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  • Stepping into adulthood comes with a game-changing moment – hitting the big 26 and waving goodbye to the safety net of your parent’s health insurance. It’s like unlocking a new level of independence but navigating the health care landscape can feel like a rollercoaster ride. This transition isn’t just about paperwork and getting the proper coverage; it’s a real-life journey into adulting. Picture this blog as your guide, unraveling the ins and outs of claiming your own health coverage. It’s going to feel like a breeze when you approach the 26th year of your life.

    Understanding The Transition

    Young adults lose coverage from their parents’ plans because of the Affordable Care Act (ACA), which only requires companies to cover dependents on a parent’s plan until they turn 26. Before the ACA, insurance companies dropped young adults from their parent’s policies after they reached a certain age or stopped attending college. This resulted in many young adults losing their insurance earlier in life. Now, with the ACA, adults 26 years and under can stay on their parent’s plan even if they:

    • Have started or finished school
    • Are no longer a dependent
    • Are married
    • Adopt or have a child
    • Turn down group health insurance through work 

    What this means is that when you turn 26, you’ll need to find alternative coverage to ensure you’re protected in case of illness or injury. Understanding the options available to you is crucial as you embark on this new phase of your life.

    Exploring Your Health Care Options

    It’s essential to understand you have various options when choosing health care options. Let’s take a look at your options:

    Employer-sponsored plans: If employed, your company may offer health insurance benefits. It’s essential to familiarize yourself with the coverage options and enrollment periods provided by your employer.

    Health insurance marketplace: You can explore plans through the Health Insurance Market, where you may be eligible for subsidies based on your income. A subsidy is a benefit given to an individual, business, or institution, usually by the government. It can be direct (cash payments) or indirect (tax breaks). It’s typically given to remove some burden and is often considered in the public’s overall interest, given to promote a social good or an economic policy.

    COBRA coverage: You may qualify for the Consolidated Omnibus Budget Reconciliation Act (COBRA) for a temporary extension of your parents’ plan, although it can be costly. This coverage gives workers, and their families who lost their health benefits the right to choose to continue group health benefits provided by their group health plan for limited periods of time under certain circumstances, such as voluntary or involuntary job loss.

    Medicaid: Depending on your income, you may qualify for Medicaid, which provides low-cost or free health care coverage. In all states, Medicaid provides coverage for some low-income individuals, families and children, pregnant women, the elderly, and those with disabilities.

    Transitioning off your parents’ health plan can pose several challenges, such as understanding insurance jargon, comparing different plans, and budgeting for health care expenses. It’s normal to feel overwhelmed, but there are resources available to guide you through this process. The following are a few resources available to you:

    Financial Considerations

    • Budgeting for premiums: Evaluate the cost of premiums for different plans and consider how they fit into your monthly budget. For a healthy 26-year-old, the average cost of a marketplace plan is $372 per month.
    • Out-of-pocket expenses: Understand the potential out-of-pocket costs for deductibles, copayments, and coinsurance when comparing plans.
    • Health savings accounts (HSAs): If eligible, consider opening an HSA to save for medical expenses with pre-tax dollars. An HSA is a type of savings account that lets individuals set aside money on a pre-tax basis to pay for qualified medical expenses.

    In addition, it’s essential to understand the plan coverage:

    • Network providers: Check if your preferred doctors and health care facilities are included in the plan’s network to ensure continuity of care.
    • Prescription drugs: Assess how different plans cover the cost of prescription medications you may currently use or anticipate needing in the future.

    What Next?

    If 26 is just around the corner, you must start thinking about this process. Being able to compare your options allows you to get the best coverage for the best price as opposed to waiting until the last minute and rushing this decision. If your employer offers health insurance, you’re in luck. Your colleagues should be able to offer you advice, and if you’re lucky, your company might have a designated benefits specialist who can walk you through the entire process. If your employer doesn’t offer health insurance, the process will be longer, and you’ll have to make decisions on your own.

    For employers, have you considered partnering with a professional employer organization (PEO) like GMS? As your employees transition to their independent health care coverage, it’s essential you provide them with the tools and resources to make the right choice. When you partner with GMS, we provide access to comprehensive group health plans, leveraging our buying power to offer competitive rates and quality insurance. In addition, our Benefits Account Managers work with you and your employees to guide them through the enrollment process. We will also simplify complex paperwork, ensure compliance with regulations, and get the coverage your employees want and need. Contact our benefits experts today to ensure a seamless process for employees during this transitional period.

