Group Health

 What is group health insurance?

Group health insurance is a single policy issued to a group of people, offering uniform healthcare benefits to all members. In most cases, these policies are purchased by employers and offered to eligible employees and their families as part of an employee benefits package. Enrolling in group health insurance generally costs participants less than what they would pay for an individual healthcare policy for two main reasons:

1.     The risk is spread over the whole group, as opposed to just one individual.

2.     Many employers pay a portion of employees’ premiums.

What are the benefits of group health insurance?

For employees, the benefits of group health insurance include the reduced price of healthcare and the ease of enrolling through their employer. For employers, the benefits range from attracting quality workers to the tax credits they can receive.

Is your business required to purchase group health insurance?

Large businesses with 50 or more employees are now required to offer group health insurance under the Affordable Care Act. Small businesses with fewer than 50 employees are not required to offer coverage, but they can qualify for tax credits to help offset the cost if they choose to offer healthcare and pay for at least half of each employee’s premium.

Contact us today for more information about group health insurance.

Self Funded Health Plans

• A self-insured healthcare plan, sometimes referred to as a partially self funded healthcare plan or partial self funding your healthcare plan, is a healthcare plan in which the employer assumes partial financial risk for providing health care benefits to its employees. 
• Everything that is provided in a conventionally fully insured program is duplicated in the partially self funded health plan. 
• The employer can duplicate it’s current fully insured benefit plan or it can “redesign” and tailor the benefits to meet the specific needs of the employer. 
• Since Self funded healthcare plans are governed by ERISA, they follow Federal law, and are not required to cover “State-Mandated” benefits, which can be expensive and unnecessary.
• The employer only pays for their own claims. With a fully insured plan, the premium is paid every month regardless of where there are claims or not.

Referenced Based Reimbursement

Reference Based Reimbursement (RBR), also known as Cost Plus or Reference Based Pricing (RBP), offers self-funded plans a defined benefit structure based on more economical reimbursement levels designed to be fair and reasonable to providers on various pricing data sets, most notably Medicare.

Referenced Based Reimbursement is a solution growing exponentially in use. 

• Reimbursement methodology based on fair market value of teh services rendered
• Reprieve from inflated medical pricing and PPO overpayment
• Optimization of every health care dollar spent
• A fair, transparent, defensible and sustainable solution
• Reduces cost of benefits & improves operating margins
• Ensures open access to all local providers
• Patient Advocate in the event of a balance bill from the provider