special group insurance plan

Setting Up a Special Group Insurance Plan

special group insurance plan

Also known as employer-sponsored health insurance, the Kaiser Family Foundation (KFF) data shows that 49% of the US population receives group insurance. The states with the highest number of group insured employees are Illinois at 53% and New York at 49%. 

For an employer, a special group insurance plan is cheaper than individual plans. In addition, insurance companies can offer coverage at a lower cost because they don’t have to pay administrative and acquisition costs. 

So, how do you get the most out of an insurance plan? Here’s a step-by-step guide on setting up a special group insurance place.

Steps to setting up a special group insurance plan

Getting affordable premium rates while ensuring your employees receive the best plans involves coming up with a long-term strategy that includes the following steps:

1. Analyzing risk

This step comprises evaluating how much of the risk you want to take on as the employer versus the risk your employees will take. For example, it would be best to decide if you wish to fund 100%, 50% of their health insurance deductible, or somewhere in between. 

Inquire from a promising employee benefits advisor who will help you determine the best amount of risk to take on as an employer. 

Note that the employers’ contributions will vary from State to State and insurer to insurer.

2. Evaluating and managing claims

You will need to determine the cost of your employees’ claims. Employee claims directly impact insurance premiums, so you must look at your employees’ claim history. 

Ask where they are receiving their care, what they mostly spend their insurance on, and what amount of their claims come from pharmacy costs. 

If you can help your workers reduce the amount of money spent on such claims, that will translate to reduced health insurance premiums. Moreover, you need to monitor claims management effectively, to ensure proper claims processing. 

3. Designing the group plan

As an employer, you can directly impact how your employees access affordable medical care. You can do this by creating a special group insurance plan that: 

  • Discourages using the emergency room
  • Encourages telemedicine
  • Utilizes copays
  • Incentivizes employees to go to freestanding facilities that offer affordable rates for MRIs, CT scans, and other services 

4. Reviewing compliance regulations 

Ensuring your business is compliant with government regulations is challenging. Some of the rules you have to abide by include:

  1. Employee Retirement Income Security Act (ERISA) 
  2. Affordable Care Act (ACA) 
  3. Section 125 or cafeteria plan 
  4. Health Insurance Portability and Accountability Act (HIPAA)

To remain on the right side of the law, always seek the help of an employee benefits advisor.

5. Tackling the insurance marketplace

The goal is to find the right insurance quote. How an insurance company will view your proposal depends on how well you showcase yourself. 

In short, if you present a great picture, there’s a good chance you’ll walk away with competitive premium rates. 

Benefits of a special group insurance plan

The most significant benefit of a group insurance plan is that it comes with lower premiums than individual covers. Forbes states that the average cost for personal health insurance is $440, compared to $409 for a group insurance plan. 

The insurer often offers supplemental health plans, including vision, dental, and pharmacy, which employers can offer as additional plans separately or as a bundle. 

Contact Health Consultants Group

To learn more about how you can help your employees with such problems and other essential HR issues, visit our contact page or give us a call at (800) 367-2482.