  • The phrase “aging with grace” has taken on a new meaning in modern times. As we age, we not only face the typical challenges associated with getting older but also a new set of factors that have reshaped the aging process. It’s crucial for individuals to confront these challenges head-on rather than avoiding them altogether. The good news is that people are becoming more proactive about aging, particularly those who have taken on the role of caregivers themselves. Recent data from New York Life reveals members of the Sandwich Generation, who care for aging parents and children, are actively saving for retirement, purchasing long-term care insurance, and setting aside funds for their children’s future care.

    Changing Care Options

    The aging population continues to transform the landscape of care options. In the past, Americans could rely on federal support to meet their retirement needs. However, today’s retirees can no longer be certain about the availability of such support. Federal programs are already under strain, with a significant increase in the number of retirees receiving social security benefits. In addition, the U.S. Census Bureau states approximately 4.4 million Americans (12,000 people per day) will turn 65 in 2024, placing even more pressure on an already stretched system.

    Statistically, individuals aged 65 or older have a 70% chance of requiring some form of long-term care support. Surprisingly, Medicare does not cover long-term care, and Medicaid coverage is limited to approved facilities, leaving individuals with minimal control over their aging journey. In addition, to qualify for Medicaid coverage, individuals must exhaust a significant portion of their hard-earned assets. Although some states have introduced long-term care funding programs, the limited benefits they offer are unlikely to cover the substantial costs associated with long-term care.

    The Role Of Private Insurance

    The retreat of many private insurance carriers from the long-term care space has left consumers with fewer options. However, private insurance alone cannot provide a comprehensive solution. While the current landscape may appear overwhelming, there are viable options available. As a business owner, you play a crucial role in supporting your client’s lifestyle goals as they age, including helping them design a robust financial strategy to meet their long-term care needs.

    Pandemic-Era Trends And Costs Of Care

    The COVID-19 pandemic has further highlighted the importance of at-home care, with 88% of Americans expressing a preference for receiving ongoing assistance in their own homes or with loved ones. In-home care costs an average of $60,570 annually, while a one-bedroom assisted living apartment costs around $63,337 annually. The average cost of a year’s care in a private Medicare-certified long-term nursing home room is $116,577. This preference for at-home care places additional strain on caregivers, impacting their personal finances, mental health, and social lives. Caregiving is often emotionally, socially, physically, and financially more challenging than expected, particularly for women who tend to spend more time caring for aging relatives.

    Building Support Systems

    As more individuals opt for aging at home, robust support networks become increasingly critical. Caregivers face mounting physical and mental health challenges, making it essential to establish reliable support systems. Data indicates that caregivers are already seeking help, with family members and friends being the most common sources of support. Planning for a network of paid and unpaid caregivers empowers individuals to maintain control over their care situation while alleviating the burden on individual caregivers.

    The Role Of Financial Planning

    Financial planning is often the weakest link in people’s support systems. Encourage your clients to plan early for their long-term care needs, regularly reassess their plans, and make necessary adjustments. Collaborating with a trusted financial professional can make all the difference, providing clients with the confidence and peace of mind they need as they navigate the complexities of long-term care.

    Addressing Long-Term Care Challenges With A PEO

    In navigating the increasingly complex landscape of long-term care, small business owners face unique challenges in supporting their employees and planning for their future care needs. A professional employer organization (PEO) can lend a helping hand in this journey, offering comprehensive solutions to address the evolving needs of employees and employers.

    Small business owners can access tailored benefits packages, expert guidance on financial planning for long-term care, and support in establishing robust support systems for employees when they partner with a PEO. In addition, GMS, a certified PEO (CPEO), can provide access to cost-effective insurance options and valuable resources to help small business owners and their employees navigate the intricacies of long-term care planning. Address the long-term care needs of your employees while securing their financial well-being by partnering with GMS. Contact us today to learn more.

  • Health care costs in the United States have been steadily climbing, and the burden on employers providing health care benefits for their workforce is intensifying year by year. A recent report by Aon forecasts a looming challenge: average costs for employers covering their employees’ health care are projected to surge by 8.5% in 2024, amounting to over $15,000 per employee. This steep rise marks a concerning trend, nearly doubling the previous year’s increase of 4.5%, setting off alarm bells for companies navigating their health care budgets.

