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Group Health Plan VS Group Health Insurance Plan

Group health plan, and group health insurance plan. These two words are used interchangeably, because they are almost the same thing. Almost. There are some key differences between the two. One is actual health insurance, while the other is a blanket term for different kinds of group plans. Knowing the difference will help you can use the terms correctly in conversation, without confusion.

Group Health Plan

a drawing of a light red umbrella — *Group health plan is an umbrella term used to define different kinds of employer-provided benefits plans.*

A group health plan, in a way, is an umbrella term. It is a term used to define different kinds of employer-provided benefits plans. This includes group health insurance plans, self-insured health plans, and self-insured medical reimbursement plans.

Group Health Insurance Plan

A group health insurance plan is a plan that provides actual health insurance coverage, and not just a general term like group health plan. Group health insurance plans are purchased by employers to be given to their employees that are eligible and their dependents.

Group health insurance is usually job-based, and can be a number of different kinds of plans such as HMO, PPO, POS, etc.

When referring to a group health plan, you can be talking about different kinds of employer-based plans. But if you refer to a group health insurance plan, you are talking about a plan that provides insurance coverage.

Looking For A Group Insurance Plan?

Because there are so many different group health insurance plans to choose from, and from many different companies, it can be time consuming, and downright frustrating. There are different things that go into what affects the premiums for your employees.

red location symbol over a colorful map — *Your business’ location factors into your group health insurance premiums.*

Factors That Affect Premiums

Business Location– This factor takes an average number from one overall area, meaning if you live in a more expensive state, then it will be used as an excuse to raise your premium. Here is more information on the most expensive states that you can operate in.
Enrollee’s Age– Like any health coverage, insurance companies judge heavily on age. The rule is set for a 21-year-old as the standard. The coverage grows in response to being older or younger than this.

Trying to figure out which plan is best to go with is not easy. It is best to have an experienced and qualified insurance agent help you with comparing plans, and how to get you the most for your money. EZ.Insure can assist with figuring everything out and making sure you get the best plan for your budget. Your agent will answer any questions you have, compare the plans for you, and even sign you up, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected] or calling 888-998-2027. EZ.Insure makes the entire process easy, and quick.

Cigna Links Up With Upstart Oscar For Small Business Health Insurance

Cigna, and small startup insurance company Oscar are teaming to begin offering small business health insurance options that are fully insured. The plans will be branded as Cigna + Oscar, and both companies will share risk equally. The plans are set to begin selling in 2020.

chains connected together by one red link — *Cigna and Oscar Health link up to provide better small business health insurance plans.*

Oscar’s Start-up

New York based Oscar Health started out small in 2012, and has slowly expanded to different states. They offer individual market plans, and expanded to offering small group and Medicare Advantage plans. Just this past August, the company has expanded to 6 new states in the US, and grew to 400,000 members this year.

Unfortunately, Oscar does not provide vision or dental insurance. However, the company is hoping that partnering with Cigna will change this.

empty dentist patient room — *Small business health insurance does not generally cover dental and vision. Hopeful the merge provides these benefits.*

“Small businesses are the backbone of the American economy and through this partnership, we can take a disciplined approach to offering differentiated healthcare solutions that help small businesses save money, expand network and product choice and keep employees healthy,” Julie McCarter, vice president of product solutions at Cigna, said in a statement.

How Small Businesses Can Save

Small businesses do not necessarily have to offer health insurance to their employees. It can become too expensive for the business. However, with this new merge, this will open the door to small businesses being able to afford healthcare coverage for their employees.

silhouette of a group of people with a huge red heart behind them in the background. — *“Together, we are giving small business owners an affordable, simple-to-use option.”*

“Together, we are giving small business owners an affordable, simple-to-use option that makes it easier for their employees to get appropriate care quickly and stay healthy,” Oscar Chief Policy and Strategy Officer Joel Klein said in a news release. “Cigna + Oscar will give these business owners and their employees consumer-centric health care coverage and physician networks that provide personalized care.”

