Medical Insurance: All You Need To Know

We all know that medical insurance is a vital part of our lives and our businesses. It provides workers with the health and benefits they deserve. But what do you…

September 7, 2022

Written by Trey Bongiovanni

We all know that medical insurance is a vital part of our lives and our businesses. It provides workers with the health and benefits they deserve. But what do you really know about it? Do you understand its benefits and how it works in Connecticut?

 

In this blog post, we’ll answer all of those questions and more. Take a closer look at how medical insurance can help your business succeed!

What Is Medical Insurance?

Medical insurance is a type of insurance that helps to pay for medical expenses. This can include doctor visits, hospital stays, prescriptions, and preventative care. Medical insurance can help relieve some of the financial strain during difficult times.

 

It can be provided by an employer, purchased individually, or obtained through a government program like Medicaid or Medicare. There are many different types of medical insurance plans available, and choosing one that meets your needs and budget is important.

How Does Medical Insurance Work In Connecticut?

In Connecticut, medical insurance is a vital part of the healthcare system. It runs its own health insurance market to ensure residents and businesses have access to quality care and protect them from the financial burden of medical expenses.

 

Aspects to take into consideration:

Different plans

You can buy an individual insurance policy if you’re unhappy with your employer coverage, self-employed, or uninsured.

Enrollment Period

In Connecticut, Health Insurance Marketplace enrollment for 2022 began on November 1, 2021, and ended on January 15, 2022. When the deadline is missed, you must wait until the next enrollment period to apply for coverage unless you’re eligible for a special enrollment period.

Special Enrollment

There’s a special enrollment period (SEP) for people who have experienced a qualified life event (QLE). This can be like getting divorced, married, or having a baby. If you’ve experienced a QLE, you have 60 days to sign up for a new health insurance plan or change your current plan. You may also be eligible if you’ve changed your eligibility for Medicare or Medicaid.

Types of Coverage

  • Employer-sponsored coverage is the most common type of health insurance, with just over 53% of residents receiving benefits through their job.
  • Nearly 5% of people in the state have a non-group plan.
  • Around 21.5% are enrolled in HUSKY, the state’s Medicaid program.
  • Medicare is used by 14% of people in Connecticut.
  • Under 6% of the state’s population has no health insurance coverage.

Enrollment Process In Connecticut 

First Enrollment

  1. Visit the Access Health CT website to create an account.
  2. Provide your contact information, security questions, and password.
  3. Once the account is created, apply for health insurance.
  4. Get the full name, birth date, and Social Security number of every person you intend to enroll under your insurance plan.
  5. Let the website determine what programs like Medicaid, Advanced Premium Tax Credit, or other financial assistance you qualify for.

Important Information You Must Provide

  • Married or single
  • Dependents you claimed on your last tax return
  • Total household income
  • Intentions to apply for financial assistance

Compare Insurance Plans

To ensure you and your family have the right coverage, the next time you enroll, you can make a comparison between insurance plans.

 

Take into consideration:

  • Annual deductible
  • Copayment requirements
  • The monthly premium for each insurance policy

Companies Available in Connecticut

  • Aetna
  • Anthem
  • ConnectiCare
  • United Health One

The Benefits of Having Medical Insurance For Your Business

It’s no secret that medical insurance is expensive. In fact, the cost of healthcare is one of the biggest financial burdens facing Americans today. But while the cost of medical insurance may seem daunting, several benefits make the investment worthy, especially for businesses.

 

  • It helps protect businesses from potential lawsuits: If an employee is injured on the job and does not have health insurance, they may be more likely to sue the company to cover their medical expenses.
  • It helps attract and retain employees: Employees with access to affordable health care are often more loyal and productive than those without it, so offering this benefit can save businesses money in the long run.
  • It helps businesses avoid penalties under the Affordable Care Act: Businesses that do not offer health insurance to their employees may be subject to fines, so it’s important to make sure you comply with the law.
  • It helps businesses save money in the long run: By providing employees with access to preventive care, businesses can avoid the high costs of treating potentially serious health conditions. For all these reasons, medical insurance is a wise investment for any business owner.

Why Is Medical Insurance So Important?

Health insurance is essential for maintaining a company’s team’s good health and well-being. Unexpected medical bills can bankrupt a business, and even minor injuries or illnesses that occur during job hours can cost thousands of dollars.

 

No matter what size, all businesses are responsible for providing a safe work environment for their employees. This means protecting them from financial hardship if they’re injured or become ill due to their job.