    Driving Factors Behind Escalating Costs

    Let’s take a look at three pivotal elements that are steering this surge in health care expenses.

    Inflation: The silent aggressor

    Inflation, accounting for roughly half of the cost hikes, substantially impacts health care expenses. The health care sector experiences a delayed effect due to multi-year provider contracts. Renewals in these contracts are causing providers to demand higher fees, thereby stretching the impact of inflation over several years.

    COVID-19’s lingering impact

    The aftermath of the pandemic continues to cast a shadow over health care costs. Medical utilization, which plummeted during the peak of the pandemic, is now reverting to pre-COVID levels. This resurgence in medical usage is a driving force behind the escalating health care expenditures for employers.

    Surging prescription drug costs

    Prescription drug expenses are spiraling at an alarming rate, surpassing the growth rate of medical costs. The use of specialty drugs such as GLP-1 and medications initially designed for diabetes, which are now being utilized for weight loss, have doubled between 2022 and 2023.

    Navigating The Way Forward

    The tight labor market continues to discourage passing higher health care expenses onto workers. However, future projections indicate an inevitable shift towards significant changes in employee contribution as employers prepare for 2025. Employers are creating strategies to manage costs, including targeted plan adjustments to address expensive medications and treatments. In addition, a shift in vendors is anticipated to secure better prices and discounts on health care services. The focus on mental health services is also expected to intensify, acknowledging the importance of employee well-being.

    How PEOs Are Revolutionizing Employee Benefits

    In the face of these health care cost escalations, employers find themselves at a critical stage where innovative solutions are imperative. The strain of balancing employee well-being with financial sustainability requires a strategic approach. This makes the role of Group Management Services, a certified professional employer organization (CPEO), crucial. GMS extends a lifeline to businesses, offering access to various benefits through our master health care plan (MHP). Through pooled resources, negotiated rates, and streamlined administration, GMS enables companies to combat increasing health care expenses effectively. By leveraging GMS’ buying power and expertise, businesses can navigate these unprecedented times and provide quality health care benefits to their employees while maintaining a competitive edge in the marketplace. Get a quote from us today and end the open enrollment period on a high note.

  • Imagine walking into your workplace greeted not just by colleagues but also by furry friends wagging their tails. This isn’t a far-fetched dream but a growing reality in many forward-thinking companies today. A pet-friendly workplace isn’t just about accommodating pets; it helps foster a happier, healthier, and more productive work environment.

    Creating A Welcoming Environment

    Introducing pets into the workplace isn’t just about indulging in cute and cuddly moments. It’s about setting a tone of inclusivity. Pets have the ability to reduce tension and create positivity. 87.3% of Americans were reported as happier than the average person because of owning a pet. Their presence often leads to increased social interactions among employees, fostering camaraderie. Pets contribute to longer lives by influencing longevity, stress reduction, and fighting cardiovascular disease.

    Enhancing Employee Well-Being

    Stress is a ubiquitous aspect of modern work life. Approximately one million Americans miss work each day because of stress, with 94% of workers feeling stressed at work. However, the fix to this might be simpler than we thought. Studies consistently show that interaction with pets can significantly reduce stress levels. Petting a dog or playing with a cat can trigger a release of oxytocin, the feel-good hormone, leading to decreased cortisol levels, which, in turn, reduces stress and anxiety.

    Boosting Productivity And Creativity

    Contrary to popular belief, allowing pets in the workplace doesn’t necessarily lead to chaos. Instead, it often results in increased productivity. Employees tend to take shorter breaks, opting for playful moments with pets rather than longer, more distracting pauses. In addition, the presence of pets can stimulate creativity, providing mental breaks that inspire fresh perspectives and innovative thinking.

    Fostering A Healthier Lifestyle

    Pets encourage physical activity. Taking a dog for a short walk or playing a quick game of fetch during breaks can promote a more active lifestyle among employees. In addition, the responsibility of caring for a pet can instill a sense of routine and discipline, positively impacting the overall well-being of employees who own pets.

    Attracting And Retaining Talent

    A pet-friendly policy can be a powerful tool in attracting and retaining top talent. For many, the ability to bring their furry companions to work is a significant perk. It showcases the company’s commitment to employee happiness and work-life balance, ultimately contributing to a positive employer brand.

