what is a group health plan

What Is A Group Health Plan And What Should You Include?

what is a group health plan

Employees seek employers they can work for on a long-term basis if the benefits meet their needs. Workers desire more than just money to stick around. One important benefit businesses should include is a group health plan.

What is a group health plan and what will it mean for you and your employees? You’re about to find out why you should get it and what you should include. 

Read on for information about employee group health plans.

What Is a Group Health Plan?

Benefits attract workers just as much as wages. Most companies understand this and about 50% of businesses offer some form of group health insurance to their employees in America. 

A group health plan includes a variety of employer-based benefits for their workers. It provides medical care for people businesses hire as well as their dependents. Dependants may either get direct assistance and have their name included in the plan or receive reimbursement. 

Most group health plans are covered through ERISA, or the Employee Retirement Security Act. It’s meant to protect employees and their dependents and assert their rights and access to information. 

A group health insurance plan doesn’t provide insurance directly. As a business owner, you must be sure your group health plan includes a group health insurance plan or a self-insured health plan for your worker. 

Group Health Insurance Plan 

A group health insurance plan is a part of the group health plan that includes actual health insurance coverage for your workers. There are a few health insurance policies you, as an employer, can offer your worker and eligible dependents. 

Since it is a group plan, benefits are split between those who are under the health insurance plan. Employees identify a group health insurance plan as a job-based health insurance plan, and you may explain it as such. 

Plan Types and Metal Types for Group Health Insurance Plans 

You can break a group health insurance plan down more by plan type or metal type. Both offer workers various levels of financial options and flexibility on location. 

Plan Types 


HMO(Health Maintenance Organization) plans often allow employees to choose their own primary care provider (PCP). Their PCP will then refer them to other specialists as needed if the worker or their dependents have a specific health problem. 

The main limitation is that those on an HMO plan cannot seek help from other providers outside the insurance network pool. There may only be an exception in extreme emergencies. 


PPO(Preferred Provider Organization) is like an HMO plan, only those under it have more freedom to choose more doctors, including those outside the company’s network. 


EPO(Exclusive Provider Organization) plans are a combination of HMO and PPO plans. Employees may also use the plan with a Health Savings Account, if eligible. 

Metal Plans 

Platinum plans often provide employees the most benefits. It pays as much as 90% of health-related expenses and the worker covers the rest. On the flip side, it tends to have higher monthly premiums. 

Gold plans are similar to platinum plans and pay up to 80% of health-related expenses. 

Silver plans will pay up to 70% of health-related expenses. 

Bronze plans pay the least (60%) of health-related expenses. However, they offer the most affordable premiums for workers. It’s a great plan for those who are overall healthy and don’t require many trips to see a physician. 

Do You Need a Group Health Insurance Plan for Small Businesses? 

Laws are constantly changing and businesses should keep themselves up-to-date with any and all changes. At the moment, there is no requirement for small businesses to offer group health insurance to their workers. A small business is defined as a company that has fewer than 50 full-time workers. 

If you do decide to offer a health insurance plan to your workers even as a small business, you may be entitled to tax credits. These credits will help offset the generous health insurance coverage you gave your workers. 

As a general rule of thumb, there are a few ways you can find out if you qualify for the tax credit. For one, you need to pay each of your workers less than $50,000 a year and pay a minimum of 50% of your employee’s healthcare premium. 

Any health insurance plan you cover must be through a health insurance SHOP marketplace or through a licensed agent. You are most likely to get the maximum credit on your taxes if you have less than 10 workers. 

Advantages Of Group Health Insurance Plans Over Individual Coverage 

Group health insurance plans offer many advantages over self-insured health plans for workers who are under a group health plan. The main benefit is the reduction of healthcare costs for your workers. This still holds true even of a portion of their paycheck is deducted to pay their share of the premium 

Workers can shop and pick a plan that is right for them and their families and manage all aspects of their health coverage better. 

Depending on the plan you offer they still have a choice in health insurance plans. If they have any questions about the plan, workers will receive better help and swifter responses. 

Save While Helping Your Workers 

So what is a group health plan and how can it help you? Getting a group health plan and ultimately a group health insurance plan is beneficial for both you and your workers. As a business, you must maintain a larger profit over losses. 

Profits and losses do not only include what you make and lose from customers. You must also take into consideration what you make and lose with your employees. Offering benefits is a great way to help your workers, but if it’s not done right, you can lose more money than you think. 

If you want to get a group health plan to offer your worker’s health insurance without losing money in the process, contact us. We can answer all your inquiries and can help you find the best products and plans that meet your goals and objectives.