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Understanding Group Medical Benefits Plans

Group medical benefits plans have become increasingly popular as more businesses realize the importance of having one. These plans bring several benefits that aren’t available with individual health insurance policies.…

September 1, 2022

Written by Nikki Grillo

Group medical benefits plans have become increasingly popular as more businesses realize the importance of having one. These plans bring several benefits that aren’t available with individual health insurance policies. You can also customize them to fit the needs of your business and team members.


If you’re a business owner, entrepreneur, or a human resources specialist but don’t know enough about group benefits plans to make an informed decision, don’t worry. Read through this article to learn the basics of group benefits plans, what they cover, how they work, and how to choose the right one for your business. We’ll also discuss the main reasons for having a group medical benefits plan and other key aspects.

What Are Group Medical Benefits Plans?

Group medical benefits are health insurance plans designed for businesses. These plans are also known as employee benefits. They’re designed to help team members pay for healthcare expenses not covered by their primary insurance plan (such as deductibles, co-payments, and prescriptions). They’re not designed to replace employer-sponsored health insurance but rather provide an additional option for your team members.


As opposed to individual health insurance plans, group medical benefits don’t require a team member to maintain a certain number of hours to qualify for coverage; instead, the size of the employer determines eligibility. If your company has a certain number of full-time team members (depending on the provider), you may be eligible for group medical benefits.

What Do They Cover?

You can expect to receive several types of coverage through a group medical benefits plan. For example:

  • Inpatient hospitalization
  • Outpatient services, including emergency room visits and other care in a hospital clinic (e.g., laboratory testing)
  • Physician’s office visits
  • Prescription drugs: That is, medications prescribed by a physician (including over-the-counter medicines), such as insulin for diabetes or blood pressure medication
  • Dental care: Such as fillings or root canals
  • Vision care: Such as glasses or contact lenses

How Do They Work?

Some companies and organizations acquire group health insurance plans, which they subsequently offer to their team members. Individuals can’t obtain coverage through these plans because they’re only available to groups. For a plan to be valid, it usually requires at least 70% involvement. There are numerous distinctions between plans, including insurers, plan types, fees, and terms and conditions.


Team members can decide if they want to accept or deny coverage. In some locations, plans may be divided into tiers, with insured parties choosing between basic coverage and advanced coverage with add-ons. The premiums are shared between the organization and its members depending on the plan. We’ll dive deeper into the costs of group benefits plans later on.

Reasons For Having A Group Medical Benefits Plan 

Attract And Retain Team Members

Group benefits plans are often one of the most critical factors individuals consider when choosing a job. Good benefits attract top talent. By offering a group medical benefits plan, you can improve your chances of recruiting and retaining the best people for your company.

Positive Work Environment And Increased Productivity

When team members feel like they’re being taken care of, they’re more likely to be happy and engaged with their work. Happy, engaged team members lead to a more positive work environment and increased productivity.

It Makes You Eligible For Certain Tax Breaks

You may qualify for certain tax breaks if you offer a group medical benefits plan. For example, in the United States, businesses that provide health insurance to their team members can deduct the cost of premiums from their taxes.

It Can Help You Save Money

Group medical benefits plans can also help you save money on your healthcare costs. You can often negotiate lower rates with providers when you have a group plan. This is because insurers that offer group plans can spread the risk across a larger pool of people.

Choosing The Right Plan For Your Business 

Choosing a group medical plan for your team members can be a daunting task if you aren’t sure what to look for. There are many factors to consider, including:

  • The needs of your team members
  • The costs of the plan
  • Whether it’s easy to understand and use (both from the team members’ point of view and yours)


If you want to choose a plan that will meet the needs of your team members and fit into your budget, make sure you take these things into account.

Enrolling In A Group Medical Benefits Plan 

If you’ve decided that a group medical benefits plan is right for your business, the next step is to enroll. To do so, you’ll need to:

  • Get quotes from different insurers: This will help you compare plans and find the best price for your business.
  • Choose a plan: Once you’ve found a few options that meet your needs, it’s time to choose the best one.
  • Notify your team members about the new benefit: Let them know how to enroll and what coverage they can expect.
  • Enroll your team members in the plan: This usually involves filling out some paperwork.

