Small Group

2-50

Full-Time Employees

Mid Market

51-100

Full-Time Employees

Large Group

100+

Full-Time Employees

Types of Group Insurance:

Fully Insured
These plans are ACA compliant which means they must provide coverage immediately with no waiting periods, and preexisting conditions are excluded. These rates are firm and there may be a price break with more eligible employees participating. This is because the insurance risk is pooled and the law of large numbers allows for more risk to be spread across more people v one person bearing it all. Many hands make light work.
This is a more recent trend in the Employer Benefits Group space that allows a Group, regardless of the size, to win back some of their premium. These plans are fully insured against any major claims; however, if the claims experience for the year is less than anticipated by the insurance company, the employer is eligible for a rebate or premium savings on their future bill. This is very attractive to groups that are generally healthy and expect to stay that way. For Groups under 50 lives, these plans are underwritten and the prices offered are preliminary; however, if the underwriting is favorable, the rates may be lower than the initial offering. On the flip side, the rates can be more expensive than the preliminary offering if the underwriting finds more risk.
There are different networks within each plan. Fully insured carriers use HMO or PPO networks while Self-funded plans have different names but are essentially the same as an HMO and PPO.
These are usually more restrictive in the access provided because most all decisions are run through a primary care physician in the event that a specialist is needed. You are encouraged to use in-network doctors, facilities and hospitals while not doing so could cause increased out of pocket costs or certain coverage being denied. That is because out of network benefits are not covered under HMOs. This is a great option if the network is large and there are good hospitals in the area.
These are more accessible and the freedom of choice is available to you. There are no referrals needed to see a specialist and you have the option of leaving the network and going out of network. Out of network benefits are covered under PPO plans.

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