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Health and Benefits 101
Guidebook

Health and benefits insurance hero

Question 2

What types of H&B coverage are available?


Medical coverage may be the first thing that comes to mind when you think about health and benefits. However, there ara additional coverage options to consider when looking to provide a comprehensive health and benefits package to employees.

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medical coverage

Medical

Provided by an employer to employees and sometimes their spouses, partners, and legal dependents. Employer-paid premiums are generally tax-deductible. Each state sets minimum participation requirements needed to offer group health insurance to a company.


Partially Self-Funded Plans

The employer assumes some of the financial risk for providing health care benefits to employees.


Fully Insured Plans

The employer pays a fixed premium rate based on the number of employees enrolled in the plan to the insurance carrier.


High Deductible Health Plans (HDHP)

Feature higher deductibles than traditional insurance plans, but can be combined with Health Savings Accounts (HSAs) or Health Reimbursement Arrangements (HRAs) that allow employees to pay for qualified out-of-pocket medical expenses with pretax earnings.


Physician-Hospital Organization (PHO)

An alliance of physicians and hospitals who sell their services to managed care companies or directly to employers.


Managed Care

Provides incentives for employees to use in-network and out-of-network physicians and hospitals – common plans include Preferred Provider Organizations (PPOs) or Health Maintenance Organizations (HMOs).


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Dental

Contributes to oral health and overall wellness of employees and their dependents.

Traditional Plans:

See any dentist who accepts insurance.

Preferred Providers:

In-network and out-of-network coverage.

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Vision

Eye care benefits for employees and their dependents with package or discount options.

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Prescription

Helps employees secure the medicines doctors prescribe.

  • List of covered pharmaceuticals to help manage acute and chronic conditions.
  • Tiered pricing enables employees to pay a co-pay for various prescriptions.
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Group Life Insurance

Provides financial protection for employees’ beneficiaries.

Group Life:

A single policy owned by the employer to cover all employees.

Term Life:

Yearly renewable coverage.

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Short-Term Disability Coverage

Pays a percentage of an employee’s salary for a specified amount of time, if he or she is ill or injured and cannot perform their job

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Long-Term Disability Coverage

Pays a portion of an employee’s salary when he or she cannot work for an extended period of time

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COBRA

Helps employers with 20 or more employees manage the COBRA law’s complex administrative process if coverage of a member is lost due to certain events, like loss of employment

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State Continuation Coverage

Similar to COBRA but applies to group health insurance policies of employers with fewer than 20 employees. Some states include larger group insurance policies and require COBRA protection

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Voluntary Benefits

Allows employees to purchase individual insurance coverage paid by their payroll deductions, not by the employer

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Click here for a full glossary of terms for Health & Benefits.


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