It is extremely important to have appropriate health insurance benefits for your small business.
To help you find the benefit that best suits your needs, we will review more than seven types of health insurance plans. Five of these are traditional group health insurance policies, but we will also offer you alternatives if group health is out of your budget.
Knowing these kinds of policies will prepare you to evaluate options each year as part of small business internal audits.
To help you find the benefit that best suits your needs, we will review more than seven types of health insurance plans. Five of these are traditional group health insurance policies, but we will also offer you alternatives if group health is out of your budget.
Knowing these kinds of policies will prepare you to evaluate options each year as part of small business internal audits.
1. Preferred Provider Organization (PPO)
The PPO Plan is a health insurance policy for the organized group of your preferred service provider.
With the PPO plan, employees are encouraged to use a network of favorite doctors and hospitals. These providers are contracted to serve plan members at a negotiated or reduced price. Staff are generally not required to designate a primary care doctor, but you will have the option to see any doctor or specialist within the plan's network.
Employees have an annual discount that they must meet before the insurance company begins to cover their medical bills. They may also have a copayment for certain services or joint insurance, since they are responsible for a percentage of your total medical expenses.
With PPO, out-of-network services can result in a higher than out-of-pocket cost.
With the PPO plan, employees are encouraged to use a network of favorite doctors and hospitals. These providers are contracted to serve plan members at a negotiated or reduced price. Staff are generally not required to designate a primary care doctor, but you will have the option to see any doctor or specialist within the plan's network.
Employees have an annual discount that they must meet before the insurance company begins to cover their medical bills. They may also have a copayment for certain services or joint insurance, since they are responsible for a percentage of your total medical expenses.
With PPO, out-of-network services can result in a higher than out-of-pocket cost.
PPO could be a good choice for your small business if the employees are:
- You need flexibility in choosing doctors and other service providers.
- Want the burden of getting a referral to see a specialist
- As the balance between a larger provider option for lower premiums
2. Health insurance plans for the Health Maintenance Authority
The Health Fund is a health insurance policy for a group of health maintenance organizations.
With a patient funding plan, employees generally have less out-of-pocket costs but also have less flexibility in choosing doctors or hospitals than other plans. The Staff Fund may require staff to choose a primary care physician (PCP). To see a specialist, employees will need to obtain a referral from their primary care provider.
Patient funds generally provide coverage for a broader range of preventive services than other policies. Employees may or may not be required to pay a deductible amount before coverage begins, and will generally receive joint compensation.
Most of the time, there are no mandatory forms to submit to the health fund. The main thing to note is that with most HMF plans, employees are not covered if they leave their network without proper authorization from the primary care provider or in certain emergency situations.
With a patient funding plan, employees generally have less out-of-pocket costs but also have less flexibility in choosing doctors or hospitals than other plans. The Staff Fund may require staff to choose a primary care physician (PCP). To see a specialist, employees will need to obtain a referral from their primary care provider.
Patient funds generally provide coverage for a broader range of preventive services than other policies. Employees may or may not be required to pay a deductible amount before coverage begins, and will generally receive joint compensation.
Most of the time, there are no mandatory forms to submit to the health fund. The main thing to note is that with most HMF plans, employees are not covered if they leave their network without proper authorization from the primary care provider or in certain emergency situations.
The sick box can be a good option for your small business if you:
- Lower premiums prefer
- Like barter for services within the network.
- Desire for good preventive services such as check coverage and immunizations.
3. Health insurance plans for service points
Point of sale is a health insurance policy for a group of service points.
Point of sale plans combine the characteristics of the patient fund and the PPO plan. Like a patient fund, POS plans may require employees to choose a primary care physician (PCP) from providers in the plan's network. In general, the services provided by PCP are not subject to a discount in the policy.
If employees use services covered or referred by the primary care provider, they may receive a higher level of coverage. If they use services from a provider that is not connected to the network, they may be subject to a lower level of coverage and at a discount. They may also have to prepay and file a claim for compensation.
