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TRADITIONAL GROUP HEALTH PLANSWe offer traditional 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 PLANSWhen 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 not always a popular choice for small employers, today self-insured plans are considered good options for both small and large group employers. Holtz Insurance Services specializes in helping employers set up and maintain self-funded health plans and would be happy to give you a no-cost analysis to determine if a self-funded health plan is right for your company.
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. SHARED FUNDING PLANSShared Funding Plans allow small employers to take advantage of all the cost saving and benefit design features of a self-insured plan that is typically designed for larger groups. However, any small or large group could benefit greatly by the cost saving opportunities of a shared funding plan. Here’s how it works. First, an employer will select any of the fully insured plans that the carrier offers and rates will be determined by the group’s claim history. Stop-loss insurance is added to protect against catastrophic claims. Just like with an insured plan, the carrier will handle the administration of the plan, processing claims and offering members online access to benefit explanations and other reporting tools. Premiums for shared funding plans are generally much lower than fully insured plans because the employer shares some of the risk. Employers who opt for shared funding plans may save even more costs by implementing wellness programs into the workplace. |