    Considerations And Implementation

    Implementing a pet-friendly policy requires careful consideration and guidelines to ensure a harmonious environment for everyone. Factors such as allergies and pet behavior should be taken into account. Should you consider a pet-friendly workplace, it’s essential to clearly define rules and designate pet-friendly areas to maintain a balance between accommodating pets and respecting the needs of all employees.

    Fetching Solutions

    In embracing a pet-friendly workplace, we unlock a world of positivity, improved well-being, and heightened productivity. However, transitioning to this innovative work culture requires careful planning and consideration. This is where a professional employer organization (PEO) can lend a helping hand. PEOs like GMS specialize in HR management, providing expertise in creating and implementing policies that cater to diverse workplace needs. From crafting pet-friendly guidelines to addressing logistical concerns, partnering with GMS can streamline the process, ensuring a smooth and successful integration of pets into the workplace. Partnering with GMS allows businesses to confidently venture into this exciting opportunity, fostering an environment where wagging tails and productive workdays seamlessly coexist. So, why not pave the way for a more paw-sitive work environment? Contact us today to learn more.

  • In recent years, the corporate landscape has shifted towards more inclusive and comprehensive employee benefits. A notable and groundbreaking addition to this trend is the growing acknowledgment of menopause and the need for the workplace to offer support. The conversation gained momentum when Microsoft took the lead in recognizing the gaps in its benefits package and proactively addressed the unique needs of employees navigating menopause.

    The Catalyst

    A spark for change regarding better workplace support for menopausal women echoes across the U.S. and beyond. At Microsoft, the conversation was kickstarted by an internal podcast featuring a guest who openly shared her menopause journey. Sonja Kellen, Microsoft’s Senior Director of Global Health and Wellness, reflected on the company’s existing benefits – comprehensive medical coverage and flexible working arrangements – but realized they lacked a benefit specifically tailored to menopause.

    The Turning Point

    Recognizing the missing piece in their benefits package, Microsoft partnered with Maven Clinic, a virtual health care provider specializing in women’s health. In July, the company rolled out a comprehensive menopause support program for its global workforce. The benefits, facilitated through Maven Clinic, included the following:

    • Hormone therapy
    • Physical therapy for pelvic-floor issues
    • Access to specialists in menopause care
    • Menopause-specific paid leave

    A Growing Trend

    Microsoft is among a pioneering group of employers acknowledging the importance of menopause support. While still a minority, the number of companies offering menopause benefits is gradually increasing. According to a report by benefits consultant NFP, around 4% of employers with sick leave policies currently provide additional support for menopause. However, 32% expressed openness to incorporating such benefits within the next five years.

    A growing understanding of the economic and personal impact of menopause drives the increase in interest. Studies estimate that menopause costs the U.S. economy $1.8 billion in lost working time annually, with an additional $26.6 billion in medical expenses. A Bank of America report revealed that 64% of working American women desire menopause-specific benefits, signaling a demand for more comprehensive workplace support.

    Kate Ryder, Chief Executive Officer (CEO) of Maven Clinic, highlights the significant gap in support for menopausal employees. The virtual health care provider, working with over 300 employers, has witnessed rapid adoption of its menopause benefits suite. The suite connects workers to virtual care providers, sleep coaches, OB/GYNs, nutritionists, and other professionals trained in menopause care. Ryder emphasizes that the conversation around menopause is gaining traction and is poised to continue growing.

    Inclusive Benefits

    The push for menopause benefits aligns with a broader movement towards inclusivity in workplace benefits. As companies focus on fertility benefits and parental leave, there’s a realization that employees in different life stages also need tailored support. The idea is to provide services and support similar to resources available during other transformative life stages, such as pregnancy.

    Success Stories

    You may ask – is it worth it? Microsoft’s early success with menopause benefits underscores the unmet demand for such support. With over 1,000 activations in the first week and over 3,000 provider-member interactions within the first few months, Microsoft’s menopause support resonated with its diverse global workforce. The steady increase in employee sign-ups signifies sustained interest and utilization of the new offering.

    Employers offering menopause benefits are witnessing positive impacts on workplace dynamics. Among the notable outcomes are reduced absences, enhanced productivity, and increased employee engagement. The Bank of America report indicates that 58% of women perceive positive effects on their work when menopause benefits are provided. In addition, these benefits contribute to higher retention rates, making the workplace more attractive and supportive.

