Alderette Insurance Agency, Inc.

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Group Plan Funding Structures

Fully-Insured Plans


Fully-insured plans are one of the more traditional types of health insurance. These plans involve an insurance company taking on the risks of health care costs and charging a business an annual premium which is partially paid for by the employees.


Self-Funded Plans


Self-funded plans involve the employer assuming the financial risk of health care costs. Contributions by the employer and employees create a claims fund to pay medical costs. These plans are typically administered by a Third Part Administrator (TPA). Self-funded plans can often lead to more affordable rates and more control over a plan. Large employers with thousands of employees have been known to provide this type of coverage. However, small and medium sized groups can also take advantage of self-funded strategies.


Level-Funded Plans


Level-funded plans look similar to fully-insured plans except that premiums are based on a monthly rate. Insurance carriers will use census information to determine the monthly premium. The premium is based on factors like claim allowances, fees and stop-loss coverage premiums (i.e. “reinsurance”). The carrier will adjust the monthly premium annually based on medical claims that the group has experienced.


Small Business Health Options Program (SHOP)


SHOP was created by the Affordable Care Act and is a way for small businesses to shop for group health insurance.  SHOP applies to companies with up to 50 Full-Time Equivalent employees. Eligible employers can choose coverage options for their employees. You can offer a single plan or let your employees choose from multiple options. Your business can choose how much you pay toward your employees’ premiums and whether to offer coverage to their dependents or not. 


You may also qualify for a tax credit that could be worth up to 50% of the costs you pay for your employees' premiums. To qualify for the tax credit, all of the following must apply:


  • You have fewer than 25 Full-Time Equivalent (FTE) employees
  • Your average employee salary is about $56,000 per year or less
  • You pay at least 50% of your full-time employees' premium cost
  • You offer SHOP coverage to all of your full-time employees. (Note: you don't have to offer SHOP coverage to dependents  or employees working fewer than 30 hours per week to qualify for the tax credit.)

To speak with a group insurance specialist, call us now at (866) 639-1662 or click here to get a free quote.

Looking For Group Health Insurance?

Get A Free Quote

Group Plan Funding Structures

Fully-Insured Plans


Fully-insured plans are one of the more traditional types of health insurance. These plans involve an insurance company taking on the risks of health care costs and charging a business an annual premium which is partially paid for by the employees.


Self-Funded Plans


Self-funded plans involve the employer assuming the financial risk of health care costs. Contributions by the employer and employees create a claims fund to pay medical costs. These plans are typically administered by a Third Part Administrator (TPA). Self-funded plans can often lead to more affordable rates and more control over a plan. Large employers with thousands of employees have been known to provide this type of coverage. However, small and medium sized groups can also take advantage of self-funded strategies.


Level-Funded Plans


Level-funded plans look similar to fully-insured plans except that premiums are based on a monthly rate. Insurance carriers will use census information to determine the monthly premium. The premium is based on factors like claim allowances, fees and stop-loss coverage premiums (i.e. “reinsurance”). The carrier will adjust the monthly premium annually based on medical claims that the group has experienced.


Small Business Health Options Program (SHOP)


SHOP was created by the Affordable Care Act and is a way for small businesses to shop for group health insurance.  SHOP applies to companies with up to 50 Full-Time Equivalent employees. Eligible employers can choose coverage options for their employees. You can offer a single plan or let your employees choose from multiple options. Your business can choose how much you pay toward your employees’ premiums and whether to offer coverage to their dependents or not. 


You may also qualify for a tax credit that could be worth up to 50% of the costs you pay for your employees' premiums. To qualify for the tax credit, all of the following must apply:


  • You have fewer than 25 Full-Time Equivalent (FTE) employees
  • Your average employee salary is about $56,000 per year or less
  • You pay at least 50% of your full-time employees' premium cost
  • You offer SHOP coverage to all of your full-time employees. (Note: you don't have to offer SHOP coverage to dependents  or employees working fewer than 30 hours per week to qualify for the tax credit.)

To speak with a group insurance specialist, call us now at (866) 639-1662 or tap here to get a free quote.

Looking For Group Health Benefits?

Get A Free Quote

Group Plan Funding Structures

Fully-Insured Plans


Fully-insured plans are one of the more traditional types of health insurance. These plans involve an insurance company taking on the risks of health care costs and charging a business an annual premium which is partially paid for by the employees.


Self-Funded Plans


Self-funded plans involve the employer assuming the financial risk of health care costs. Contributions by the employer and employees create a claims fund to pay medical costs. These plans are typically administered by a Third Part Administrator (TPA). Self-funded plans can often lead to more affordable rates and more control over a plan. Large employers with thousands of employees have been known to provide this type of coverage. However, small and medium sized groups can also take advantage of self-funded strategies.


Level-Funded Plans


Level-funded plans look similar to fully-insured plans except that premiums are based on a monthly rate. Insurance carriers will use census information to determine the monthly premium. The premium is based on factors like claim allowances, fees and stop-loss coverage premiums (i.e. “reinsurance”). The carrier will adjust the monthly premium annually based on medical claims that the group has experienced.


Small Business Health Options Program (SHOP)


SHOP was created by the Affordable Care Act and is a way for small businesses to shop for group health insurance.  SHOP applies to companies with up to 50 Full-Time Equivalent employees. Eligible employers can choose coverage options for their employees. You can offer a single plan or let your employees choose from multiple options. Your business can choose how much you pay toward your employees’ premiums and whether to offer coverage to their dependents or not. 


You may also qualify for a tax credit that could be worth up to 50% of the costs you pay for your employees' premiums. To qualify for the tax credit, all of the following must apply:


  • You have fewer than 25 Full-Time Equivalent (FTE) employees
  • Your average employee salary is about $56,000 per year or less
  • You pay at least 50% of your full-time employees' premium cost
  • You offer SHOP coverage to all of your full-time employees. (Note: you don't have to offer SHOP coverage to dependents  or employees working fewer than 30 hours per week to qualify for the tax credit.)

To speak with a group insurance specialist, call us now at (866) 639-1662 or tap here to get a free quote.

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