7 Health Care Slots

Individual plans now have an open enrollment where employees can buy their individual health plans. If it is ON-exchange the government provides a tax credit “subsidy” to lower the monthly premium if your income is below the qualifying threshold. Depending on where you live, your preferred doctor, and your income dictates which carrier we will recommend to you. Employers interested in cancelling their group plan and going to individual plans can contact 5G Benefits and we will meet one-on-one with employees to find the best individual health plan for them. 5G Benefits has an Online Health Portal where you can search for all the health carriers on-exchange, get the exact price, see your potential subsidy, and enroll right online.

This is an option where employers actually get a tax credit from the government for offering a qualified SHOP group health plan to its employees. Employers must have 50 or fewer full-time employees to buy on the SHOP marketplace. To qualify for a tax credit you must have fewer than 25 full-time employees making an average of about $50,000 a year, and pay 50% of the premium.

This is where most employers have been buying insurance for years and years. What has changed in this market dramatically is adjusted community ratings which evens out the rates for unhealthy to healthy, older to younger, male to females. It also provides guaranteed issue (no health questions asked) to all groups with under 50 employees. Soon all plans will be ACA Rated, which for healthy groups, the rates will go up. Depending on many different factors, being in the traditional group slot may be costing you way more money than another slot. Let 5G Benefits do a review to determine which slot is best for you and your business.

These have been around for years and years but have increased popularity because of no underwriting for groups with under 50 employees. They are technically on a self-insured platform but provide protections to employers on the premiums and claims funds. Carriers have all developed products in this slot so they can still provide underwritten rates to smaller employers. A portion of your premium gets set aside into a claims fund and if the claims are left over, it comes as a check to the employer. If the claims are exhausted, then reinsurance companies cover the additional claims. Employers are taking very hard looks at switching to this slot if they are a healthy group. 5G Benefits is a pioneer of level funding plans and have years of experience ahead of most agencies just getting into this market.

In a self-funded health plan, the employer assumes the risk for claims instead of the insurance company. There is a TPA (third-party administrator) that administers everything from paying providers, billing, admin, stop-loss insurance, etc. There is a claims fund where employers can get money back if there is low utilization by employees, but the premiums each month can fluctuate a tremendous amount. Employers need to budget more appropriately to fluctuating premiums due to incoming claims and also be very in-tune with where the fixed costs of the plan are going. 5G Benefits uses Self-Insured plans for a select group of larger employers looking for more freedom on plan designs and information about costs.

This is insurance that meets the Affordable Care Act requirement for having health coverage. It provides only the Minimum Essential Coverages to allow employers to offer insurance to its employees, which avoids the employer mandate/penalty. If employees elect the coverage it allows individuals to avoid the individual mandate/penalty. 5G Benefits has multiple clients on MEC Plans and its geared more towards larger employers with over 50 employees, such as staffing firms, restaurants, seasonal employers, those with many part time employees, or employers with very low income employees where Obama Care on-exchange would be better for their employees. It helps businesses avoid the mandate and individuals avoid the mandate, and provides an employee benefit that does give some overage to those who otherwise would go without.