    Why Partner With A PEO?

    The emergence of menopause benefits as a pivotal workplace perk signifies a progressive shift in how businesses prioritize the well-being of their employees across all life stages. Microsoft’s proactive stance and the increasing interest from other employers underline a commitment to fostering an inclusive and supportive work environment. For business owners, recognizing the impact of menopause on individuals and the bottom line is essential.

    To navigate this evolving landscape seamlessly, consider the role of a professional employer organization (PEO) like Group Management Services (GMS). PEOs specialize in comprehensive HR solutions, ensuring that businesses can effortlessly integrate and manage benefits that address the diverse needs of their workforce. By embracing menopause benefits and leveraging PEO expertise, businesses can attract and retain top talent and cultivate a workplace culture that values every employee’s journey. Interested in learning more? Contact us today.

  • Let’s be honest: Managing health care can be challenging and expensive for your business. You might think about putting it on the back burner, but with health care costs consistently rising, you can’t afford to wait. In addition to a fair paycheck, your employees expect competitive benefits to take care of themselves and their families. Understanding what your employees want and need is a big part of managing health care successfully, but the complexity lies in ensuring compliance.

    Navigating health care can be a challenging endeavor, especially for small businesses. It involves grappling with ethical considerations and data privacy concerns, making compliance a growing challenge. In this context, non-compliance could result in substantial fines and potentially lead to legal ramifications, a scenario you want to avoid.

    Partnering with a professional employer organization (PEO) like GMS can be a great option to alleviate some stress. GMS offers an excellent solution for obtaining comprehensive health care coverage for your team while maintaining compliance. However, if you are determined to handle health coverage independently, there are essential things to consider.

    Health Care Compliance

    Under the Affordable Care Act (ACA) guidelines, businesses with 50 or more full-time employees or the equivalent in full-time equivalents (FTEs) must provide health insurance coverage. In addition, you must provide this coverage to all eligible employees within a maximum waiting period of 90 days. Failure to comply can lead you and your business to face hefty penalties.

    You’ll also need to provide employees with a comprehensive Summary of Benefits and Coverage (SBC). The primary objective of the SBC is to offer a clear and detailed explanation of what the health plan encompasses, as well as the associated costs. This empowers your team to make well-informed decisions concerning their health care choices.

    Suppose your business fails to meet these requirements, and one or more of your full-time employees receive premium tax credits or other government assistance to purchase coverage on the Health Insurance Marketplace. In that case, you may be subject to the Employer Shared Responsibility Payment (ESRP). This payment is a financial penalty imposed on the company to ensure large employers play their part. The ESRP ensures that large employers provide access to affordable health care coverage for their employees and prevents them from shifting the cost of health care coverage to government-subsidized programs.

    • Note: Businesses with less than 50 full-time or FTEs are not subject to ESRP.

    Compliance For Small Businesses

    You may be thinking health care compliance doesn’t apply to smaller businesses. While it’s true that you’re not obligated to offer health insurance, it shouldn’t be overlooked as it can be a valuable tool in recruitment and retention efforts. If you decide to provide health insurance for your staff, it’s crucial to customize your coverage to match your team’s specific needs while ensuring compliance with the regulations and protections outlined in the Americans with Disabilities Act (ADA). A general framework for achieving this is outlined below:

    1. Use anonymous surveys. Seek input from your team regarding their health care needs and preferences by using anonymous surveys. Anonymity can help ensure that individuals feel comfortable providing honest and open feedback without fear of potential discrimination.

    • Focus on health care needs. Frame your questions to inquire about specific health care needs and preferences rather than individual health conditions. For example, you might ask your employees about preferred types of coverage, particular services they value, or what aspects of their current plan they find beneficial or lacking.
    • Avoid discrimination. Be careful not to ask questions that directly or indirectly solicit information about an employee’s medical condition or disability. Questions about medical histories, specific conditions, or disabilities are inappropriate and can violate the ADA.
    • Consult legal or HR experts. If you have doubts about the legality or sensitivity of your survey questions, consider consulting legal experts or human resource professionals who are well-versed in ADA and ACA compliance. They can help you craft surveys that are both effective and legally sound.

    2. Educate your team. Ensure your employees know their responses will remain confidential and used solely to improve the company’s health care offerings. This can help build trust and encourage participation. 

