Group Health Insurance and Employee Benefits

 As long as employers meet participation guidelines community-rated group health plans do not deny coverage for pre-existing conditions. 

Pros:

• The group cannot be denied coverage.
• Insurance carriers cannot ask health questions.

Cons:

•  Typically the most expensive type of group coverage. Many times rates are 30-40% more expensive than level-funded plans.
• Carriers keep premiums regardless of usage.
• The group has very little ability to impact the rising costs.
• Rates cannot be negotiated or lowered for any reason.

Partially self-funded plans are great for organizations that manage their resources well and want to take control of the direction of their healthcare. The biggest driving factor in insurance premiums is the cost of healthcare itself. In a partially self-funded plan, claims are paid as they are incurred. The administrator pays claims when they receive claim submissions from a doctor or a hospital. They handle the eligibility to determine if the claim is something that is covered under the plan and the plan design.

Pros:

• Employers can retain claims premiums not spent by the employees and their dependents. 
• The group can negotiate the cost of healthcare.
• The group has the protection of reinsurance carriers for large claims.
• Employers can develop long-term strategies to ensure lower costs and better coverage for years to come.

Cons:

•  Group members are dependent upon their employer to fund claims. If an employer has poor cash-flow management employees can experience difficulty with their coverage.

Level Funding Insurance is a hybrid of traditional community-rated health plans and self-insured plans. In this model employers only pay premiums and the insurance company pays claims.

Pros:

• Groups get some of the benefits of self-insured plans without the claims administration.
• Employers can get claims funding back after the plan year with most carriers.
• Typically level-funded plans are the best rates for small groups.

Cons:

• Groups can be denied coverage due to health risks.
• Unhealthy groups may pay more than community-rated groups if approved.

A bi-partisan act of both the Obama and Trump administrations, ICHRA plans allow employers to reimburse their employees tax-free for acquiring their own health insurance. Our firm not only administers these plans but we assist employees with making complicated decisions on the plans the employees choose.

Pros:

•  The annual budget for insurance can be controlled and predicted.
• Employees pick health plans rather than employers.
• Employers do not have to contribute dollars to those who may receive full or partial subsidies from the federal government.
• Great for organizations with employees in multiple states.
• Helps employers with 50 or more employees, meet their federal mandates to offer coverage.

Cons:

• Employees are responsible to manage and pay their own premiums.

MEC (Minimum Essential Coverage) Plans are good for employers who have 50+ employees and have a lot of turnover or that utilize seasonal workers due to the nature of their business. 

Pros:

• Premiums are extremely low-costs compared to any other type of coverage.
• Helps employers with 50 or more employees, meet their federal mandates to over coverage.

Cons:

• Coverage, networks, and plans are subpar than other forms of coverage.
• Many MEC Plans do not cover hospitalizations, surgeries, or treat major illnesses like cancer.

If you have 50 or more employees you are required to offer group health insurance that meets ACA guidelines and the current year's affordability guidelines.

Yes, we offer coverage down to 2 employees including spouses.

Yes, we offer group medical plans to 1099 workers as well.

On most plans, employers are required to contribute 50% of the employee-only premiums.