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  • The Internal Revenue Service (IRS) has responded to rising inflation by raising the contribution limits for health savings accounts (HSA). An HSA is a savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. Starting in 2024, individuals can allocate more funds towards their HSAs, offering a powerful way to save for medical expenses.

    What To Expect In 2024

    In 2024, the annual HSA contribution limit for self-only coverage will surge to $4,150, representing a remarkable seven percent increase from 2023. This means you can set aside even more money on a pre-tax basis, significantly boosting your health care savings potential. But that’s not all; for those with family coverage, the HSA contribution limit is increasing to $8,300 in 2024, a substantial rise from the previous limit of $7,750. This adjustment allows families to allocate more funds towards their health care expenses, ensuring comprehensive coverage and financial peace of mind. Additionally, individuals aged 55 and older can take advantage of being able to contribute an extra $1,000 to their HSAs.

    High-deductible health plans (HDHPs) are also subject to updates in 2024, ensuring a balance between affordability and comprehensive coverage. An HDHP is a plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (your deductible). In 2024, HDHPs must have a minimum deductible of $1,600 for self-only coverage and $3,200 for family coverage. The annual out-of-pocket expense maximum cannot exceed $8,050 for self-only coverage in 2024 or $16,100 for family coverage, representing significant increases.

    What Employers Should Know

    Apart from individual benefits, the IRS has introduced updates that benefit employers as well. The IRS announced that in 2024, it will also raise the maximum amount employers may contribute to an excepted-benefit health reimbursement arrangement (HRA) to $2,100. An HRA is an account an employer can set up to reimburse employees for out-of-pocket health care expenses. This means you can provide your employees with even more financial support for their out-of-pocket health care costs. Show your team you care by offering enhanced benefits that truly make a difference.

    Boost Your Benefits For Your Team

    As we recognize the IRS’s boosts to HSA and HDHP limits in 2024, it’s important to remember that navigating these changes can be complex. As a business owner that has made it through unprecedented times, such as the COVID-19 pandemic and the intense labor market, you understand how important it is to stay ahead of the curve. This is where a professional employer organization (PEO) like GMS enters the picture to become a small business owner’s best friend.

    When you partner with GMS, you gain access to our comprehensive group health coverage plan that ensures compliance with the latest regulations and provides cost-effective solutions tailored to your unique needs. GMS represents more than 45,000 employees, which allows us to help small businesses purchase group health insurance for an average of a 24% lower cost for employee premiums and 21% lower for family premiums than the U.S. average.

    Allow us to guide you through these transformative times, empowering you to focus on what you do best – growing your business while securing the well-being of your employees. With GMS by your side, you can confidently embrace the future of health care and thrive in an ever-changing business landscape. Interested in learning more? Contact us today.

  • When shopping for health insurance plans for your employees, you may be overwhelmed by all the different options’ nuances. The prices and coverage can vary widely, so understanding the differences between each plan is essential to determine which suits your situation best. In this post, we’ll discuss the main distinctions between Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Provider Organizations (EPOs), and Point-of-Service (POS) plans and weigh the benefits and drawbacks of each program so you can provide your team with the right health plan.

    What Are Provider Networks?

    Provider networks are a collection of doctors, hospitals, facilities, and health care providers and insurer contracts to offer medical care to their insureds at a negotiated rate. For example, if someone uses in-network providers (doctors or hospitals), their out-of-pocket costs will be lower than if they went out of network.

    However, if you choose a plan without provider choice and your employee doesn’t use an in-network doctor, your employee should expect higher out-of-pocket costs because the insurer won’t cover the higher cost of services their contracted providers could have provided.

    What Are The Types Of Health Insurance Plans?

    There are four main types of health insurance plans: HMO, PPO, EPO, and POS. Plans can include the use of a primary care physician (PCP), who is typically the first person someone sees when visiting a doctor and will serve as their main point of contact for medical services. PCPs generally coordinate all aspects of care and can refer their patients to specialists if necessary.

    What are HMOs?

    An HMO is a networked system where a primary care physician can oversee care and refer patients to specialists when required. HMOs require patients to receive care from a determined network of doctors and hospitals and may not cover additional costs if they see an outside physician or seek treatment out of town.
    Because HMOs are so restrictive regarding freedom-to-choose health care providers, they typically have lower out-of-pocket costs for covered services.

    Likewise, suppose your employee needs specialized services such as physical therapy or mammography testing outside regular doctors’ offices/hospitals within their respective networks. In that case, there are additional steps to go through. For example, “pre-authorization” approvals may be required from both their PCP and the specialized physician, plus a sign-off stating why such procedures should occur at particular locations according to the guidelines of their HMO plan.