The plans will include medical, behavioral health, and pharmacy services. Telemedicine will also be provided at no cost 24/7. This will help employees with the ability to call and speak with a doctor. They will also get their medicine quicker than going into the doctor’s office.

Although Cigna is not one of the largest 3 insurers in the small group market, they do offer group insurance to employers with 50 or more employees. The company is hoping tha partnering up with Oscar will help the company grow more and bring in more revenue. Together, the companies can do more in smaller markets than they would have been able to do alone. Let’s hope the future is bright for small businesses, and more importantly their employees receiving health insurance!

Are Employers Required To Offer Health Insurance?

Medical costs in the U.S. are high, which is why a lot of employees look for a job that offers health insurance. Over 88% of people consider health insurance benefits when choosing a job. For companies, providing group insurance to

cartoon of a man in a suit pointing at a clipboard with magnifying glass over a certain part. — *There is no specific law that requires employers to provide health insurance coverage to their employees, but there is a penalty.*

employees costs a lot of money, so some companies opt out of providing insurance. But are they required to? Yes, and no.

Affordable Healthcare Act

There is no specific law that requires employers to provide health insurance coverage to their employees. However, in January of 2015, the Affordable Care Act, ACA, required that employers who have 50 or more full-time employees provide health insurance. If they do not, they will face a tax penalty.

According to the ACA, full-time employees are employees who work an average of 50 hours a week.

Group Insurance Penalties

If a larger company with 50 or more full-time employees does not offer health insurance, they are subject to IRS penalties.

The IRS will penalize the company if one or more of their full-time employees gets a premium tax credit for getting their own health insurance coverage from the Marketplace. The company can owe up to $2,500 for each employee.

The company must offer insurance to 95% of their employees to avoid a penalty, and it must be year round. If the business offers healthcare for some months, and not others, then they will face a portion of the annual penalty.

Small Businesses

people working inside many cubicles. — *Small businesses (less than 50 employees) do not have a penalty if they do not offer health insurance to their employees.*

Small businesses are not required to offer healthcare coverage to their employees. Since they have less than 50 full-time employees, they will not face penalties. If a small business does not offer health insurance, then a person can seek their own health insurance plan from the Marketplace or a private company.

While there is no longer a penalty for going without healthcare coverage, it is important to seek out information on different plans. There are plans within your budget that will meet your needs and lifestyle. If you need help searching and comparing all the group insurance plans around, EZ.Insure can help. We offer local specialized insurance agents that can do all the comparisons for you, and just provide you the quotes. All for free! It’s that simple. To begin, enter your zip code in the bar above, or to speak to an agent, email [email protected], or call 888-998-2027. There is no hassle involved, and no obligation to buy, and no headaches. Just easy, fast, and free quotes!

Your 2020 ACA Compliance Checklist

If you’re purchasing or renewing group health coverage, then you’ll need a comprehensive look at what changes are coming in 2020. The ACA is updated every year, so it can be difficult to stay on top of things. With our checklist, you’ll have a better understanding of what’s taking place so that you can make the best decisions for your company’s health coverage.

ACA checklist for business owners — *As a business owner, you already have a lot on your plate, but don’t forget this checklist too!*

Are you an Applicable Large Employer?

Several rules only apply to you if you’re considered an ALE (Applicable Large Employer). For example, the ACA states there are Employer Shared Responsibility rules that require ALEs to offer affordable coverage. However, if you don’t have 50+ employees in your workforce, this doesn’t apply to you.

This also goes for Employer Mandate Penalties. If you’re considered an ALE, you can incur penalties if you don’t follow certain ACA standards like:

Offering coverage to full-time employees plus their families (or dependants)
Offering coverage that is not affordable
Offering coverage that does not provide minimum value

As a note, the minimum value is the standard minimum coverage that you can get in employer-based plans. For example, the policy needs to pay at least 60% of the total cost of medical services for an average population.

