Employee Benefits

Group Health Insurance Types

Fully Insured

A fully-insured health plan involves an employer or association purchasing health insurance from a commercial insurer. This coverage is extended to employees or members. Premiums are paid by the employer to the insurer, who assumes the financial risk for coverage and administration. In case of medical claims, the insurer handles payments. State regulations apply to fully-insured plans.

Level Funding

Level funding is a form of self-funding where all plan components are combined into a monthly premium paid by the employer. It resembles fully-insured plans, but any surplus claims at year-end can be returned to the employer. This option offers security and potential savings.

Small Business Health Options Program (SHOP)

SHOP helps businesses provide health coverage. It's for employers with 1-50 full-time employees. It offers flexible coverage options and tax credits for qualifying businesses.

ICHRA - Individual Coverage Health Reimbursement Arrangement

ICHRA lets employers reimburse employees for health insurance premiums and medical expenses. It provides flexibility, portability, and cost control in a changing healthcare landscape.

ICHRA - Individual Coverage Health Reimbursement Arrangement

Individual Coverage Health Reimbursement Arrangement (ICHRA) is a type of health insurance arrangement designed to assist people in paying their medical expenses. Employers often help employees to acquire insurance policies that cover these expenses and cover healthcare costs through this method.

It's Employer Assistance: As part of an ICHRA plan, your employer sets aside money specifically to pay for health expenses that are exempt from income or payroll taxes for both you and them.
Pick Your Own Plan: An ICHRA allows you to choose your own health insurance plan. No longer does the employer select it for you; rather, an individual can select their ideal health plan from those offered through health exchanges or private providers.
Coverage Reimbursement: Once you enroll in a health insurance plan of your choice, monthly premiums must be paid individually by you. Once eligible medical expenses such as doctor visits, prescription costs or hospital stays occur, receipts should be submitted to either your employer or company managing ICHRA for reimbursement.
Customizable: Individual Contributory Health Reimbursement Accounts (ICHRAs) offer greater freedom when it comes to healthcare spending. Your employer can decide the exact amount they contribute depending on factors like your age, family size and location - giving you more control over healthcare expenditure.
Portability: One significant advantage of ICHRAs is their portability: If you change jobs or leave your current employer, taking your ICHRA with you ensures access to health coverage and financial support from it.
No Networks: ICHRAs offer more flexibility in choosing healthcare providers and facilities that best suit your needs, unlike some traditional employer plans that limit you to specific networks of doctors or hospitals. You have more freedom of choice.
Pre Tax Savings: Utilizing an ICHRA is a smart way to save on healthcare expenses as the contributions from your employer are tax-free, offering significant tax-free savings on healthcare expenditures. It could prove invaluable. An Individual Coverage Health Reimbursement Arrangement is a type of health insurance arrangement that enables employees to choose their own healthcare plans while receiving financial support from their employer. It offers employees flexibility, portability and potential tax savings which make it a desirable option when seeking healthcare coverage. Employers use it as a tool to assist employees in acquiring and paying for health insurance which gives individuals greater control over healthcare choices and costs.

Small Business Health Options Program (SHOP)

The Small Business Health Options Program, more commonly referred to by its acronym SHOP, is a government initiative in the US designed to aid small businesses provide health insurance for their employees at an affordable cost. Simply put, SHOP insurance gives small business owners an affordable way to offer coverage options to their workers. Let’s look at how it works:

Tailored for Small Businesses: SHOP insurance was specifically developed with small businesses of 50 or fewer full-time employees in mind, taking into account that these smaller enterprises may require different needs and resources than larger corporations.
Access to Group Health Coverage: SHOP offers small businesses the ability to purchase group health plans at more cost-effective rates than individual plans by spreading risk among multiple employees, making premiums more manageable and premiums more manageable for all involved.
Select Your Coverage Options: SHOP provides access to various health insurance plans from various insurance providers. Small businesses owners can select coverage options with different levels of benefits, deductibles and premium costs so as to select one that best meets both their budget and employee needs.
Employee Participation: For SHOP eligibility, businesses typically need at least one full-time employee other than themselves (excluding themselves ). In certain states, businesses with under 25 employees may also qualify for tax credits if they offer health insurance through SHOP.
Tax Benefits: One of the primary advantages of SHOP for small businesses is making them eligible for tax credits that help offset the costs of providing health insurance to employees. The amount of this credit depends upon various factors such as size of business and average wages of employees.
Enrollment Periods: Just like individuals can enroll for health insurance during open enrollment periods, SHOP also has specific enrollment periods that businesses should take note of. Businesses generally need to enroll during either the annual open enrollment period or when hiring new employees unless special enrollment periods apply due to certain events such as hiring new workers.
Employee Benefits: In some states, SHOP allows employees to shop around in its marketplace and select plans which best meet their healthcare needs, even though they work for one employer. This ensures employees can select an ideal plan suited for themselves even though all work for one organization.
Employer Contribution: Employers using SHOP must contribute a certain percentage of premium costs for their employees as part of making coverage more cost-effective for workers. This contribution makes insurance more accessible.
Compliance with the Affordable Care Act: SHOP insurance plans must comply with the Affordable Care Act (ACA), providing essential health benefits and adhering to applicable regulations such as not denying coverage based on preexisting conditions.
Simplified Administration: SHOP's goal is to make providing health insurance more manageable by streamlining administrative tasks related to enrollment, premium collection and paperwork management - making life simpler for small business owners managing employee benefits. The Small Business Health Options Program (SHOP) is a government initiative to assist small businesses in providing healthcare coverage for their employees. By participating in SHOP, small businesses can provide quality healthcare more cost-effectively while improving employee well-being as well as attracting and retaining talented staff members.

Level Funding

Level funding combines elements of self-funding and traditional health insurance to form one comprehensive solution. To better comprehend it, let’s unpack its key concepts:

Self-Funding: Employers using self-funded health plans cover employees' healthcare costs directly instead of paying fixed premiums to an insurance company, which offers flexibility and potential cost savings but could lead to unexpected medical claims that increase healthcare expenses significantly.
Traditional Health Insurance: Most people are familiar with traditional health insurance plans. Employers pay a set premium to an insurance company that assumes financial risk for employees' healthcare expenses and manages this plan on behalf of its members. Although this offers predictability and predictable monthly premium payments, this model often comes with higher premiums and limited control over plan design.
Fixed Monthly Payments: With level funding, employers make regular monthly payments to an insurance carrier similar to traditional policies - although typically at reduced premiums.
Self-Funded Component: Under this option, part of your premium goes toward covering expected healthcare expenses (such as routine doctor visits) while the remaining amount goes into a claims fund that acts like a savings account for unexpected or larger medical costs.
Stop-Loss Insurance: To mitigate financial risk, employers often purchase stop-loss insurance which takes effect when claims exceed a predetermined threshold (aggregate or individual). This safeguard provides protection from costly expenses.
Claims Administration and Processing: Insurance companies usually handle claims administration and processing, which may include paying for healthcare services as needed.
Transparency: Level funding provides more transparency, as employers can easily see where their healthcare dollars are being spent, helping them make informed decisions regarding plan design and employee wellness programs.
Potential Cost Savings Potential: If an employer's actual healthcare costs for the year fall below their premium payments, they could receive a refund or credit against future premium payments. Level funding combines two benefits into one plan, providing predictable insurance premiums with self-funding flexibility. Businesses using level funding can customize healthcare plans more effectively while managing costs more effectively and potentially saving money when claims come in lower than anticipated. Furthermore, stop-loss insurance acts as a safety net, protecting them from unexpected medical bills that might otherwise exceed financial expectations.

