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group health insurance for non employees

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How to provide health insurance for non-employees

Things to consider around health benefits for non-employees.

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PUBLISHED ON

May 12, 2022

One of the top benefits a company can offer its employees is health insurance coverage. This gives workers access to a group policy, which often allows them to secure more affordable and comprehensive coverage than they could on their own. 

But what if you want to provide health insurance for non-employees, such as contractors?

While your options may be limited, there are ways to provide health insurance to non-employees. Through careful consideration of the details, you can provide contractors with a high-level benefit that will strengthen your relationship.

Before we go any further, remember this: you’re under no legal obligation to offer health insurance to individual contractors. This is a decision your company can make at its own discretion. 

The best path forward is to offer contractors the same health insurance as your employees. This makes it easier to manage payroll and benefits , thus reducing the risk of error and saving you time. 

If you opt to offer contract medical insurance, there are four points to keep in mind:

1. Employers can offer the same group plan

As noted above, you can offer contractors the same group plan as your part and full-time employees. You don’t have to select a different plan for contractors to access. 

2. The contractor may need to declare it as taxable income 

Urge your contractors to discuss the tax implications of receiving health insurance from your company. They may need to declare any employer contribution as taxable income. 

3. Employers don’t have to pay any portion of the premium

There’s no requirement for employers to pay any portion of the premiums for contractors. You can do this if you want, but it’s not an obligation. That holds true even if you pay some or all of the premium for your employees. 

4. Contractors may be able to deduct the premium paid

Contractors may be able to deduct any premiums paid from their income. This can help reduce the impact of the cost at tax time. 

Want to see the Oyster platform in action? Book a demo and we promise to show you all the features that’ll make your People Ops team go whoa .

Is health insurance for non-employees a good idea.

There’s no right or wrong answer to this question, as the situation varies from company to company and contractor to contractor. If you’re on the fence, here are some benefits of offering health insurance coverage to “1099 employees.”

  • Health insurance can help retain contractors. One of the primary disadvantages of working as a contractor is a lack of access to benefits such as medical coverage. You can help contractors by giving them access to your group policy. 
  • It can save you money. The more people you have on your group policy — especially if you add younger, healthier contractors — the better chance there is of reducing premiums for your entire team. 
  • It can help you qualify: For instance, if you’re the only employee at your company, you may need to add contractors to qualify for group health insurance.

Questions to ask and answer

As you inch closer to making a final decision, answering these questions can help you proceed with confidence:

  • How many contractors do you work with?
  • Do you generally maintain long-term relationships with your contractors?
  • Can you afford to pay a portion of contractor health insurance premiums?
  • Do you know if some or all of your contractors are interested in buying coverage through your group plan?
  • Does it make sense to search for a different health insurance provider before allowing contractors to join?

Answering these questions provides insight into your situation so that you can make a more informed decision.

Oyster is here to help

Deciding for or against health insurance for non-employees is easier said than done. For that reason, you want to gather as much information and professional guidance as possible. And that’s where Oyster can help.

Oyster Health makes it simple and affordable to offer health insurance to team members in more than 180 countries. You’re not limited to offering coverage to contractors and employees in your home country.

By working directly with various health insurance carriers, Oyster can provide you with multiple quotes to help you make the right decision for your team and your company financials.

About Oyster

Oyster is a global employment platform designed to enable visionary HR leaders to find, hire, pay, manage, develop and take care of a thriving global workforce. It lets growing companies give valued international team members the experience they deserve, without the usual headaches and expense.

Oyster enables hiring anywhere in the world with reliable, compliant payroll, and great local benefits and perks. Try Oyster out with a free demo!

group health insurance for non employees

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Additional resources.

group health insurance for non employees

Do employers have to offer health insurance?

Are you required to provide healthcare to your team?

group health insurance for non employees

Health insurance for foreign nationals

How to provide health insurance to foreign nationals.

group health insurance for non employees

What’s the difference between public and private health insurance?

