At Heath Quote Gurus, we match clients with affordable health insurance plans that are best-suited for their needs. Whether you’re running a small business or a large-scale company, we can help you navigate different types of plans to find the best option for you and your employees.
A group health insurance policy is purchased by an employer or employee organization and offered to eligible employees and eligible dependents (family members) of employees. There are various types of group health insurance plan available, such as health maintenance organization (HMO) and preferred provider organization (PPO) health plans.
Employers who own small businesses can put most or all of the cost of their group health insurance plan onto eligible employees, but it’s easier for employers to retain employees if they pay a portion of the premiums.
According to the United States Code (U.S.C.), a group health insurance plan, otherwise referred to as employer-sponsored health insurance or job-based health insurance, is a type of health play that provides medical care to employees and their dependents through insurance.
In the United States, health insurance premiums can be high, and finding the right insurance plan can be confusing. Group health insurance is often more affordable than traditional health insurance because more people are participating in it. In other words, the larger the risk pool the lower the health insurance costs. Group health insurance plans can also offer significantly lower premiums than traditional insurance.
As the pool of people participating in the group health insurance plan grows, the cost of the group health insurance decreases, allowing participants to enjoy discounts on health insurance costs. Group health insurance is one of the best ways to offer employees comprehensive and affordable health insurance. It can also help provide coverage to employees who may not be able to afford health insurance under a traditional plan.
Enrollment in a group health plan is also relatively easy for eligible participants. After an employee is hired, at the end of their initial waiting period—or during the time of year that the annual open enrollment period is offered by the employer—the employee is given information about the types of plans available, as well as instructions on how to enroll.
Employers who offer group health insurance coverage to their employees may be eligible for a tax credit up to 50% what they pay in. If you want to offer eligible employees coverage under a group health plan, but you’re not sure whether you’ll be able to afford it, tax breaks can make a significant difference.
The group health plan market is composed of small groups and large groups. Under the Affordable Care Act (ACA), insurance regulation laws vary for each type of group. In California, Colorado, New York, and Vermont, “small group” means up to 100 employees. However, in all other states, “small group” refers to small businesses with no more than 50 employees. Meanwhile, “large group” refers to anything more than that.
All small-group health insurance plans under the ACA must also cover the ACA’s essential health benefits. Out-of-pocket medical costs are capped at no more than $7,150 for individual employees, and eligible dependents must be allowed to remain on their parent’s policy until age 26.
Additionally, under the ACA, all employers with 50 or more full-time employees have a legal obligation to offer affordable health insurance for their employees. While most large employers offered health insurance coverage prior to the ACA, the ACA poses a tax penalty on large employers who do not offer health insurance. There’s no requirement under the ACA for small employers (fewer than 50 full-time employees) to offer health insurance.
Medi-share is a health care sharing ministry based on Christian beliefs, and is “modeled after the early church in the Book of Acts where people were of one heart and mind.” Similar to the concept of a good Samaritan, the idea behind a nonprofit health care sharing ministry is to take burdens off neighbors in times of need.
Under medi-share, members pay into a group pool of money. The monthly share is similar to a monthly premium under a traditional health insurance plan. When a member of medi-share incurs health care costs, money from the shared pool is used to pay for eligible medical bills. However, medi-share members are generally still responsible for paying a portion of their medical bills out-of-pocket.
Each family has an annual household portion (AHP), similar to an annual deductible, for which they are responsible. Members need to reach the amount of their annual household portion before the medi-share plan contributes to the costs of their medical care. Similarly, members of medi-share are individually responsible for their own out-of-pocket individual mandate.
Since medi-share is part of the Christian Care Ministry (CCM), a non-profit organization, members are understood to follow Christian beliefs. Medi-share members are also expected to abide by the regulations of Samaritan ministries and are encouraged to participate in the Christian lifestyle.
With a group health plan, the employer or employee organization selects the insurance company, type of insurance plan, and terms of coverage. As an alternative to medi-share, group health plans typically offer more comprehensive and affordable coverage.
As medi-share is Christian health care organization and not a straightforward insurance company, there is no guarantee that certain medical claims will be upheld. Medi-share plans have exemptions for pre-existing conditions that may require members to pay additional costs.
Meanwhile, depending on the group health insurance plan, employees may be covered for pre-existing conditions, emergency room visits, doctor visits, prescription drugs, primary care, and other medical expenses.
Group health insurance is a more affordable option for many employees, but is a group health plan a good option for you?
Because group insurance is chosen by the employer, employees don’t have a say in what network they’ll have available, the deductible they’ll need to meet before medical expenses are covered, or the premium they’ll have to pay.
The ACA created patient protection provisions related to pre-existing conditions, which prevent employers from imposing pre-existing conditions waiting periods and higher premiums on new enrollees, regardless of their health care or medical history.
Despite these protections, for individuals with an extensive medical history or pre-existing condition such as high blood pressure, an employer-sponsored group health insurance plan might not offer the health benefits and coverage needed.
On the flip side, for employees who expect to incur few health care costs throughout the year, a low-premium traditional insurance plan with a higher deductible may be a better deal than a group plan.
As you navigate your health insurance options, it’s important to understand how group insurance policies work.
If you missed the open enrollment period, you can shop for a group health plan through Health Quote Gurus. Shopping off-market for a group health plan can help you find a policy that you might not be able to get on the market, and opens up group coverage options that are available without subsidies or tax credits.
The experts at Health Quote Gurus can help you understand all of your options so you can pick the best health plan for your company and employees. For a fast and accurate quote, fill out our application or speak to a licensed health insurance agent at 866-317-7340.
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