    3. Review and adjust coverage. After collecting anonymous feedback, use the information to assess your current health care coverage and identify potential areas for improvement. Seek out insurance plans that align with the stated needs of your employees. 

    Traditionally, small-group insurance has been a primary option for small businesses providing benefits to their team. However, several other options may be suitable for your business, including self-funded, level-funded, and health reimbursement arrangements (HRAs).

    Supplemental Insurance

    To attract and retain top talent, every business owner should understand the importance of providing a comprehensive benefits package. However, in today’s increasingly competitive labor market, solely offering traditional group health insurance may no longer suffice. This is where supplemental insurance plans come into play.

    Supplemental insurance plans, often referred to as voluntary benefits plans, are not mandatory under the law but have become a crucial component of a well-rounded benefits package. These plans offer a host of valuable benefits that can complement your standard group health insurance, making them an attractive proposition for both employers and employees alike.

    At GMS, we recognize the significance of offering diverse and tailored health coverage options to meet the unique needs of your workforce. When you choose to partner with us, you empower your employees with the flexibility to select supplemental health insurance that suits their individual requirements. These supplemental insurance plans can include, but are not limited to:

    • Life
    • Dental
    • Vision
    • Accidental and critical illness
    • Long and short-term disability
    • And more!

    By incorporating these supplemental insurance plans into your benefits package, you empower your employees to make choices that align with their unique health care and financial needs. This not only sets your organization apart as an employer of choice but also demonstrates your commitment to the well-being and financial security of your workforce, fostering a loyal and contented team. Contact us today and let us find a plan that meets your team’s needs.

  • Health spending has steadily increased over the last few years, making health insurance one of the most highly prized employee benefits. Employer-provided health care plays a crucial role in recruitment and retaining top talent. In an era where employees are increasingly open to changing jobs, businesses are reassessing the benefits they offer, including health insurance – however, not all health plans work the same way.

    Group health insurance varies in terms of how the insurance is purchased and how it affects the group’s premiums and plan options. If you’re looking for ways to navigate your options, we’ve compiled a few of the most popular plans available.

    Group Health Insurance Options

    While all health plans have their pros and cons, it’s up to you to decide which makes the most sense for you and your employees’ needs. The following are common types of group health insurance options available for small businesses.

    Fully Insured Plans

    A fully insured plan is one of the more traditional types of group health insurance. Fully insured plans involve the insurance company taking on the risks involved with health care costs. Your business is then charged an annual premium for the benefits in the insurance policy, which is partially paid for by the employees.
    The insurer uses a variety of factors to calculate group health insurance premiums, including:

    The insurer uses a variety of factors to calculate group health insurance premiums, including:

    • Size and health of the group
    • The average age of the group
    • The employer’s claims history
    • Types of occupation
    • Level of coverage and add-on benefits

    Self-Funded Plans

    While the insurance company covers employee health costs in a fully insured plan, self-funding burdens the employer. In a self-funded plan, you’ll pay for employees’ health care claims and administrative costs directly rather than paying fixed premiums to an insurance company. This can often lead to more affordable rates and more control over your plan, with the tradeoff of your business accepting the risk of paying for catastrophic claims.

    The potential risk is why self-funded plans are more prevalent among larger companies and organizations that can easily absorb fluctuations in health care costs and want more control over their benefit offerings. However, small groups can also take advantage of self-funded plans. Small businesses can opt for a partially self-funded plan if they have a financial buffer or stop-loss insurance. This option allows small businesses to reap some of the benefits of self-funding while limiting risk.

    Level-Funded Plans

    Level-funded plans strike a balance by merging elements from fully insured and self-funded models. They’re an excellent fit for smaller businesses that might need more time to embrace the risk of a self-funded plan but are prepared to step away from fully insured premiums. They offer cost-saving potential and greater control compared to fully insured plans while still providing financial predictability.
    Unlike traditional plans with annual premiums, level-funded options are charged at a monthly payment rate. Insurance carriers will use census information to determine the amount your small group should pay. This rate is based on factors such as claims allowances, fees, and stop-loss coverage premiums. At the end of the year, the carrier will adjust the monthly level based on group performance.
    The employer is typically refunded if there is a surplus in the fund due to lower-than-expected claims. This approach allows small businesses to manage costs efficiently and consider a future transition into a self-funded plan.

