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What are the various types of Medical Plan Design?

10/10/2017

 
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

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  • Home
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