    Pros:

    • Coordinated care
    • Lower monthly premiums
    • Lower out-of-pocket expenses 

    Cons: 

    • Most restrictive options
    • Higher deductibles 
    • Coverage does not travel 
    • Require referrals

    What are PPOs?

    A PPO is the most common type of network-based plan. This plan allows patients to see any doctor within its network but requires preapproval if they want to see an out-of-network specialist or hospital for services not covered by the plan’s benefits package. With a PPO, your employees can access a network of doctors and hospitals that have agreed to provide services at a discounted rate for their plan.

    Additionally, they can see any doctor or hospital within the PPO’s network, even if the care isn’t in-network with your insurance company, and they’ll pay some or all the cost depending on what level of coverage you have chosen.

    Because there are so many providers available through these networks, there will likely be one nearby where your employees live or work, as well as other locations in case something happens while traveling. There’s additional flexibility when choosing where to go when seeking medical treatment since there aren’t any restrictions based on location.

    Pros:

    • Access to negotiated rates
    • Flexibility to see doctors in and out-of-network
    • No referrals are required
    • Travels with you

    Cons: 

    • Higher premiums
    • Require more preapprovals 
    • Must coordinate and manage your own care
    • Higher out-of-pocket expenses

    What are EPOs?

    An EPO also allows patients to see any doctor within its network but doesn’t require preapproval for non-covered services as long as providers within that network provide them. If you choose an EPO plan, your coverage correlates with the provider’s negotiated rates based on the services performed. Therefore, there are no pre-set prices for procedures or services; it’s up to the individual doctor or hospital what they charge for their services (and how much they’ll accept from your insurer).

    In an EPO plan, PCPs aren’t a requirement, but many people still choose to have one for convenience and ease of coordinating care. However, if you select an EPO plan, your employee’s coverage is limited to the network of providers within the EPO to cover all their medical needs, as there are no out-of-network benefits.

    Pros: 

    • Freedom to see any in-network provider
    • Lower monthly premiums
    • Large networks 

    Cons: 

    • No out-of-network benefits 
    • Higher deductibles 

    What is a POS?

    POS plans fall between an HMO and PPO plan. Members typically need a referral before seeing a specialist, but they still have coverage for out-of-network care—though the copays might be higher than if everything were in-network. Patients must generally stay in-network for services, but they may be authorized to receive out-of-network care if it is medically necessary. However, as with a PPO plan, benefits and coverage may be at a reduced rate.

    Pros: 

    • Flexibility to see doctors in and out-of-network
    • Lower copays
    • Zero deductibles when in-network

    Cons: 

    • Require referrals 
    • Upfront fees
    • High out-of-network costs

    Managing Health Care Expenses

    High deductible health plans (HDHPs) combined with enrollment in a health savings account (HSA) are alternative health care plans with lower premiums and higher deductibles than more traditional plans.

    What are HDHPs?

    The IRS defines HDHPs as any health plan with a minimum deductible of $1,500 for individuals and $2,800 for families. These plans have lower monthly premiums than traditional plans and typically cover less in terms of medical services; however, your employees pay more out-of-pocket if they use their health insurance benefits before meeting their deductible (the amount one must pay before insurance kicks in).

    Healthy individuals may benefit from having an HDHP because they don’t need medical care as often, so they can save money on their monthly premiums. In comparison, people with chronic illnesses or those who are older may end up paying more out-of-pocket when they use their benefits before meeting the high deductible amount each year.

    What are HSAs?

    An HSA allows employees to set aside pre-tax income to pay for qualified medical expenses, including deductibles, copayments, and other out-of-pocket costs. They can also use HSA funds to save for retirement as well as help cover medical costs in retirement.
    Additionally, funds roll over from year to year and never expire, so they won’t lose money if they don’t use it all at once.

    HSAs offer some flexibility when making contributions: if you, as their employer, make contributions directly into their account, those amounts count toward meeting the annual deductible requirement. However, if they make their own contributions (either directly or through payroll deduction), they don’t count toward meeting that requirement but do increase the amount of funds available for future use.

    How To Choose The Best Plan For Your Employees

    Before signing up for a policy, ensure you understand how the plan works and what type of coverage it will provide. You should have sufficient information about each plan and compare their details before making an educated decision about which is best for your employees. Here is a list of questions you should be able to answer before selecting a plan:

    • Are the doctors or hospitals included in the network located where your employees live?
    • Are specific procedures or medications vital for managing chronic conditions such as diabetes or blood pressure covered?
    • Is the plan self-funded or fully insured?
    • What is the size of the network, and how is it structured?
    • Will they use savings options such as an HSA, flexible spending account, or health reimbursement arrangement?
    • What does the pharmacy plan look like?
    • What can your company comfortably contribute?
    • What does the servicing model look like? Who are you purchasing the plan through?

