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Group Health And Benefits You Need In Your Company

As a business owner or HR manager, you know that providing health coverage for your employees is important and expensive. But did you know that options are available to help…

April 22, 2022

Written by Trey Bongiovanni

As a business owner or HR manager, you know that providing health coverage for your employees is important and expensive. But did you know that options are available to help make coverage more affordable? Group health coverage can be a great way to provide your employees with quality health care while saving money on premiums. 

In this blog post, we will discuss the benefits of group health coverage and explore some of the available plan options. So if you’re looking for ways to reduce your business expenses, read on!

What Is Group Health Coverage?

A group health plan is an employee welfare benefit plan that is established or maintained by an employer or an employee organization (such as a union), or both, and offers medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.

Group health coverage is a type of insurance plan that provides benefits to a group of people. Typically, these plans are offered through employers, although they can also be obtained through professional or trade organizations membership. Group health plans usually offer lower premiums than individual policies, and they may also include features such as preventive care services that are not available with other types of health insurance.

How Does Group Health Coverage Work?

Group health coverage works in a few different ways. In most cases, the employer or sponsoring organization will negotiate a discounted rate with an insurance company for the group health plan. This means that the business or organization can offer its employees quality health care at a lower cost than if they were to purchase individual plans. Additionally, many group health plans offer “preferred provider organizations” (PPOs), allowing employees to visit any doctor or hospital they want without worrying about increased costs.

Another great thing about group health coverage is that it often includes employee support services. These services can include things like on-site clinics, wellness programs, and disease management programs. Having access to these types of services can be very helpful for employees who are trying to stay healthy and manage any health conditions they may have.

Group Health vs. Individual Plans

There are a few key differences between group health coverage and individual plans. The most obvious difference is that group health coverage covers more people. This can be helpful for businesses that have a lot of employees, as it allows them to get a better rate on premiums. Group health plans also tend to be more flexible than individual plans, offering a wider range of doctors and hospitals that employees can visit. Additionally, group health plans often include employee support services that can be very beneficial to employees.

Individual plans are a good option for people who are not covered by group health insurance or need additional coverage beyond a group plan. Individual plans typically offer more customization options, which can be helpful for people with specific needs. They also tend to be more expensive than group health plans, but this can be offset by the fact that they do not include employer contributions.

Types of Group Health Coverage

There are a few different types of group health coverage available, so it’s important to understand the differences before deciding which plan is right for your business. The most common types of group health plans are:

1. Traditional group health plans – These plans offer a set amount of coverage for each employee, regardless of how often they see the doctor or whether they have any major medical expenses.

2. HMOs (Health Maintenance Organizations) – An HMO (Health Maintenance Organization) is a type of group health plan that restricts employees from visiting doctors and hospitals that are part of the HMO’s network. Under an HMO, employees cannot visit any doctor or hospital they want; they must visit a doctor or hospital that is in the network.

3. POS (Point-of-Service) plans – A POS plan is a hybrid plan that combines features of traditional group health plans and HMOs.

4. EPOs (Exclusive Provider Organizations) – An EPO is a type of group health plan that allows employees to visit any doctor or hospital they want, but they will have to pay more for services if they go outside the network.

Which Group Health Plan is Right For My Business?

Depending on the size and needs of your business, different group health plans may be a better fit than others. Here are a few things to consider when choosing a group health plan:

How many employees do you have? 

The more employees you have, the more likely you are to qualify for a group health plan.

Do your employees have any pre-existing conditions?

If your employees have pre-existing conditions, they may not be eligible for coverage under some group health plans.

What type of services do your employees need?

Some group health plans offer more comprehensive services than others.

How often do your employees visit the doctor?

If your employees typically visit the doctor often, you may want to consider a plan with lower deductibles and copays.

How much can you afford to pay each month? 

Group health plans can be expensive, so make sure you budget for them accordingly.

It’s important to weigh all of these factors when deciding which group health plan is right for your business. If you’re not sure which plan is right for you, talk to an insurance agent or benefits specialist who can help you choose the right plan.

Self-Funding: What It Is And How It Works?

Self-funded programs are insurance plans where a company pays for employee health care costs out of their own pocket. The idea behind it is that this will save the company money in the long run, but there are some risks involved. Here we’ll take a look at how self-funding works and what you need to know before deciding if this is the right option for your business.

When you sign up for a self-funded program, you become responsible for all of the costs associated with employee health care. This includes things like hospital visits, doctor’s appointments, and prescriptions. You’ll also be responsible for covering any claims that employees file. You’ll need to set aside money each month to cover these costs in most cases.

There are a few benefits of self-funding:

  • Self-funding allows businesses to negotiate lower rates with healthcare providers because they are paying for the services themselves.
  • Self-funding gives businesses more control and transparency over their healthcare costs. 
  • This type of program allows for much more flexibility. 
  • Self-funding is a tax-deductible expense for businesses.
  • Self-funding allows for a much more progressive, strategic plan for future cost mitigation.  

However, there are also a few drawbacks to self-funding:

  • If the employer sets up their own health insurance company, they are responsible for all of the claims themselves. This can be risky if the company experiences high volumes of claims.
  • Businesses that partner with an insurance company specializing in self-funded plans may not have as much control over their healthcare costs and benefits packages.
  • Self-funding is not necessarily a fit for all businesses. It depends on the size, demographic and needs of the organization and its employees.  

If you’re interested in learning more about self-funding, talk to an insurance agent. They can help you decide if this is the right option for your business.

Drawbacks Of Group Health Plans

Group health plans have a few drawbacks that business owners should be aware of before enrolling their employees:

  1. Group health plans typically have a higher deductible and co-pay than other healthcare options.
  2. Employees may have difficulty finding a doctor in the network who can treat their specific medical condition.
  3. An HMO typically has a higher deductible and co-pay than other group health plans.
  4. If an employee needs to see a doctor or go to the hospital outside of the network, they will have to pay out-of-pocket expenses. This can be expensive if the visit is not considered preventive care.
  5. Group health plans are not available to all businesses. The employer must have at least 50 employees to qualify.

How Does HR and Employee Support work?

Group health plans typically have a human resources department responsible for managing the plan. This department typically handles enrolling employees, approving claims, and resolving disputes between employees and the insurance company. They can also provide employees with support and resources to understand their benefits package and use their insurance.

Many group health plans also offer employee assistance programs (EAPs). These programs provide employees access to mental health and counseling services, financial planning services, legal advice, etc. EAPs are often offered free of charge to employees.

Nesso Group – Group Health & Benefit Plans With A Purpose

At Nesso Group, we believe that employee benefits and health plans should have a purpose. That’s why we offer a range of plans and services that are tailored to meet the needs of businesses and their employees. We understand that every business is different, so we work with our clients to create a plan that fits their unique needs.

Our team at Nesso Benefits is dedicated to providing our clients with the highest level of service. Contact us today if you’re interested in learning more about our group health plans or employee assistance programs. We would be happy to answer any questions you have.


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