A Guide to Choosing Group Health Insurance Plans

When it comes to choosing a group health insurance plan, the array of options can be overwhelming. Insurance is a crowded market with plenty of options on the table. As an employer, your responsibility is to your workers, and you want to offer them the best coverage.

Note that not all group health insurance plans are created equal. Some may be a better fit for your team than others. Engaging the services of an independent broker, such as Lake Region Insurance Agency, narrows down the search. Reach out today to talk with a team member.

Why Should I Consider Group Health Insurance Plans?

If your company’s workforce includes 50 or more full-time or full-time equivalent (FTE) employees, you are likely required to offer them medical coverage. The Affordable Care Act lays out guidelines and requirements

But even companies that do not have to provide insurance coverage often choose to do so as an employee perk. It is an excellent way to find and retain highly-qualified talent for your team.

Opting for group coverage offers a range of benefits for both the employee and employer, including:

  • Greater Choice – As an employer, you can shop from many insurance companies to find the best offering for your workers and yourself. And employees generally can choose from several plans that they otherwise would not be able to access. 
  • Affordability – The larger number of subscribers in group plans spreads the risk for the insurer. A lower risk for the underwriters translates into a lower premium for all of the people on the plan. 
  • Better Coverage – Group health insurance plans often cover more services than individual coverage. They may offer lower copays or more visits to specialists, such as physical therapists.
  • Tax Benefits – As the employer, you may qualify for tax credits when you offer group coverage and pay part of the premiums. 
  • Benefits For The Job Market – Offering health insurance is a sure-fire way to make your workplace more appealing to employees. It demonstrates that you have their interests at heart and value your staff. In addition, providing health insurance coverage can cut down on sick days and reduced productivity.

Doctor's visit covered under group health plans

Consider Voluntary Plans

If you are a small or microbusiness, a voluntary plan might be the best fit. This option allows employees to contribute a specific amount to a group plan while saving money on the total cost. This option carries little to no cost for employers. Premiums come from the worker’s paycheck pre-tax, so there is a tax saving for them, too.

How to Choose a Compliant Plan

Choosing a group health plan can be tricky, and it’s crucial that it is compliant with the Affordable Care Act (ACA) requirements. In addition to the rules regarding the number of employees, group health insurance plans must also meet the following criteria:

Must Cover Essential Health Benefits

Any group plan you offer to your workforce must include coverage for the ten essential health benefits (EHBs):

  1. Hospitalization Services
  2. Ambulatory Care – This includes doctor visits and outpatient care.
  3. Emergency Services 
  4. Maternity and Newborn Care
  5. Mental Health Care and Substance Abuse Treatment
  6. Lab Tests  
  7. Prescription Drugs
  8. Rehabilitative and Habilitative Services – These can include things such as speech therapy or occupational therapy.
  9. Pediatric Services for Children – This section must include vision and dental care under most circumstances.
  10. Preventive Care, “Well Check” Visits, and Chronic Disease Management

To be compliant, a group plan must not place a dollar limit on EHBs. It may, however, set a limit on the number of visits in some categories, such as rehabilitative services. 

Physical therapy under group health plans

Must Qualify as Affordable 

In 2020, requirements state that the lowest coverage option must have premiums costing less than 9.78% of your employee’s overall income.

Must Provide Minimum Value

The plan must cover at least 60% of the expected total cost of services.

Making the Decision

Whether you have a legal obligation to provide insurance or not, having a group health plan is valuable. As you work with your independent insurance broker, here are some things to consider.

Make Sure It Fits Your Budget

If your staff has fewer than 50 employees, you are exempt from the ACA’s shared responsibility provision. As a result, you legally do not have to pay a percentage of the premiums. You will be able to choose to pay 100% of your employee’s premiums, pay a smaller portion, or have your employees pay the full cost.

It is essential to do your research in advance. You want a plan that balances the needs of your employees with the company budget.

Consider Health Spending Accounts

A health spending account can allow you to offer the flexibility employees need, at a price your business can afford. Employers and employees may contribute to these accounts, and then employees can use the funds for qualified health expenses. 

Group health plans and HSAs for medications

Work with an Expert

Trying to navigate this decision on your own is frustrating at best and costly, at worst. You will have hundreds of plans from insurance companies to consider. And finding the right fit is overwhelming for most business owners.

Companies may bombard you with options ranging from PPOs to HMOs. You will see lists of percentages and copayments. Comparing these plans as you try to decide which one to choose is enough to give business owners nightmares.

Instead, find an independent agent to help you make the right choice for your workers. An independent broker is not limited to a particular plan or company. They help you select what you need without stress.

How Can We Help?

Choosing your group insurance policy is time-consuming on your own because there are so many factors to take into account. Here at Lake Region, we have the autonomy to access the very best deals. 

We work hard to make sure you have a clear view of your options. And we help you understand the health insurance marketplace.

As an independent agency, we do not have ties to a particular firm, group, or policy. This objectivity means that we will be able to build the perfect plan for your business. Get in touch today to see how we can help. Our team members in New London, Cokato, and Willmar, MN, are here to serve.

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