Group Health- Insured

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Group Health – Insured

Small group – Current law defines this as fewer than 50 full-time equivalent employees. Plans for these groups are filed by insurance companies annually and approved by state regulators. The insurance companies offer a variety of plan designs such as HSA, HRA, Copay, and Deductibles. The rates for a particular plan design vary only by geographic location and by the age of the covered employee or dependent. This is called community rating. Underwriters cannot change the rates for a specific group.

Large Group – Any group that has over 50 full-time equivalent employees. Once an employer meets this threshold, the premiums are determined by their actual historical experience. Depending on a groups past claims, their premiums can be reduced or increased by underwriting.

Networks The current trend to control cost, is to offer smaller networks with limited providers. Employers need to work closely with their agent to determine the availability of providers in an area. Provider disruption (i.e. forcing employees to change doctors) can have a negative impact on employee perception of benefits and general employee morale.

Wellness Programs A group that focuses on wellness programs can find ways to incentivize their employees to have healthier lifestyles. The success of such a program can mean lower than average claims costs and a more productive workforce.

At Solutions Agencies we work with clients to find the best plan design(s) and wellness programs for the employer’s culture. We work to find a balance between cost and benefit satisfaction.

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