Medical Insurance Products
Group health insurance plans provide coverage to members or employees of an organization. Members or employees of the group usually receive insurance at a reduced cost because the insurer’s risk is spread across a group of policyholders. Types of medical health plans include Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), Point-of-Service (POS), Catastrophic, and High-Deductible Health plans with or without a Health Savings Account (H.S.A.).
A fully-insured health plan is purchased from an insurance carrier and the employer pays the monthly premium directly to the insurance carrier. If applicable, the employer then deducts the employee’s portion of the premium from their paycheck. This is the more traditional way of setting up a group health insurance plan. For companies with less than 50 employees, the premium is community rated. In other wordsAnother wards, premiums remain unchanged regardless of the health of the group. For companies with more than 50 employees, premiums can be adjusted based upon the group’s claims utilization.
A self-insured (self-funded) health plan allows employers to operate their own health plan, versus purchasing a fully-insured plan from an insurance company. Some companies prefer to administer their own group health insurance plan as it allows them the opportunity to save the profit margin that an insurance company would add to its premiums for fully-insured plans. It is important to note than in a self-insured scenario, the company is exposed to a much larger risk should more claims be processed than expected. A self-insured plan is more suitable for companies with at least 150+ enrolled employees, however, a partially self-insured plan can mitigate the risk and can be an excellent way for a smaller company with good claims history to reduce premium costs.
Interested in group health insurance for your organization? Blue Chip Benefits can help you select a group health insurance plan to meet your organization’s needs.
Prior to 2019, the U.S. government mandated via the Affordable Care Act that all individuals and families have minimum essential (health care) coverage, and that companies with 50+ full time employees offer employees affordable coverage or incur a penalty. Although this mandate is no longer in effect for individuals and families, minimum essential coverage is still available to companies and remains an excellent option for the larger employer needing to meet the 9.86% of earnings affordability requirement. These plans must typically have the following qualities:
- Affordability: On average, plans must cover no less than 60% of out-of-pocket expenses on required services.
- Guaranteed Availability of Coverage: Under no circumstances can you be denied coverage, unless you cannot afford it.
- Guaranteed Renewability of Coverage: There must be the ability to renew coverage no matter the health status of the participant(s) or claims filed.
- Fair Health Insurance Premiums: There are limits on how much can be charged based on age, family size, geography or tobacco use.
- Medical Loss Ratio: The Affordable Care Act (ACA) sets minimum medical loss ratios for different markets, as do some state laws, that specify the amount of premium an insurance company can take in to cover costs such as overhead, marketing, profits, salaries, administration costs and agent commissions, before needing to rebate a portion of that premium back to the employer.
Companies with 50 or more enrolled employees must still offer medical insurance, and this can be a good solution.
A medical bridge plan provides health insurance coverage to those who are waiting for Medicare eligibility and is available to persons between the ages of 60 and 95.
Short term health Insurance is a medical plan that provides health insurance on a short term, temporary basis, typically 3 months. It is designed to help bridge the gap in healthcare coverage when a person is in between jobs and has no other health insurance, or when their current health insurance expires before meeting their new employer’s benefits waiting period.
To view pricing, options and to sign-up for coverage, go to: https://myaccount.altruahealthshare.org/AltruaRegistration?IsAgent=0051Q00000GqPcxQAF
Offered via the United States government, this national health insurance program provides health insurance to Americans aged 65+, to younger people with a disability status determined by the Social Security Administration, and those in end stage renal disease or amyotrophic lateral sclerosis. To find out more, visit www.medicare.gov for the official U.S. government website.
A federal and state insurance program that helps with medical costs. The program is available to people of all ages that have limited income and resources. To find out more, visit www.medicaid.gov.