Fully Insured

Fully Insured Insurance (FII) is an agreement between an individual or entity (the policyholder) and an insurance company to provide financial coverage in case of certain events or risks outlined in a policy, such as medical costs associated with illness or accidents, damage to property (like your house or car) or accidental injury claims from others. Premiums paid each month promise this financial protection should anything come up, such as illness or accidents which require medical care coverage, damage caused to either property ( like your house or car), or liability coverage should you accidentally cause harm.

Full coverage insurance comes in many shapes and forms, each tailored specifically to a customer’s needs. Here are some popular forms:

Health Insurance: Health insurance policies cover healthcare expenses such as doctor visits, hospital stays and prescription medications without leaving policyholders exposed to financial strain. They enable accessing healthcare services without incurring crippling costs.
Auto Insurance: Auto insurance provides coverage for damages to your vehicle as well as liability protection in case an accident caused by you causes harm or property loss for others.
Homeowners Insurance: Homeowners insurance provides protection for both you and your personal belongings from fire, storm and theft damage as well as offering liability coverage should accidents take place on your property.
Life Insurance: Life insurance provides financial security to your loved ones in the event of your death, covering funeral costs and any outstanding debts while offering peace of mind to beneficiaries.
Business Insurance: Businesses often require various forms of fully insured coverage for protection from various risks, including commercial property insurance, workers' compensation insurance and liability coverage.
Risk Management: Risk management provides individuals and businesses alike with a means of mitigating unexpected events that might present financial challenges, reducing uncertainty and potential hardship.
Legal Requirements: Oftentimes, fully insured policies are mandated by law - for instance auto insurance in most states is usually mandatory to operate legally.
Financial Security and Peace of Mind: Financial security provides individuals and families with a protective buffer against costly medical treatments, repairs or legal liabilities that might put them into financial hardship. Knowing you have comprehensive financial protection can bring immense peace of mind, freeing you to focus on other areas of your life or business.
Asset Protection: Insurance can protect valuable assets such as your home, car or business - protecting financial stability by safeguarding valuable investments such as your house, car or company. Fully Insured Insurance is an essential financial tool that offers peace of mind and financial security. The basic idea is straightforward: pay premiums to an insurance company and, in return, they cover eligible expenses when certain events or risks occur. Whether protecting health, property or your loved ones' financial future, fully insured insurance provides peace of mind in an uncertain world - understanding your insurance needs and selecting appropriate coverage can lead to an enjoyable, worry-free existence.

Group Life Insurance

Group life insurance, often part of employment benefits, offers coverage for workers through employers or associations. It’s affordable and can cover various costs, although coverage may be limited.

Group Dental Insurance

Employer-sponsored dental insurance helps cover dental care costs, encouraging preventive care and making dental services more affordable.

Vision Insurance

Vision insurance covers eye care expenses, from regular checkups to eyewear and procedures. It promotes healthy eyesight and can save on costs.

Voluntary Benefits

Voluntary benefits are additional options employees can choose beyond standard offerings. They offer flexibility, gap coverage, and affordability, attracting and retaining top talent.

Group Disability Insurance

Group disability insurance replaces income if an employee can’t work due to illness or injury. It comes in short-term and long-term coverage, ensuring financial stability.

Group Accident Insurance

Group accident insurance covers medical expenses and financial losses from accidental injuries. It’s offered as an employee benefit and provides added protection.

Group Critical Illness Insurance

Group critical illness insurance provides a lump-sum benefit to help with unexpected life events, covering costs like childcare and medical expenses.

Health Savings Account (HSA)

HSAs are savings accounts for medical expenses, paired with high-deductible health plans. They offer tax advantages and control over healthcare spending.

Flexible Spending Account (FSA)

FSAs allow employees to set aside pre-tax income for qualified medical expenses. They offer tax savings, cost reductions, and convenience.

Health Reimbursement Account

HRAs are employer-funded plans reimbursing employees for medical expenses. They offer tax deductions, convenience, and cost control.

401(k) Retirement Plan

401(k) plans help employees save for retirement with tax advantages. They include traditional and Roth options, with employer matches and investment choices.