Understanding different types of insurance for employees.

group health insurance for non employees

How much is health insurance for 1099 workers?

Must-knows about insurance for independent contractors.

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Best Small-Business Group Health Insurance Plans

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Table of Contents

Best overall: Blue Cross Blue Shield

Best for low-cost plan options: kaiser permanente, best for transparency: unitedhealthcare, best for customer service: humana, best for health expense funds: aetna (cvs health).

As a small-business owner, the decision to offer health insurance to your employees is a personal one. If you have fewer than 50 employees, you are not required by law to offer a group health insurance plan. But you may still want to consider it as a tool to hire and retain workers and to claim tax benefits for your business.

Choosing the right group health insurance plan for your employees depends on your budget and also factors like the number of employees you have, how old they are and where they live. You can purchase insurance through the federal government’s Small Business Health Options marketplace, directly from an insurance provider or using an insurance broker.

» MORE: How much does small business health insurance cost?

Here are our picks for the top small-business group health insurance providers to consider.

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Largest provider network in the country.

Limited plan details available online; must talk to a sales representative.

Why we like it: Blue Cross Blue Shield is an association of 35 locally operated insurance companies throughout the country. Together, the association provides access to 93% of doctors and 96% of hospitals nationwide. This means finding in-network doctors should not be a problem for your employees anywhere in the country.

Blue Cross Blue Shield provides a variety of plan options for your employees, including preferred provider organizations, health maintenance organizations and high-deductible health plans, as well as group dental and vision plans. The company ranks well in J.D. Power’s 2021 Commercial Member Health Plan Study, which measures member satisfaction. Blue Cross Blue Shield wins the top spot in eight U.S. regions.

For 2019, the average rating for Blue Cross Blue Shield plans on the National Committee for Quality Assurance website was 3.5 on a scale of 1 to 5. The NCQA rates plans on factors such as clinical quality and member satisfaction.

Low-cost HMO plans.

Small-business plan comparisons available online.

Available only in California, Colorado, Georgia, Hawaii, Maryland, Oregon, Virginia, Washington and Washington, D.C.

Why we like it: Kaiser Permanente is only available in a handful of states but it is well-rated in those regions, according to the J.D. Power study. Its average rating on the NCQA website is also high, at 4.3. Kaiser is best known for its HMO plans, which it offers at a low cost because patients are generally required to see providers within a small network. As a small-business owner, you can easily view the details of all of Kaiser's group offerings, including pricing information, on its website.

Comparison tool for small-business plans available online.

Available in all 50 states.

Does not rank in J.D. Power’s Commercial Member Health Plan Study of top insurers.

Why we like it: UnitedHealthcare is the largest insurance company in the country by market share; it works with more than 1.3 million physicians and care professionals, and 6,500 hospitals. Its small-business plan comparison tool makes it stand out from the competition. You can enter some basic information about your business and compare plan costs and features easily on UnitedHealthcare’s website. On average, the company’s NCQA rating is 3.4.

Plan details available online.

Smaller provider network than other insurers.

Why we like it: Humana is ranked well for customer service according to the J.D. Power study. The company’s customer service was also rated the best in the health insurance category of Newsweek’s annual Best Customer Service report two years in a row, for 2019 and 2020. On average, its plans had an NCQA rating of 3.4. Humana offers five types of plans geared toward small businesses and lists the features of each on its website.

Large network of providers.

Limited plan details available online.

Why we like it: Aetna has a comprehensive set of health expense funds that you can offer employees for pre-tax savings, such as health savings accounts and flexible savings accounts, as well as health and retirement reimbursement arrangements. (Note: Aetna’s HSA option is paired only with its high-deductible health plans.) Aetna ranks high on J.D. Power’s Commercial Member Health Plan Study and has an average NCQA rating of 3.3.