Point of sale plans combine the characteristics of the patient fund and the PPO plan. Like a patient fund, POS plans may require employees to choose a primary care physician (PCP) from providers in the plan's network. In general, the services provided by PCP are not subject to a discount in the policy.
If employees use services covered or referred by the primary care provider, they may receive a higher level of coverage. If they use services from a provider that is not connected to the network, they may be subject to a lower level of coverage and at a discount. They may also have to prepay and file a claim for compensation.
The point of sale can be a good option for your small business if the employees are:
- You need flexibility in choosing doctors and other service providers.
- Primary care physicians want to coordinate care
- As the balance between a larger provider option for lower premiums
4. EPOs Health Insurance Plans
EPO is a group health insurance policy from exclusive providers.
EPO plans are similar to HMO plans in that they contain a network of doctors whose members must use them, except in an emergency. Staff members will have a Primary Care Physician (PCP) who will provide referrals to network professionals. EPO members are responsible for small joint payments and may require a discount.
EPO plans are similar to HMO plans in that they contain a network of doctors whose members must use them, except in an emergency. Staff members will have a Primary Care Physician (PCP) who will provide referrals to network professionals. EPO members are responsible for small joint payments and may require a discount.
EPO could be a good option for your small business if you:
- Like the bottom line of choosing a lower provider for lower prices
- Get employees who can find value with a smaller plate of service providers
- Ask comfortable staff to incur higher costs for unplanned events.
5. Health insurance compensation plans
Compensation health plans are known as service fee plans because of predetermined amounts or percentages of costs paid to a member against covered services. The member may be responsible for deductions and joint insurance amounts.
In most cases, the member will pay out of pocket first and then file a claim to recover the covered amount.
In most cases, the member will pay out of pocket first and then file a claim to recover the covered amount.
A compensation plan can be a good option for your business if:
- Potentially increased administrative burden can be accepted for paper claims and claims
- They find a higher price balance for greater control of the service.
- It has employees who need high levels of flexibility for doctors and hospitals.
6. Health insurance plans for the health savings account
An alternative to traditional group health insurance is the HSA. HSA is a health savings account.
HSA is a preferred tax savings account that is used with a high discount health plan and is HSA compliant to pay for eligible medical expenses. While HSAs can be associated with group health insurance, they are owned by employees, and small businesses can contribute to it, whether they offer group policies or not.
Contributions to the HSA can be made before taxes, up to certain limits established by the Tax Authority. Unused funds in the HSA account are renewed every year and accrued interest is tax free. The money can also be used for other life events, but fines and interest can be charged.
HSA is a preferred tax savings account that is used with a high discount health plan and is HSA compliant to pay for eligible medical expenses. While HSAs can be associated with group health insurance, they are owned by employees, and small businesses can contribute to it, whether they offer group policies or not.
Contributions to the HSA can be made before taxes, up to certain limits established by the Tax Authority. Unused funds in the HSA account are renewed every year and accrued interest is tax free. The money can also be used for other life events, but fines and interest can be charged.
HSA could be a good option for your small business if you:
- You cannot afford a group health insurance policy
- You want more control over how much you contribute to health benefits
- You have a lot of employees that have HSA
7. Health Payment Arrangements (HRA)
The health payment agreement is a type of health benefit that allows employers to provide health benefits without the need to provide a group health insurance plan. Using HRA, employers compensate employees for insurance premiums and even out-of-pocket medical expenses.
With each HRA, employers can set a monthly allowance limit for employees to use. From there, employees purchase the individual health insurance policy that best meets their needs and provide proof of purchase to pay.
With each HRA, employers can set a monthly allowance limit for employees to use. From there, employees purchase the individual health insurance policy that best meets their needs and provide proof of purchase to pay.
There are six types of HRA, each with its own uses and requirements. They are:
- HRA for Qualified Employer (QSEHRA)
- HRA Individual Coverage (ICHRA)
- HRA group coverage
- HRA Extra Benefit
- Dental / Vision HRA
- HRA retired
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