Group Medical



The majority of businesses in the United States are small companies. For many of them, particularly those with under 50 employees, state insurance laws may determine the plan design, rating structure, and administrative details of the company’s health insurance.

Companies with less than 50 employees often opt for fully insured plans, which offer:

Fixed costs per employee
• Varying benefits limited to plans offered by the insurance company
• Claims administration by the insurance company
• Negotiable premiums based on experience and/or pooling.

 

Companies with over 50 employees (and in some cases less) are faced with even a broader array of challenges and opportunities. While many employers choose to stay fully insured, they also have the option of self insuring, or partial self insurance.

Important aspects of self-funded plans are:

• Greater control of plan design
• Large claims typically covered by catastrophic "stop loss"
insurance
• Claims administered by an insurance company or TPA (Third Party Administrator)
• Employer can target benefits for use and abuse
• Possible savings for employers
• Varying month to month cash flow
• Premium tax savings

Benefit Sources & Solutions can guide employers in determining the best plan to meet their needs.