Types of Insurance Plans For Business

There are many different types of health insurance plans available for businesses. The type of plan you choose will depend on a number of factors, including the size of the business and the needs of its employees.

Small Groups Health Insurance Plans

What Is It?

A small group health insurance plan is typically offered by an employer to its employees. The employer pays a portion of the premium, and the employees pay the remainder through payroll deduction. 

 

These plans are usually governed by state and federal laws, which set minimum standards for coverage. In most states, employers with 50 or fewer full-time equivalent employees (FTEs) are considered small businesses and can purchase small group health insurance plans, but this can vary.

 

How Does It Work?

Since January 2014, small-group plans have been required to fully comply with Affordable Care Act (ACA) rules that apply to individual and small-group health plans. There’s no specific time to enroll, and it can be acquired through three main sources:

 

  • Contacting an insurance company directly and working with them to create a policy that meets the needs of the business.
  • Working with a broker or private exchange. These organizations can help businesses compare different policies and choose one that is the best fit.
  • Through the Small Business Health Options Program (SHOP). This program was created by the Affordable Care Act. It offers businesses a way to provide quality health care to their employees.

What Does It Cover? 

  • Hospitalization
  • Emergency services
  • Maternity
  • Newborn care
  • Mental health
  • Substance abuse services
  • Health disorders
  • Prescription drugs
  • Lab tests
  • Preventive care
  • Pediatric dental for children
  • Rehabilitative and “habilitative”

Large Group Health Insurance Plans

What Is It?

A large group health plan is a type of insurance plan that covers a large number of people. A high participation rate by employees is usually needed to make it viable, as employees often have the choice of declining or accepting coverage.

 

A large group health plan can save both the insurer and the policyholders money by spreading the risk across many individuals. These plans usually come with various features, depending on the insurance provider and the company’s needs. 

How Does It Work?

A large health plan links all employees with the same benefits and offers coverage at minimal value. It’s perfect for insuring employees with the proper resources and eliminating the need for individual insurance. Although there’s no legal minimum number for this type of plan, it’s important to consider what fits the company and its current needs.

 

There are 6 main plans you can choose from:

 

  • Fully-Insured Plans: With this type of plan, you pay premiums to an insurance company, and the company is then responsible for paying claims. It can often be more expensive than other types of plans. Still, it’s a good option for businesses with many employees or whose employees have high medical costs.
  • Preferred Provider Organization (PPO): Similar to fully-insured plans but allows you to choose from a network of preferred providers. This can help keep costs down, as providers in the network often offer discounts on services. However, you may have to pay more if you use out-of-network providers.
  • High-Deductible Health Plan with a Savings Option (HDHP/SO): Designed for businesses that want to keep premiums low. You have a high deductible, meaning you’ll have to pay more out-of-pocket before your insurance kicks in. However, many HDHPs come with a savings option, which allows you to set aside money pre-tax to help cover deductibles and other out-of-pocket costs.
  • Level-Funded Plans: A hybrid between fully-insured and self-funded plans. Businesses pay premiums into a pool, which is then used to pay claims. This type of plan can be cheaper than fully-insured plans, but it still offers some protection in the event of large claims.
  • Health Maintenance Organization (HMO): Designed to reduce costs by requiring patients to use in-network providers. This can often lead to lower premiums and out-of-pocket costs, but it may also mean that patients have less choice in their care.
  • Self-Funded Plans: With this type of plan, businesses assume responsibility for paying claims themselves. This means there is no need for an insurance company, which can save on premiums. However, self-funded plans also come with a lot more risk, as businesses could be liable for large claims.

What Does It Cover? 

  • Pre-existing conditions
  • Deductibles
  • Coinsurance
  • Employer-sponsored (funded) Medicare/Medicaid enrollment
  • Dental plans and dental coverage for employees
  • Health Savings Accounts (HSAs)
  • Vision insurance and vision care for employees
  • Drug coverage for employees
  • Co-pay
  • Comprehensive health plan
  • Major medical expenses for employees
  • Out-of-pocket expenses
  • Wellness programs for employees
  • Medical devices
  • Registered massage therapists (RMTs)
  • Physiotherapists

Provide Quality Coverage For Your Businesses

Nesso Group is proud to be a part of the Connecticut business community, and we want to help you thrive too! At Nesso Benefits, we offer a wide list of comprehensive medical insurance plans to meet the needs of your business while keeping your members healthy and protected.

 

Our team is experienced in working with businesses of all sizes. We understand the importance of protecting the people who make your company run. Contact us today to learn more about how we can help you get the proper healthcare coverage for your business.

 

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