Group Health Insurance
Secure your business’s future by investing in your employees’ well-being today.
Secure your business’s future by investing in your employees’ well-being today.
You may assume that group health plans and group health insurance plans are the same, but they’re actually different.
Employers have various financing options for group health plans, including self-funding (also known as ASO), level-funding, captives, exchanges and fully insured.
At a federal level, these plans are defined as “employee welfare benefit plans established or maintained by an employer, employee organization or both that provide medical care for plan participants and their dependents.” They’re usually covered by the Employee Retirement Income Security Act (ERISA) and must comply with its conduct standards and fiduciary responsibilities.
We value health, so we make your employees’ health our priority. That’s why we work hard to offer the best group health insurance options for your organization.
By partnering with reputable national insurance carriers, we help you discover competitively priced employee benefits with built-in cost control solutions. Our employer-sponsored health insurance plans are designed to save your employees money on premiums and out-of-pocket expenses, all while offering your organization competitive prices, transparent fees and unparalleled value year round.
If you have questions, we have answers.
Our dedicated team of group health insurance specialists is here to provide answers and to help transform your uncertainties into opportunities.
A preferred provider organization plan, or PPO, offers flexibility, allowing freedom to choose healthcare providers, albeit at a higher cost than an HMO.
Visit any in-network health care provider, with no need for a designated primary care physician (PCP) or referrals to access care.
And, out-of-network services, including specialists, are available, even without a PCP referral. But, while a PPO may extend some degree of coverage to out-of-network service providers, these often carry higher out-of-pocket costs.
Health Maintenance Organization (HMO) plans are cost-effective with a structured network of physicians.
Choose a Primary Care Physician who coordinates your care and provides referrals to other in-network specialists or secondary care providers. Health care provider options are limited to a predetermined list of in-network physicians.
Enjoy lower premium costs in comparison to a PPO. However, due to the high out-of-network costs associated with an HMO, subscribers seeking out-of-network care may pay more than they would under a comparable PPO plan.
Create potential savings by shifting from traditional rates to a pricing model based on Medicare reimbursement rates.
Instead of carriers or networks negotiating discounts from provider-billed charges that result in a “contracted rate” or “allowed amount” that the health plan pays the provider, reference-based pricing determines provider reimbursement by a percentage, usually between 120 and 170 percent, of what Medicare would typically pay the provider.
With pricing outside of the traditional rates set by insurance carriers or rented networks, reference-based pricing may help to reduce out-of-pocket costs.
Your team is going to have a lot of questions about their health insurance. Here’s some insight to help give them the answers they need.
Designed to help businesses reduce health care costs for employees and their dependents, a group health insurance policy splits the cost of coverage by way of blanket coverage provided to all participating employees, with premium cost being split between the employer and the employed. An insurance carrier pays for the agreed-upon portion of your employee medical costs outlined in your policy in exchange for premium payment and an employee copay.
Typically, the higher the monthly premium cost you pay, the lower your employee deductible will be. Group plan coverage can help with the cost of checkups at the doctor, prescriptions, emergency room visits, long-term care and more.
In most cases, buying into an employer group health plan is more cost-effective for an employee than purchasing individual or family coverage independently.
While a group plan can improve job satisfaction, retention and recruiting capabilities, there are requirements an employer should understand.
If your business employs one or more people, you may be eligible to purchase group health insurance coverage.
Depending on the size of your full-time employee group, you will fall into one of several market segments based on insurance carrier guidelines and state and federal laws. Your market will dictate the types of products available and pricing strategies.
Group health insurance plans can help take care of your employees’ health needs while boosting their satisfaction and retention. And, compared to individual health insurance options, group health plans potentially lower the total cost of care thanks to the larger risk pool created by group enrollment.
In other words, a plan with many employee participants enables the insurance carrier to spread the risk among all enrollees, offsetting the increased cost of covering high-risk participants through the reduced cost of covering low-risk participants.
Besides premium savings for employees, group plans can also save businesses money through tax benefit: because employer contributions to the plan are tax-deductible, participating businesses can offset their payroll and income tax liability.
Our employee benefits specialists are ready to assist. Contact Higginbotham today and find out how we can tailor a plan to meet your organization’s needs.