group health insurance plan options

Association Health Plans

Association Health Plans are group health plans made up of multiple employer groups or associations to provide health coverage for employees. These are similar to MEWAs and Multiple Employer Trusts.

In June 2018, the U.S. Department of Labor provided regulations that allowed the expansion of Association Health Plans to operate but they are still regulated by the states in which they cover people. In Ohio, many insurers and associations had already taken steps to establish MEWAs for small groups (those with 50 employees or less) to offer medically underwritten alternatives to ACA plans which are community-rated.

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Fully Insured

Fully Insured products refer to an insurance product that covers certain expenses incurred during the covered period of time according to a policy stating specific benefits and conditions. Employers pay set fees, called premiums, for each covered person each month. Premiums are typically set for 12 months at a time.

Individual Coverage Health Reimbursement Arrangement (ICHRA)

An Individual Coverage Health Reimbursement Arrangement (ICHRA) reimburses employees, tax-free, for individual health insurance premiums and out-of-pocket costs. Essentially, this arrangement reimburses employees for their health insurance rather than purchasing it for them. The arrangement is designed to provide greater cost control for the employer and more options for the employee. With this arrangement, you no longer have the burden of managing a group health insurance plan, which means no more time wasted fussing around with renewals and participation rates, and more time spent focusing on your business and your clients.

When you choose an ICHRA plan for your group, your employees will get their individual health insurance on the marketplace. You, the employer, will then set up a health reimbursement account (HRA) that assists the employee with their individual premiums on a tax-free basis for the employee and the employer has the ability to take the cost of the reimbursements on a business expense basis. The employee may still be eligible for subsidies, but the costs will offset each other.

Level-Funded

A level-funded health plan (also known as a partially self-funded plan) is a type of health insurance plan that combines the cost savings and customization of self-funding with the financial safety and predictability of fully funded plans. Administrative costs are fixed and charged per employee. These are underwritten products that require employees and their dependents to fill out medical applications to get a premium rate.

Multiple Employer Welfare Arrangement (MEWA)

A Multiple Employer Welfare Arrangement (MEWA) is an employee welfare plan that provides welfare plan benefits to the employees of two or more unrelated employers. These are underwritten products that require employees and their dependents to fill out medical applications to determine the risk of the group and the monthly premium to cover that risk. This helps the insurance company to determine a risk score for the business, which will then help in determining the monthly premium for the health insurance plan.

Click here to learn more about MEWAs.

Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)

QSEHRAs were introduced in December 2016 as part of the 21st Century Cures Act. QSEHRAs are a type of Health Reimbursement Account that small employers, who don’t offer a group health plan, can establish to reimburse employees who purchase individual health insurance. Employees must provide eligible proof of minimum essential coverage and proof of expense.

Self Funding

Self-funding is sometimes also referred to as Self-Insurance. It is a way for employers to restructure how they pay for health benefits for employees and their families. The employer typically purchases Stop Loss Insurance and hires a third-party administrator (TPA) to manage their plan and assist with pharmacy and network selections. Self-funded employers with good risk can often save year over year versus traditional fully insured arrangements; however, there is financial risk involved.