What are the various types of Medical Plan Design?

The "right" benefits program varies based on your company's individual needs and goals. Here are some of the most common combinations of programs.

Traditional (Fully Insured)

• Rates not dependent on health of employer group but on the health of the "pool" or everyone on a particular insurance carrier's offerings
• Rates are filed annually - no room for negotiation
• Plan types include PPO, HMO, POS and EPO

​HSA Health Savings Account Compatible

• Compatible insurance plan paired with a Health Savings Account that allows the saving of money pre-tax to pay for unreimbursed medical, dental and vision expenses
• Deductible must be met before benefits are paid

T​raditional with HRA Pairing

• A Traditional plan with a high deductible paired with a Health
• Reimbursement Account
• Employer reimburses employee for specific expenses - such as part of a deductible

​Self Funded / Level Funded

• Traditional or H.S.A. these plans are medically underwritten as a group or individually
• Group may receive money back based on claims experience
• Chance to experience return on wellness plan

Concierge with Self Funding

• Primary Care Home offered with high deductible self-funded plan
• Typically participants with utilize a high value medical home for most needs
• Helps with cost containment

​Employee Only Group Coverage

Some plans allow coverage for employes only, allowing spouses to receive a tax credit

​Individual

• Drop the Group Plan everyone can purchase an individual plan
• Not always a good option - it can be beneficial if employees or most qualify for a Tax Credit/we provide a Tax Credit Survey
• Premiums for individual plans are currently taxable