Are You Informing Your Employees?

There are three major instances where your workforce needs to be notified. This means not only reaching out with the correct information, but also making supplemental information available, and being knowledgeable yourself so that you can help them make solid decisions.

The first is a written notice of ACA Exchange Requirements. This needs to be given to all new hires. Inside the notice, it should detail the ACA’s health insurance exchange and talk about how and why an individual can obtain coverage through an Exchange.

The second is a Summary of Benefits and Coverage or an SBC. Any plans you offer, including the providers that write these policies, need to be provided to each employee. Basically, this is to make sure everyone is up to date, and no one can say that they weren’t sure about different plan options or otherwise.

business owner talking with employees about ACA changes — *Your employees are your team. Make sure you’re taking care of them with the best group policies.*

The third is for ALEs only, and it’s providing 1094-C and 1095-C tax forms. These forms are specifically used to detail what benefits each employee receives from their employer’s health plan.

For non-ALEs, the plans are 1094-B and 1095-B. These are only if you sponsor your workforce with a self-insured health plan.

For both of these cases, you need to give the forms to your staff by January 31, 2020, and the forms need to be reported to the IRS. Once that’s done, you’re set!

Coverage Affordability

Your employees need to be able to afford their health plans. How can something qualify as unaffordable? Technically, the IRS has a guide to help make these decisions.

A plan is considered unaffordable if it’s offered at 9.78% less than their taxable household annual income. This means if they have a yearly income of $10,000, then the offered plans will be considered unaffordable if their costs amount to $9,780 or more for the year.

New Out-of-Pocket Maximum

With the ACA affecting health plans, there are changes to the dollar amount for certain factors in your health policies, specifically the out-of-pocket maximums.

The maximums for out-of-pocket expenditures are not to go above $8,150 for your employees as long as they cover the essential health benefits. This number is for individual coverage in your group health plan. For family coverage, the maximum is $16,300.

These changes can be confusing, and you don’t want anything to slip by when you decide on coverage. For any group health plan, the bottom line is to keep both your employees happy and your insurance premiums well within budget.

If you need help picking out the best policy, EZ.Insure offers you an expert guide. Your agent will answer any questions you have, compare the plans for you, and even sign you up, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process easy, simple, and quick.

Can Small Business Owners Afford Group Health?

Studies answer this question with a tentative “for now.”

Group health is the best option for the majority of Americans, with over 100 million covered. People list insurance coverage as a top priority when choosing an employer. However, the question on most researchers’ minds is how long will this be a reality? With healthcare costs increasing yearly, this coverage type is the only option for most Americans.

The Kaiser Family Foundation’s survey conducted over the past decade found increasingly worrisome data.

For Example

To make things simple, we’ll say in 2019, an average worker makes $1000 in one month. (This is excluding the half of Americans not making the average income, and thus not even qualifying for this breakdown.) Counting for inflation, the $1000 average is an adequate amount for this fictional example.

employees in their store working on how to afford group health — *When you’re working hard to keep your business afloat, it can be difficult to offer insurance to your employees. Thankfully, you have help.*

However, the premiums for a family are 50% more expensive than the average worker’s income. Meaning, in this example, a premium would cost $2000 per month. Factoring in a spouse, and the employer’s contribution, this should keep things down well enough for affordability, right?

Wrong.

Even with employer help, the 50% higher premium would bring the total up to $500 per month. That’s half or more of each monthly paycheck. On top of this, deductibles soar over 150%. So, in essence, if you make the fictional $12,000/year, you’re expected to contribute to $6,000 in premiums that year, and then meet a $2500 deductible on top of before insurance companies will offer you any assistance for medical expenses.

At $500 a month, you’ll be struggling to pay your rent, let alone medical bills. It paints a somber picture if you’re an average American.

What Can We Do?

This is easier for larger corporate employers who can afford to take more of the premium burden for their employees, creating a subset of people who are happy with their insurance. For these people, they have lucked out joining a business that can ease this healthcare burden.

