Group Benefits
Whether you're setting up a new plan, reviewing your current benefits, or expanding coverage as your team grows, our licensed agents are here to ensure your employees get the protection they need at a cost that works for your business. With no added cost to you, we make it easy to feel confident about your group insurance choices.
What Are Fully-Insured Group Health Insurance Plans?
A fully-insured group health insurance plan is a traditional form of coverage in which an employer contracts with an insurance company to provide health benefits to employees. These plans are regulated at the state level and must comply with specific requirements under the Affordable Care Act (ACA), such as providing essential health benefits and limiting out-of-pocket costs.
Types of Fully-Insured Plans
Fully-insured group health insurance plans come in several forms, each catering to different needs and preferences:
Exclusive Provider Organization (EPO): EPOs are a hybrid of HMOs and PPOs. They provide a network of providers but do not require referrals for specialists. However, out-of-network care is not covered, except in emergencies.
Health Maintenance Organization (HMO): HMOs are known for their affordability and strict network limitations. Policyholders must choose a primary care physician (PCP) who coordinates all medical care and provides referrals for specialists. Services outside the HMO network are typically not covered except in emergencies.
High-Deductible Health Plans (HDHP): HDHPs are designed for cost-conscious individuals and are often paired with Health Savings Accounts (HSAs). These plans feature lower premiums and higher deductibles, making them ideal for those who are generally healthy and can afford the upfront costs of medical care.
Point of Service (POS): POS plans combine elements of HMOs and PPOs. Policyholders need a primary care physician and must obtain referrals for specialists, but they can also see out-of-network providers at a higher cost.
Preferred Provider Organization (PPO): PPOs offer greater flexibility by allowing policyholders to see any healthcare provider. Unlike HMOs, PPOs do not require referrals for specialists, making them popular for those who value freedom of choice.
Benefits Fully-Insured Group Health Insurance Plans
Fully-insured group health insurance plans offer several benefits:
Comprehensive Coverage: Fully-insured plans typically include essential health benefits such as preventive care, maternity coverage, mental health services, and prescription drugs, covering most employee needs
Predictable Costs: The fixed monthly premium for both employers and employees simplifies budgeting and reduces financial uncertainty for all parties.
Reduced Administrative Burden: The insurance company or carrier manages claims, compliance, and customer service, centralizing all questions to one avenue of support.
Regulatory Compliance: All fully-insured plans meet legal requirements and follow federal regulations.