Oftentimes, the health insurance benefits that an employee will receive upon being hired by your company is a huge factor in their final decision of whether or not they want to work for you. For a lot of people, these employee benefits are just as important as their actual salary.
If you want to entice people to work at your company and retain rockstar employees, then you are going to have to offer great employee benefits to your team members. Needless to say, this can get very expensive very fast, which is why hiring a group health insurance agency should be of your utmost priority.
What Does a Group Health Insurance Agency Do?
A group health insurance company offers coverage options that encapsulate an entire group of people (typically a group of employees or members of an organization). Because of this, group health members usually receive insurance coverage at a reduced cost due to the insurer’s risk being spread out across a large group of people.
How Does Group Health Insurance Work?
Group health insurance programs are purchased by companies and organizations, who then offer the plan to their various employees and members. Each individual can choose whether or not they want to be a part of the plan. Because these plans can only be purchased by groups, individuals cannot purchase group health insurance coverage.
Something important to keep in mind… group health insurance plans typically require minimum participation in order for the plan to be valid.
Due to the number of differences between each one, no two plans are ever the same. This makes them perfect for business owners who are looking to save money, while also providing their employees with the insurance benefits that they deserve.
Agencies offering group health insurance plans are ideal partners for small businesses, as they keep premiums low and help to attract and retain employees due to the reduced cost all around.
Types of Group Health Insurance Plans
There are four main types of group health insurance plans.
Preferred Provider Organization
A Preferred Provider Organization (PPO) allows policyholders to utilize whatever medical provider they choose, as long as it is within the PPO network, and they pay the copayment amount for each service.
If a policyholder chooses to go to an out-of-network medical care provider, then they must pay the doctor’s fees directly and file for reimbursement from the insurance provider at a higher cost. This encourages policyholders to see a medical care provider that is within the PPO network.
PPOs are the most common variety of group health insurance agency and are what we specialize in here at Cowell James Forge Insurance Group. We typically focus on groups of anywhere from five to 250 employees, though we will go up to 500 or even 1,000 employees if needed.
Health Maintenance Organization
A Health Maintenance Organization (HMO) is a type of group health insurance plan that allows physicians and medical personnel to work either directly for the HMO or under contract to provide the necessary medical care to the members of the HMO. HMOs typically account for a small percentage of group health insurance agencies.
Point of Service
Point of Service (POS) insurance combines both HMOs and PPOs together into one package. They require that you use a primary care provider, but they also allow you to see other network health providers without a referral. If a policyholder wants to see a provider outside of the network without a referral, then they will have to pay more.
High-Deductible Health Plan
A High-Deductible Health Plan (HDHP) is typically more expensive than other types of plans, but, despite this, HDHPs are often the most affordable option that employers have to offer. Depending on which HDHP is chosen, policyholders may have the choice between network and out-of-network providers. As per usual, utilizing network providers saves money.
With the exception of preventative care, employers must meet the annual deductible before the HDHP pays benefits. Preventative care services are usually paid as first-dollar coverage or after a small deductible or copayment.
What Is the Affordable Care Act?
The Affordable Care Act (ACA), more commonly known as Obamacare, is the comprehensive healthcare reform that was signed into law by President Barack Obama in March of 2010. The law includes a list of healthcare policies that are intended to extend health insurance coverage to uninsured Americans.
The ACA prevents insurance companies from refusing coverage to people or charging more for people who have pre-existing health conditions. This is one of the primary characteristics of group health insurance, which is one of the many reasons why the signing of the ACA into law was significant.
In addition, the ACA also expanded Medicaid eligibility, created health insurance exchanges, and allowed children to remain on their parents’ insurance plan until the age of twenty-six.
Is it Mandatory to Have Health Insurance Coverage in the United States?
When the ACA was signed into law, not only did it make health insurance more affordable for qualified Americans, but it also made health insurance mandatory. If you did not have insurance coverage, then you would suffer from a tax penalty. However, this is not the case anymore.
On January 1st, 2019, under the Trump administration, health insurance was made to be no longer mandatory at the federal level. Although, some states still require you to have health insurance to avoid a tax penalty. These states are California, Massachusetts, New Jersey, and Vermont.
The primary benefit of people not having health insurance is that they don’t have to pay a premium. This, of course, means that more money remains in their pockets. However, not having any form of health insurance is a huge risk. If a person or one of his or her family members suffers from an injury or a serious illness, then they will have to pay out of pocket to get it taken care of.
Of course, this is one of the reasons why employee benefits are so important to people. If their employer offers health care plans, then they will not have to shop around for one.
If you are looking to provide your employees with the benefits that they deserve, then reach out to Cowell James Forge and inquire about our group health insurance plans. Our licensed agents will help you navigate the healthcare process so that you can hire and retain talented employees. In addition, we offer a number of other business insurance plans that are designed to fit your individual needs.