However, for the rest, including small businesses, the struggle is much more apparent. Without the help of a larger group, it is difficult for legislation to help extend coverage. While the focus is on extending coverage, perhaps it would be more helpful to talk about lowering premium costs instead or extending other programs like HRAs. With lower costs for everyone, it would bring a greater impact. Both covered employees would be able to afford higher plans, and non-covered ones could actually purchase coverage.

computers to help afford group health for small business owner — *Start with EZ.Insure! Our agents can help find the best plan to keep everyone covered–and your bottom line met!*

There needs to be a balance, and it looks like the best option for that is to set legislation to lower insurance premiums. For now, Americans’ best choice for health insurance is Group with their employers, making it more important than ever to choose a solid policy.

For the best policy choice, EZ.Insure can help. Our agents are highly trained within your region on all group health insurance plans. When you use EZ.Insure, you will be provided with your own personal agent. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. There is no hassle involved, and no obligation to buy, and no headaches. Just easy, fast, and free quotes.

Group Health Plans Accused of Medicare Fraud

If you live in the Seattle area, you might have seen that Group Health Cooperative (GHC) is under investigation. The nonprofit health insurance company allegedly took advantage of Medicare’s system, stealing millions of dollars to recover from earlier financial losses.

A former employee noticed the company was embellishing patient stories to claim more funds. This extended to even billing Medicare for conditions that were not real.

This all started in 2012 but has remained under lock and key in court until this year. While several employees came forward, the investigation is still in the “ongoing” phase.

Situations like these aren’t isolated.

Almost 20 major cases under Kaiser Health News saw companies skimming off the top of government funds. Medicare Advantage is the easiest tool to do so. All the companies have to do is lie about their patient’s cases, and the money pours in.

face of an insurance building with people walking alongside of it — *Make sure to double-check your information when you give it to your insurance company.*

How It Happened

One employee, Teresa Ross, worked at GHC and noticed the company’s management making some bad choices. Because of these, Group Health saw a drop in operating income by $60 million.

To recover from this, the insurer allegedly took advantage of Medicare’s billing formula. Under Medicare, they give a patient a “risk score.” The higher the risk score, the sicker the patient, and higher-risk patients receive more funds.

GHC hired another company, DxID, to assist with medical charts. With their help, GHC gained $12 million in new claims, and DxID received $1.5 million that year for their assistance.

Ross, with a doctor’s help, reviewed cases GHC oversaw. In the medical coding, she found errors that directly contradicted each other. One case stated the patient had a great disposition, but on further searching, this patient was also billed with having major depression. Clinical depression easily raises a patient’s risk score under Medicare, and this is only one of $35 million in new claims that GHC inflated.

Overestimating these scores, the company received enough funds from Medicare to climb out of their financial hole, but at the cost of government funds allocated to help a sick country–and directly from taxpayers’ pockets. The estimated gross damages climbed up into billions of dollars in just the past few years.

What Happens Next

The Justice Department is investigating this whistleblower case. Like other insurance cases, these last for years in order to provide the most accurate evidence to support such allegations. If Ross succeeds in her case, she will share in reparations the company must make for their actions.

meeting room to discuss medicare fraud — *Investigations take a while for a reason. People just like to make sure justice will be served without any doubt.*

However, the company’s official stance is: “We believe the doing policies being challenged here were lawful and proper and all parties paid appropriately.” GHC’s defense is that Ross found an “honest mistake” and made a bigger conflict out of it than was necessary.

Two conflicting defenses for one stance? For now, we wait for the Justice Department.

Don’t worry about big insurance problems; EZ.Insure offers solutions. Your agent will answer any questions you have, compare the plans available to you, and even sign you up when you are ready, free of charge. To get started simply enter your zip code in the bar above, or you can speak to an agent by emailing [email protected], or calling 888-998-2027. EZ.Insure makes the entire process simple, easy, and quick.

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