FULLY INSURED GROUP HEALTH PLANS
We offer fully insured health plans through most major carriers. Depending on your needs, we have plans that offer the Minimum Essential Coverage (MEC) as required by the Affordable Care Act (ACA) to full customized packages that offer a rich variety of benefits.
A Health Maintenance Organization (HMO) requires group members to obtain their health care services from doctors and hospitals affiliated with the HMO. Members are required to designate a primary care physician who treats and directs health care decisions and who coordinates referrals to specialists within the HMO network. HMOs offer access to a comprehensive package of covered health care services in return for a prepaid monthly amount (or “premium”). Most HMOs charge a small co-payment depending upon the type of service provided.
With a Preferred Provider Organization (PPO) members save the most money on healthcare, if they use providers within their network. If providers outside of the network are used, it is possible that those services may not be covered at all. Deductibles must be met on this plan before some services will be covered. PPOs require a co-pay for physician visits.
A Health Savings Account (HSA) combines a high deductible/lower premium health insurance plan (PPO) with a savings account. Both employer and employee can contribute tax-free to the savings account, which can help fund the deductible and other qualified medical expenses. Once the deductible is met, the insurance starts paying.
A Health Reimbursement Account (HRA) combines high deductible/low premium health insurance with a tax-favored savings account. Employers contribute to the savings account, which can be used to fund co-pays and other qualified expenses prior to the deductible being met.
SELF FUNDED GROUP HEALTH PLANS
When employers self-fund their own health plan, they benefit from significant savings in premiums, increased cash flow, and tax advantages along with increased control over their benefits. Although traditional self-funding is not always the best fit for small employers, "level" self-funded options can work well and provide savings and potential for a refund at the end of the plan year. Self-Funding an insurance plan does place more administrative and compliance responsibility on the group, but we educate groups on their responsibilities and are here to assist throughout the plan year.
Here’s how it works.
A self-funded health plan requires the employer to become the insurer. Most often, employers will partner with a PPO to provide services for the plan. A third party administrator (a TPA) is engaged to handle claims and processing. Because self-insured employers run the risk of large catastrophic claims, they purchase stop-loss insurance to protect themselves in such an event. Even with the additional expense of stop-loss insurance, employers can still enjoy saving thousands in premiums.