Avoid Penalties and Get Tax Credit
Health insurance is one of the most sought after and useful benefits a company can
provide for its employees. But choosing a health insurance provider for your small
business can be very challenging.
It is worth the time and effort to find a quality health insurance plan provided by a
reputable broker or agent. You will need to carefully consider the options you want to
offer as well as the cost to your company. This guide will equip you with the information
you need to choose a health insurance provider for your business, and will provide tips
for making your final selection with confidence.
Important Facts About Health Insurance Benefits
Businesses usually obtain health insurance through either an agency or a broker. It is
important to know the difference. Basically, an agent works for the insurance
companies. Independent agents may represent several insurance companies while
others work only for a single company. A broker, on the other hand, works for the
insured company rather than the insurer.
Business health insurance has undergone some significant changes in recent years,
transforming the way companies provide health insurance for their employees.
Conventional plans, for example, are rarely offered, while user-driven policies have
become increasingly popular.
Conventional (indemnity) plans allow employees to receive treatment from any hospital
or doctor they choose. No referral is required to visit a specialist, and the insurance
company does not have to approve a specific treatment before authorizing coverage.
This type of plan, while offering great flexibility for patients, is rarely provided by
businesses today due to the largely prohibitive costs. These plans also come with high
deductibles for the patient as well as higher out-of-pocket costs for each visit.
Health insurance plans provided by employers today typically fall under one of three
main categories; preferred provider organizations (PPOs), health maintenance
organizations (HMOs), and point of service (POS) plans. Here is an overview of each
type of plan:
HMOs carry the lowest premiums of all types of insurance plans, keeping costs down by
working with a network of hospitals and medical care practitioners. However, they also
offer the least amount of flexibility to patients, who must select a primary care physician
(PCP) from among the plan's network of providers.
PPOs offer greater flexibility than traditional HMOs, while still working with a network of
preferred providers. Patients may visit providers outside the network, but their out-ofpocket
costs will be higher than when using a preferred provider. Most PPO plans do
not require the insured person to have a primary care physician. Also, employees can
visit a specialist without first obtaining a recommendation.
POS plans combine features of both HMOs and PPOs. Employees do need to have a
designated primary care provider, but they may also go to an out-of-network provider.
The cost for out-of-network treatment will be mostly or completely covered if the primary
care physician has made the recommendation. If not, then the patient is responsible for
the bill.