    The Importance Of Understanding The Unique Benefits Of Each Health Insurance Plan

    Health insurance is becoming increasingly complex. A solid understanding of the different types of plans and their benefits is essential to make the best choice for your business and employees. With so many situational aspects affecting families and individuals differently, speaking with an expert to evaluate your needs can be a game changer. That’s where GMS comes in.

    GMS has a team of dedicated professionals who will walk you through the plans based on your specific circumstances, so you know exactly what you’re signing up for. We take care of complicated decisions so you can easily find what’s best for you and your employees. Additionally, by working with us, you can access top-tier group health insurance plans just like larger corporations, but at a reduced price. If you want to find out more about how our buying power will save you money while providing quality care for your employees, contact us today.

  • Among many things, the COVID-19 pandemic changed how providers connected with patients worldwide. To stop the spread of COVID-19 early on, many providers postponed or canceled patients’ appointments. As a result, telehealth became a prominent source of patient care and monitoring. Telehealth provides individuals with easy access to providers while decreasing in-person contact with health care facilities and staff. Patients receive real-time interactions monitored through a smartphone, tablet, or computer. Pre-deductible telehealth coverage was included in the 2023 omnibus spending bill. The bill proposed that the telehealth pre-deductible coverage would remain available for an additional two years. On December 29th, 2022, President Joe Biden signed the $1.7 trillion spending bill into law. The bill included extending telehealth relief provision, which supported the 2020 Coronavirus Aid Relief and Economic Security Act (CARES). The CARES Act pushed payments to eligible adults, expanded unemployment insurance, and gave loan borrowers additional time to make payments.

    Understanding Pre-Deductible Coverage 

    Understanding how your deductible works is an integral part of getting the most out of your policy. It’s imperative to understand how pre-deductibles work within your business. Pre-deductible benefits are implemented when your plan starts – giving access to you and your employees before reaching the set deductible. This allows you and your employees to receive coverage while removing the financial barrier – allowing the use of essential medicines, medical devices, and diagnostic tests.

    Good news for employers: the bill’s provision allows health savings account (HSA) -qualifying high-deductible health plans (HDHPs) to cover telehealth and other remote-care service options on a pre-deductible basis. Additionally, an otherwise HSA-eligible individual can receive pre-deductible coverage for such remote-care services from a stand-alone vendor outside of the HDHP. In both cases, the pre-deductible telehealth coverage won’t affect an individual’s eligibility to make or receive HSA contributions. In short, this pre-deductible coverage has improved access to health care options, in a convenient and accessible way.

    Following the HSA contribution rules, employees remain eligible for telehealth without affecting their contributions. Individuals within your organization could receive remote care from vendors in and outside of one’s network.

    Remain Protected With GMS 

    When the world shut down amidst the COVID-19 pandemic, telehealth services reached an all-time high. As we transition out of that period, there are certain benefits employees want to stay – pre-deductible telehealth coverage being one of them. Luckily, it has been extended another two years, but still leaves uncertainty for the future thereafter. As a partner of GMS, you can receive affordable and convenient health consultations with licensed physicians. Additionally, Teladoc saves you and your employees time from sitting in waiting rooms, minimizing the need to take time off work. Through our partner, Teladoc, your employees can stay healthy and productive. Contact GMS today to learn more. 

  • For the 2023 calendar year, the Internal Revenue Service (IRS) raised the contribution limit to a health savings account (HSA) to $3,850 for an individual and $7,750 for a family. Currently, the HSA limit is $3,650 for individuals and $7,300 for a family. These higher limits allow individuals and families to save more money on qualified expenses.

    An HSA is a savings account that allows you to set aside money on a pre-tax basis to pay for qualified medical expenses. With an HSA, you can use untaxed dollars to pay for deductibles, co-payments, and coinsurance which may lower your health care costs. HSAs are available only to individuals with a high deductible health plan (HDHP) which the IRS defines as a plan with an annual deductible that is no less than $1,500 for self-only coverage or $3,000 for family coverages for 2023. It also articulated that annual out-of-pocket expenses including deductibles and co-payments for an HDHP cannot exceed $7,500 for individuals and $15,000 for family coverage.

    There will be no change to the age 55+ HSA catch-up limit rules for 2023 so it remains at $1,000 per year. This allows any individual ages 55 and older to put away an additional “catch-up” contribution up to that amount annually. All adjusted limits will go into effect starting January 1, 2023.

    GMS Is Here To Help!

    Are you a business owner that doesn’t offer any health care benefits, but you think now might be a good time to introduce them? You’ve come to the right place. We understand that health coverage can be confusing. At GMS, our team of experts sits with your employees to explain the different health coverages available to them and determine the right fit. Learn more! 

  • 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.

    A woman stacking health insurance options for a small 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.