The Cost Of Enrolling In A Group Medical Benefits Plan 

The cost of a medical benefits plan depends on the type of plan. You can choose to pay a set amount for each team member or elect to cover a certain percentage of their medical expenses. If you’re paying a set amount, you’ll be given a flat rate that you pay per month or year, and this amount covers all medical costs up to that limit.


If you want more flexibility in your choice, you may opt to pay based on the percentage of a team member’s salary paid out each year. You may also have to consider other factors, such as whether they have dependents and what age bracket they fall into (younger team members tend to cost less).

Tax Implications Of Having A Group Medical Benefits Plan

Workers who receive health insurance through their employer aren’t subject to federal income tax on the coverage value. However, if an employer pays for part or all of a team member’s premiums for a private health insurance policy, that amount is included in the team member’s gross income and is subject to federal income tax.


For self-employed individuals, the cost of health insurance is deductible on both their federal income tax return and their self-employment tax return. Premiums paid for long-term care insurance policies are also deductible on federal income tax returns, up to specific amounts.

Things To Consider When Choosing A Provider

Choosing the right provider is essential for getting the most out of your group medical benefits plan. Here are some things to consider when making your choice:

  • Location: Choose a conveniently located provider for you and your team members. This will make it easier to get the care you need and make appointments more convenient.
  • Services: Make sure the provider you choose offers the services you need. With the right research, you can get the care you need and avoid paying out-of-pocket for services not covered by your insurance. Consider things like preventive care, mental health services, and prescription coverage.
  • Cost: Compare costs between different providers before making your final decision. You want to be sure you’re getting the best value for your money. A trustworthy provider should be transparent about its pricing and offer a competitive rate.
  • Reviews: Read reviews of different providers to understand what past clients have thought about their experience.

How To Make The Most Of Your Group Medical Benefits Plan?

Once you have a group medical benefits plan in place, there are a few things you can do to make the most of it:

  • Encourage team members to use preventive care services: Preventive care can help catch health problems early when they are easier to treat. It can also help avoid more serious and costly health problems.
  • Educate team members about their coverage: Helping your team members understand their coverage will help them make better decisions about their health. They will be more likely to use their benefits if they know what’s covered and what’s not.
  • Make sure claims are filed correctly: Incorrectly filed claims can delay payment or result in denied claims. Review claims before they’re submitted to ensure accuracy.

Group Benefits Reviews

Plan reviews are an important part of managing your group medical benefits plan. They can help you understand how your plan is performing and identify areas where you can make improvements. Regularly reviewing your plan will help you keep it up-to-date so that it meets your team members’ needs.


Here are a few aspects to keep in mind when conducting a review of your group medical benefits plan:

  • Identify Goals: What do you hope to accomplish with your review? Do you want to improve coverage, lower costs, or both?
  • Review Data: Look at data from previous years to identify trends. Old data will help you understand what worked well and could be improved.
  • Gather Feedback: Talk to team members and gather their feedback about the plan. By gathering feedback, you’ll understand what they like and don’t like about the plan.
  • Make Changes: Based on your data and feedback, make changes to your plan. This could involve adding or removing coverage, changing providers, or adjusting prices.

Nesso Benefits: Group Medical Benefits Plans

At Nesso Benefits, we understand the importance of having a group medical benefits plan in place for your business. We also recognize that each company has its own set of needs; that’s why we offer a variety of different plans to choose from. Our experts are highly trained and experienced in the industry, and they’ll help you understand your coverage and make the most of your benefits with comprehensive benefits reviews.


We’ll be there to assist you every step of the way and are eager to answer any questions you may have. Our transparent and proactive approach to benefits gives the control back to employers by controlling the cost of insurance and helping their team members make healthier choices.


If you’re looking for health and benefits advice in Connecticut, Nesso Benefits will be pleased to help. We’re also a part of the Nesso Group, which provides accounting, tax and legal assistance, insurance, Medicare, and other services to businesses and people. When you team up with us, you know we’ll work for your best interests.



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