While businesses with fewer than 50 full-time equivalent employees aren’t required to provide health insurance to employees, it can certainly be a good idea to do so. 95 percent of HR professionals named health care benefits as one of the most important benefits businesses can offer, making it a powerful tool to attract and retain top talent.
It’s not always easy to decide the best path forward when it comes to weighing health insurance options. Here are four different factors you need to consider when comparing health insurance options for your business.
Individual vs. Group Health Insurance Plans
The first consideration you need to make is simple: do you offer health insurance or not? This scenario breaks down to whether you want employees to purchase health insurance for themselves or if you want to offer a group health insurance plan.
The difference between individual and group health plans
While you may not need to offer health insurance, the Affordable Care Act (ACA) mandates that Americans have it. If you don’t offer health insurance, your employees will need to purchase an individual health insurance policy for them and their families.
A group health insurance plan allows businesses to provide coverage to a group of members, which is comprised of members of your organization and potentially their families. Businesses that do offer these plans must offer it to every full-time equivalent employee – you can’t pick and choose who gets coverage and who doesn’t. However, employees can choose to opt out to pursue an individual plan or join another plan if eligible.
What makes the most sense for my business?
This decision comes down to your employees and costs. While individual health insurance is the least costly route for employers, it comes with the caveat that nearly half of employees named health insurance as either a positive influence or the sole deciding factor in choosing their current job.
Meanwhile, group health insurance gives you and your employees benefits an individual plan would not. Individual plans have higher out-of-pocket limits. The Affordable Care Act caps these at $7,350, while individual limits could be as high as $10,000. In addition, the increased buying power of group plans can offer a higher-quality overall plan design than what you and your employees could get at the same cost in individual coverage.
Some companies may be tempted to combat the lack of health insurance benefits by providing a bonus for employees to help pay their indiviual premiums. While this offers a level of financial support to employees, it is not viewed that way by other government and financial institutions and is strongly advised against. Group health plans allow employers and employees to pay premiums with pre-tax dollars. Anything spent on group healthcare costs is tax-deductible, whereas individual plans are not.
Another issue with individual plans is that renewals are typically high if you utilize the coverage at all. The size and health of a group affects health insurance premiums, potentially giving group health plans more stability than a plan built for one person or family. When you tie in the tax benefits, group plans often end up being more cost effective than individual plans, all while offering a key perk to new and existing employees. This makes group health plans a much more attractive long-term option for many small businesses.
Plan Design
Every health insurance plan can differ in terms of what is covered and you and your employees’ financial responsibilities for doctors’ visits and other medical costs. When comparing plan design, there are two different routes you can go:
- Traditional plans
- High deductible health plans (HDHP)
The differences between traditional and high deductible health plans
A traditional plan operates on a system with copayments (also called copays) and deductibles. The plan helps you and your employees pay for doctor's visits, prescriptions, and other in-network medical costs. Meanwhile, group members are responsible for paying any copays, coinsurance, and deductibles associated with your specific plan. Once an individual has met their deductible, that person is typically only responsible for coinsurance payments up to the listed out-of-pocket maximum.
An HDHP also has deductibles, but no copays involved. With these plans, individuals must meet a higher deductible before insurance pays its share of in-network medical costs. However, HDHP plans are eligible for a health savings account (HSA). Employees can use an HSA to set aside money from their paychecks and pay medical costs with tax-free dollars.
What plan design makes the most sense for my business?
Of the two options, most people are more familiar with traditional plans – HDHP designs are a newer design that started with the Affordable Care Act. Because of this, some employees may be more comfortable with traditional copay plans due to familiarity and the lower deductibles.
While newer, HDHP designs open both employers and employees up to lower premiums and potential tax savings through the HSA. In fact, HDHPs are sometimes called HSA plans because of this particular advantage. Some employers even choose to contribute to employees’ HSAs – this gives employees some funds to pay medical bills while allowing employers to receive the tax benefit.
Both plan designs offer certain advantages, so your decision comes down to costs and comfort level. People who are used to having copays will often prefer traditional plans. Meanwhile, others may realize the benefits of an HSA with some education around how HDHPs help them. Take some time to estimate how your employees would use the plan and what you and your employees need when it comes to healthcare coverage.
Health Insurance Network
When comparing health insurance, you also need to weigh how much freedom you need when it comes to which facilities, providers, and suppliers are available to you and your employees. A health insurance network is the group of medical care providers that have a contract with your plan. There are three levels of health insurance networks:
- Preferred provider organization (PPO)
- Exclusive provider organization (EPO)
- Health maintenance organization (HMO)
The differences between PPO, EPO, and HMO networks
A PPO network does not limit you in terms of medical facilities or caregivers as long as you’re with an in-network provider. In this type of network, you won’t need your primary care physician to refer you to another specialist or other provider outside of your network – you can simply go see that person for an additional out-of-network cost.
An EPO network adds some additional limitations to this process. A typical EPO may limit your group members to one major hospital network in your region, except in the case of an emergency. Essentially, that group of doctors negotiated a contract to be the exclusive providers for that network. As such, you’re limited to that hospital network and may need referrals to see outside providers.
An HMO network limits in-network care to a specific location. Some HMOs require employees to live or work in a certain service area for coverage and can range from specific hospitals to a broader circle of locations and providers. People with an HMO network will need referrals to see any specialists or other providers outside your primary care or emergency room needs.
What health insurance network makes the most sense for my business?
Your choice of health insurance network comes down to desired flexibility and nationwide accessibility. PPOs offer the greatest amount of freedom in terms of access, whereas HMOs offer the least. An HMO may work for a small business where everyone is located in the same small area, but it’s likely not an option if your employees are spread out.
You also need to consider what happens if you ever leave a certain area. With an EPO or HMO, you may not have coverage options if you go on vacation or have college-age children in different areas. For that reason, PPO networks tend to be more popular with employees.
Healthcare Administration
If you do decide to offer health insurance, you’ll need to consider how to handle the benefits administration process. A business can turn to a broker for group health insurance or find an organization like a PEO that can manage both benefits and payroll administration.
The difference between administrative options
If you opt for a broker that can’t manage payroll, that will place the responsibility of benefits administration in your hands. This means that you or someone else at your company would need to administer your plan, handle adding new hires to the plan, and manage the renewal process.
If an employer goes with a broker that also houses payroll, everything would be done for them and automated so that they didn’t have to administer the plan themselves. This type of relationship offers you full administrative management and support for new hires, compliance tracking, and reporting.
What makes the most sense for my business?
It depends on how much time and expertise you have. Benefits administration is a major endeavor for a small business. Not only do you need to oversee benefits administration, but also key aspects of payroll management for your small business. You can opt to hire someone internally to oversee these responsibilities, but that does require increasing payroll for administrative efforts.
Meanwhile, an organization like a PEO is a natural fit for health insurance administration. A PEO can offer you greater buying power and educate employees about how your plan works, your network, and ways to keep premiums down. It also gives you and your employees experts to talk to whenever there’s a question.
Ready to offer a competitive benefits package without taking on the administrative burden? Contact GMS today to find out how we can quality group health insurance at a lower cost.