Small Group Health Insurance

Deep breath. Once you choose a plan, the rest of the process will be a lot easier. When it comes to plan design, there are three options to choose from.

1. HMO (Health Maintenance Organization) is the most popular choice, and usually the most cost effective. This plan emphasizes health and wellness, covers all the services your employees will likely need and keeps costs manageable. In-network specialists are also usually available without a referral.
2. PPO (Preferred Provider Organization) plans let employees choose by giving provider options both in and out of network. Employees decide if they’d like to save money and stay in-network or spend more by going outside the network. Basically, a PPO plan provides broader care than HMO, including more hospitals and doctors, but with higher monthly premiums and out-of-pocket costs. PPO plans are only available to employers that live or work outside of the GHC-SCW service area.
3. POS (Point of Service) is a type of managed care plan that combines elements of HMO and PPO plans. Like an HMO plan, employees choose a primary care provider in their network. Similar to PPO plans, POS plans also offer the option to receive care out of network. When employees stay in-network, a POS plan is very affordable, but once they venture out of network, high premiums and out-of-pocket costs add up quickly.

There are four main elements that small business owners should know about health insurance.

1. Number of employees: This one’s easy. You only need to have two employees on your payroll to qualify for small business health insurance coverage.
2. Coverage: If you’re eligible for a small business health insurance plan, you’ll get your coverage through a health insurance company. That means that you, your employees and their families cannot be denied coverage based on pre-existing medical conditions.
3. Premiums: You must pay at least half of your employees’ monthly health insurance premiums. Minimum percentages vary depending on the insurance company.
4. Shopping for coverage: You can start shopping anytime! There’s no need to wait for your current plan to expire or for a special enrollment period to browse. Just keep in mind that once you purchase a plan, you are typically locked in for at least a year. During that time, you can add new employees and dependents or drop your coverage for former employees. Once your contract is up, you can either renew or shop for a new plan.

You should approach choosing a health insurance plan from a collective perspective. What do your employees and their families need to feel supported in their health and well-being? What can you afford with your budget?

Think about your employee base. What would make the most sense for the group? Don’t be afraid to consult your employees. Consider creating an anonymous survey regarding the most important health care plan benefits so you can get a read on what your employees value most.

Then talk to a GHC-SCW expert who can help you weigh your options and find the right solution.

Yes! GHC-SCW understands how important it is for you to offer your employees benefits that support them as a whole person.

Our health plans include behavioral health benefits, including options at our GHC-SCW clinics and a large network of approved providers. We can help your employees address their mental and behavioral health needs.

Small groups have 2-50 total employees. Large groups have more than 50 total employees.

Wisconsin small employers are not required by state law to offer employees health care benefits.

But many small employers do offer health benefits to their employees to attract and keep good employees. According to a 2018 survey by America’s Health Insurance Plans, 56% of American employees stated the quality of their health care coverage was a key factor in determining whether they stayed at their job.

You have a few options for offering coverage.

• Choose a health plan with a multi-state or national provider network. At GHC-SCW, we have a national network of providers through our PPO plan.
• You can also offer different Small Business Health Options Program (SHOP) health plans in each state where your employees work, even if you only have one employee in a location.

There are a few factors that affect the cost:

• Your employees’ and dependents’ age. Older people usually have more expensive and more frequent health-related claims so the plans might cost more.
• Whether or not any of the people covered by your plan use tobacco.
• The network you select. More choice in network (national, statewide, etc.) usually means higher cost. Narrower networks (Dane County only for example) can be less expensive.
• The services covered in the plan and any cost-sharing amounts. Plans that provide more benefits usually have more cost.
• Where you are. Health care can cost different amounts based on things like cost of living, the number of providers in our area, etc.