    Health Maintenance Organization (HMO)

    An HMO is a group coverage setup where members pay for specific health services through monthly premiums. These plans prioritize cost-effective and comprehensive health care services for their members. With an HMO, you gain access to a designated network of health care providers and facilities, but your coverage is typically limited to services within this network. This focus on in-network care makes HMOs more affordable than other health insurance plans. However, seeing any physicians or facilities not included in your HMO network can result in a group member having to foot the entire bill.

    Preferred Provider Organization (PPO)

    PPO plans are like HMO plans, except with more flexibility. Like HMOs, PPOs also maintain a network of preferred health care providers, encompassing doctors, hospitals, and specialists. However, what sets PPOs apart is the freedom they grant their members. PPO members can choose to receive care from within the in-network providers or venture outside to out-of-network providers without having to cover the entire cost themselves. Instead, these visits will result in higher co-pays and additional service costs, giving members more freedom than HMO plans.

    High-Deductible Health Plan (HDHP) With A Savings Option (HDHP/SO)

    An HDHP is based on lower premiums and higher deductibles for group members. This means that members with this type of health care insurance will have to pay more out-of-pocket before the plan pays for its share. The tradeoff, however, is that this route allows monthly premiums to be lower, making it a good group health insurance option for employees who don’t use many medical services.

    In addition, you can pair HDHPs with savings options such as a health savings account (HSA). These accounts allow members to make tax-free contributions to an account that can be used to pay for health care costs, ranging from co-pays to primary medical services. The funds in these accounts roll over every year, making them a great retirement savings option, too.

    Health reimbursement accounts (HRAs) are another potential savings option that can be tied to an HDHP. These accounts are similar to HSAs, except employers make the contributions instead of employees.

    Choosing The Right Type Of Health Insurance For Your Small Business

    Finding the right group health insurance plan for your budget can be difficult. Balancing benefits administration and budgets can be overwhelming for anyone without a firm grasp of the health care system.
    That’s why many small business owners work with a professional employer organization (PEO) to help weigh their group health insurance options and handle the administrative burden of health care coverage. Whether your organization lacks an HR department or simply needs a resource to make more informed decisions about the management of benefits, GMS is here to help.

    GMS changes the approach to increase affordable options and give your employees access to small business health insurance. We give small businesses the buying power of a large corporation. Contact GMS today to speak with one of our experts about how we can help you offer quality healthcare plans that work with your budget.

  • Open enrollment is here again, and it brings the stress of navigating and enrolling in the ideal health care plan. Under the Affordable Care Act (ACA), employers with 50 or more full-time employees or the equivalent must provide health care to their team. Regardless of your team’s size, health care is a leading benefit that can assist with hiring and retention efforts due to the rising cost of personal health expenditures. Therefore, offering health care to your employees is something you should take seriously.

    Finding and evaluating multiple plans and pinpointing the best option for you and your team is no easy feat. Moreover, after making your choice, ensuring your team comprehends and successfully enrolls in their chosen plans adds another layer of complexity.

    So, how can you best prepare your workforce and ensure a seamless experience for all? Collaborating with a professional employer organization (PEO), like GMS, can effectively reduce some of the stress and complications associated with open enrollment. In the meantime, we’ve gathered some strategies to help you get started.

    Open Enrollment

    Open enrollment occurs annually, usually from November to January. During this time, employees can enroll in a new health insurance plan, tweak their existing coverage, or, if necessary, say goodbye to their current coverage.

    The significance of this period lies in the fact that any changes outside this window are restricted and limited. If you miss the enrollment season, make a mistake, or decide you want a different plan after it’s over, you’ll have to wait until the next open enrollment period to make those changes. Some exceptions include qualified life experiences such as having or adopting a child, marriage, or divorce, to name a few. Making informed decisions during this time can significantly impact your financial and overall well-being throughout the year. So, take your time, weigh your options, and ensure you’ve covered everything.

    Mistakes To Avoid

    Open enrollment is confusing enough. Preparing for the most common mistakes can help you and your team have a successful enrollment season.

    Missed deadlines

    Missing deadlines is one of the most common pitfalls because open enrollment can vary from year to year. However, open enrollment typically begins on November 1st and concludes on January 15th. To ensure your employees meet these deadlines, it’s essential to be well-prepared, maintain transparent communication with your team, and consistently send reminders about approaching cut-off dates. Timely submission of enrollment forms is necessary to secure coverage for the upcoming year.

