Group health insurance costs have been increasing. As a result, many companies I work with have been looking for other lower costing group insurance plan alternates. All of the group health insurance small business plans that I’m finding fit into 3 main categories. I’d like to clarify the differences between the 3 types of group insurance plan alternates.
The 3 categories are faith-based plans, partial self-funded plans, and group health insurance plans.
Faith-Based Plans
The faith-based plans are also known as cost-sharing plans or health care sharing ministries. Their members are exempt from many of the requirements of the Affordable Care Act. These faith-based groups will specifically state that they are not health insurance. They’re not subject to the same laws and requirements that other health insurance companies are. To be a health insurance company in Nevada, you need to meet certain requirements. These include being approved by the Nevada Division of Insurance, you need to have contracts with local doctors and so on. The largest downside with these cost-sharing plans is they don’t have contracts with doctors.
The cost-sharing plans can keep their prices low because they simply reimburse you for the service and they’re unconcerned about the total cost. If you know you’re going to need a medical service ahead of time you may avoid this. You can contact the plan and try to have them contact the hospital to talk about reducing the price. Unfortunately, you don’t always know ahead of time you’re going to need medical services. Faith-based plans also involve additional reporting requirements and administration.
Partially Self Funded Plans
The second type of plan is a partially self-funded plan. Both Hometown Health and Aetna came out with partially self-funded plans and they work great for specific types of groups. For the Hometown plan, you need to hold a contractor’s license. The Aetna self-funded plan requires a minimum of 10 employees. For both plan,s we will need to complete health statements and no one in the group can have a major medical condition. If we meet these requirements Aetna and Hometown Health both offer excellent rates for these groups! These plans also have additional reporting requirements at the end of the year including 1095C reporting.
Group Health Insurance Plans
The third type of plan is the group health insurance plan. All of these plans are filed with the Nevada Division of Insurance. They have contracts with local doctors and no additional reporting requirements are needed at the end of the year. These also end up being the simplest to access care. Since the doctors are already contracted, an online list of doctors is available from each insurance company. All requirements to start a group health insurance plan can be found here. Almost all of our clients have a group health insurance plan.
If you’re considering one of these group insurance plan alternates, I’d like to make sure you understand the risks before committing. I may sound like I’m against one option or another but I would like to be an educational resource. If you understand the risks I believe you can use the plan better and have a better overall outcome. Our office can also provide you with free group health insurance quotes for your business.
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