance company; sometimes employees share this cost, but not always.

Cost is based on the advice of actuaries who price the products to cover the potential underwriting losses, and provide for profitable business. This is a very straight–forward approach and the simplest to understand.

Other funding mechanisms include ASO (Administrative Services Only), Level Funding (a type of ASO), and self-insured plans. These plans, as opposed to fully insured plans, leave some of the risk of exposure to the employer. However, there is the possibility of large cost savings with these types of plans. Some of these plans will require the services of a TPA. 

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Carriers

We work with almost all major carriers in 48 states, including but not limited to:

  • Aetna
  • Cigna
  • Blue Cross (several)
  • Blue Shield (several)
  • Health Net
  • Kaiser Permanente
  • MODA
  • Providence
  • Samaritan
  • UnitedHealthcare

We also work with stop-loss carriers for self-funded plans—this limits the amount of risk exposure for the employer—and TPAs for the administrative functions of these plans. Remember, the cost savings can more than make up for the costs of these services. Our relationships allow us to receive very competitive pricing.

Please allow us to illustrate which plan may make the most sense for your organization.

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