GROUP INSURANCE
We understand that your employees are more than simply faces in the crowd; they are part of your family. Take care of each one and protect your employees whenever and whenever with our group insurance products.
Whatever the size of your company or the nature of your industry, you’re likely to find group insurance options that meet your specific needs and budget.
What is Group Health Insurance?
Group health insurance is a kind of health insurance program provided by an employer of a member organization and is sometimes referred to as employer-based coverage. A group health insurance plan’s participants often pay less for coverage since the insurer’s risk is spread out among more people.
Businesses with 50 or more full-time employees are required by the Affordable Care Act (ACA) to offer health insurance to full-time employees and dependents under the age of 26 or face a fine. Additionally, insurers must offer group coverage to businesses with as low as two employees. Self-employed people may be eligible for group insurance policies in several states as well.
How does Group Insurance work?
Group Insurance plans are acquired by companies and organizations and then offered to their employees. This coverage can only be purchased by a group and is not available to individuals to purchase. These plans require at least 70% of group members or employees to be “valid”. Some plans have tiers, where the insured has the ability to choose whether to take the basic plan or the advanced coverage with additional benefits.
Members of the group can accept or decline the coverage being offered by the organization. Companies and organizations usually choose the plan they will offer.
Premiums are split between the company/organization and its member based on the chosen coverage. In Group Insurance, coverage may be extended to the member’s family or dependents, but usually with an extra cost.
Group Insurance is one of the most affordable types of coverage since the risk is spread among insured members of the group and offers lower premium costs, compared to a traditional individual health plan.
Advantages of Group Health Insurance
Compared to individual plans, group health insurance has a variety of advantages and benefits. Many employers offer supplemental health plans that include drug, vision, and dental insurance with other types of coverage.
- Lower premiums are the primary benefit group plans provide. The average monthly price for an individual in a group health insurance plan in 2018 was $409, compared to $440 for an individual plan.
Families with sole providers or those with much more expensive alternative or individual health plan options may find it helpful to join family members and dependents to group plans at an additional cost to members.
Group health insurance offer both the business and the employee a number of tax advantages. Employers can deduct the cost of their monthly premium payments, and employees can pay their premiums before taxes, which might lower their overall taxable income.
- The small company health care tax credit may also be available to some smaller firms. Employers with fewer than 25 full-time employees who pay average wages of under $50,000 annually, provide qualified health plans through the Small Business Health Options Program (SHOP) Marketplace, and cover at least 50% of the cost of health insurance for each employee are eligible for the small business health care tax credit (but not for family or dependents).
Health coverage options for employers and employee
Employer-sponsored group coverage
Small employers with 50 or fewer employees may be eligible for small group coverage. If you have fewer than 25 FTE (full-time equivalent), you may be qualified for the Small Business Health Care Tax Credit. Large employers with more than 50 FTE must offer employer-sponsored health coverage to their employees that meet the employer’s shared responsibility provisions.
Individual health coverage
- Oregon Health Plan
Individuals and families who work part-time may qualify for Oregon’s Medicaid program, also called Oregon Health Plan, which is free coverage for low-income Oregonians.
People who are not offered employer-sponsored health coverage, Oregon Health Plan, or Medicare can purchase health coverage through a health insurance company or through the Marketplace. Financial assistance is available through the Marketplace to lower the monthly premium and deductibles, based on income.
Federal health coverage program through Social Security for people who are 65 or older, are on Social Security Disability for more than 24 months or have an end-stage renal disease (ESRD).
Association health plans
These plans allow many small- to medium-sized companies the ability to come together under one health plan, potentially reducing costs and increasing benefit options. There are rules around these organizations and criteria to participate. These plans are not regulated or guaranteed for essential health benefits or pre-existing conditions.
Health reimbursement arrangements
- HRAs allow employers to grant pre-tax funds to help employees pay for medical expenses.
Small-group coverage
Unlike individual health insurance, which has a set enrollment window, small-group coverage is available year-round,
If you have at least one employee who receives a W2, you can purchase coverage for yourself and your workers at any time. Small businesses with one to 50 employees can purchase a plan from any insurer offering a small-group plan in Oregon.
That offered employer-sponsored coverage will likely not be eligible for financial assistance.
Who Can Sign Up for Group Health Insurance?
An employee must be paid by their employer and subject to payroll taxes in order to be eligible for group health insurance. Independent contractors, retirees, and seasonal or temporary workers are among those who are typically ineligible for group insurance. Employees on unpaid leave frequently lose their eligibility for group coverage until they resume their jobs.
Employers may choose to extend the age definition for child dependents, although in general, group health insurance coverage must be extended to an employee’s spouse and dependent children up to age 26. Unmarried partners may also receive health benefits from employers, but such coverage must be equivalent to that provided to couples under the same plan.
How to Enroll in Group Health Insurance
As soon as you are hired, find out the deadline for signing up for a group health insurance plan offered by your employer. If you miss this deadline, you could have to wait to enroll until the next open enrollment period. Some businesses may impose waiting periods of up to 90 days before health insurance coverage begins for new hires. During this time, you won’t be required to pay any premiums, but you also won’t have any access to health insurance.
Different levels of coverage or add-on benefits like dental, vision, and/or pharmacy coverage are available under some group health insurance plans. You can choose among the insurance options your employer offers, as well as add or remove any dependents, during open enrollment periods. You might be able to add these additional dependents to your group health insurance plan outside of the open enrollment period if a significant life event, such as marriage, having a kid, or your spouse losing their job, affects your circumstances.
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