    Defaulting to past plans

    We know you have a lot on your plate, and sticking with your previous year’s plan might seem like the most straightforward option. However, this can be detrimental in the long run. Health plans and their associated costs frequently change from year to year, and so do the health care needs of your team. Failing to reassess your coverage options can result in inadequate coverage or unexpected costs. It’s imperative to take the time to reevaluate your current plan and determine if it aligns with the evolving needs of your employees.

    Providing too many choices

    While offering various health care plan options is critical, it’s equally crucial not to overcomplicate the selection process. Limiting the choices to the most essential or popular plans is key. Providing too many options can confuse and overwhelm employees, making it difficult for them to make an informed decision. A concise selection of plans can streamline the decision-making process, making it easier for employees to choose the most suitable coverage.

    Ignoring plan details

    Another common mistake employers make is not thoroughly evaluating the details of the available plans. You should review each plan’s specifics to understand the coverage and costs. Ignoring these details can contribute to a poor plan selection, leading to discontent among your team, ultimately affecting employee satisfaction and, in turn, harming your retention and recruitment efforts. Therefore, it’s vital to take the time to thoroughly examine each plan to guarantee you’re making the best choice for your employees’ well-being and satisfaction.

    Not considering family needs

    Health insurance isn’t a one-size-fits-all solution. Failing to consider your team’s and their families’ specific health care needs can result in inadequate or too expensive coverage, which would, in turn, be noncompliant with the ACA. Assess whether the plans you choose meet the needs of your employees, their spouses, and dependents, including any special health care requirements or medications.

    Underestimating the cost-benefit analysis

    While lower monthly premiums might seem appealing, it’s essential to consider the broader cost-benefit analysis. A plan with slightly higher premiums may offer better coverage and lower out-of-pocket expenses, ultimately saving you and your team money in the long term.

    Failing to educate employees

    Proper information is the cornerstone of informed decision-making. Failing to educate your employees about the available plans and their intricacies can result in uninformed choices. To address this, providing clear and comprehensive information about each option is essential, including coverage details, costs, in-network providers, and any changes from the previous year. Consider conducting informational sessions or webinars to ensure your team has the knowledge to make well-informed decisions about their health care coverage.

    Forgetting ancillary benefits

    In addition to health care, other valuable benefits are often available during open enrollment, such as dental, vision, life insurance, and retirement plans such as a 401(k) match program. Overlooking these ancillary benefits can mean missing out on essential perks that contribute to the overall well-being of you and your team.

    By avoiding these common mistakes and investing time and effort into open enrollment, you can make informed decisions that lead to better health care coverage and financial well-being for you and your team.

    Compliance

    Maintaining compliance with the ACA requires meticulous attention to your health care plan choices. This encompasses a thorough assessment of various aspects, such as out-of-pocket maximums and the essential health benefits mandated by the ACA. These requirements are the foundation for ensuring that your health plans align with the legal framework and offer comprehensive coverage for your employees.

    In addition, fostering an inclusive environment is crucial for ACA compliance. It’s imperative that all employees, regardless of their circumstances, have an equal opportunity to engage in the benefit enrollment process.

    This commitment to inclusivity extends to employees with disabilities, who should receive the support they need through auxiliary aids, alternative formats, and other necessary accommodations. These measures guarantee regulatory compliance and cultivate a work environment that respects the diverse needs of all team members, contributing to a more equitable and welcoming workplace.

    Comprehensive Small Business Health Insurance Solutions

    Offering small business health insurance is easily one of the most complicated and costly aspects of running a business. You want to provide your employees with the best health care benefits, but you’re also dealing with rising insurance premiums, compliance, and mountains of paperwork. With a PEO like GMS, you can decrease costs while providing top-tier medical coverage and reducing administrative burdens.

    GMS represents more than 45,000 employees, which allows us to help small businesses purchase group health insurance for an average of 24% lower for employee premiums and 21% lower for family premiums than the U.S. average. GMS is the only PEO that provides an in-house master health plan that helps you avoid large swings in usage, trends, and renewal rates.

    Our experts are here and are ready to provide guidance on how to utilize your plans best. Contact us today and let us help get your team the best health care possible!