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Thomas J Catalano is a CFP and Registered Investment Adviser with the state of South Carolina, where he launched his own financial advisory firm in 2018. Thomas' experience gives him expertise in a variety of areas including investments, retirement, insurance, and financial planning.

group health insurance for non employees

What Is a Group Health Insurance Plan?

Group Insurance health plans provide coverage to a group of members, usually comprised of company employees or members of an organization. Group health members usually receive insurance at a reduced cost because the insurer’s risk is spread across a group of policyholders. There are plans such as these in both the U.S. and Canada .

Key Takeaways

  • Group members receive insurance at a reduced cost because the insurer’s risk is spread across a group of policyholders.
  • Plans usually require at least 70% participation in the plan to be valid. 
  • Premiums are split between the organization and its members, and coverage may be extended to members' families and/or other dependents for an extra cost.
  • Employers can enjoy favorable tax benefits for offering group health insurance to their employees.

How Group Health Insurance Works

Group health insurance plans are purchased by companies and organizations and then offered to their members or employees. Plans can only be purchased by groups, which means individuals cannot purchase coverage through these plans. Plans usually require at least 70% participation in the plan to be valid. Because of the many differences—insurers, plan types, costs, and terms and conditions—between plans, no two are ever the same.

Group plans cannot be purchased by individuals and typically require at least 70% participation by group members.

Once the organization chooses a plan, group members are given the option to accept or decline coverage. In certain areas, plans may come in tiers, where insured parties have the option of taking basic coverage or advanced insurance with add-ons. The premiums are split between the organization and its members based on the plan. Health insurance coverage may also be extended to the immediate family and/or other dependents of group members for an extra cost.

The cost of group health insurance is usually much lower than individual plans because the risk is spread across a higher number of people. Simply put, this type of insurance is cheaper and more affordable than individual plans available on the market because more people buy into the plan.

History of Group Health Insurance

The earliest known example of group coverage for health services dates to 1798, when Congress established the U.S. Marine Hospital for Navy seamen. Participation was compulsory, with deductions coming from salaries. Other examples include the mining, lumber, and railroad industries in the late 1800s, which had a vested interest in ensuring the health of its workers.

Montgomery Ward is credited with establishing the nation’s first group health insurance policy in 1910. The policy did not reimburse workers for medical expenses, but provided cash payments to workers equal to half their wages in the event of injury or illness.

The progressive political movement of the early 1900s led to several proposals to establish compulsory national health insurance. However, these proposals failed to counter opposition from doctors, who objected to uniform fee structures; labor groups, which felt their power would be weakened; and insurance companies, which feared encroachment on their business.

Employer-sponsored group health insurance grew rapidly in the 1940s as a way for employers to get around wage controls set during World War II. In 1943, the War Labor Board introduced wage caps but did not include insurance premiums as part of the cap. As such, employers were free to offer health insurance to attract and retain workers, resulting in a tripling of health insurance coverage by the end of the war.

But this failed to address the needs of retirees and other non-working adults. Federal efforts to provide coverage to those groups led to the Social Security Amendments of 1965, which laid the foundation for Medicare and Medicaid .

Benefits of a Group Health Insurance Plan

The primary advantage of a group plan is that it spreads risk across a pool of insured individuals. This benefits the group members by keeping premiums low, and insurers can better manage risk when they have a clearer idea of who they are covering. Insurers can exert even greater control over costs through health maintenance organizations (HMOs), in which providers contract with insurers to provide care to members.

The HMO model tends to keep costs low, at the cost of restrictions on the flexibility of care afforded to individuals. Preferred provider organizations (PPOs) offer the patient a greater choice of doctors and easier access to specialists but tend to charge higher premiums than HMOs.

The percent of the U.S. population covered by employer-provided group health insurance in 2021.

The vast majority of group health insurance plans are employer-sponsored benefit plans. It is possible, however, to purchase group coverage through an association or other organizations. Examples of such plans include those offered by the American Association of Retired Persons (AARP), the Freelancers Union, and wholesale membership clubs.

Insurance Options for Uninsured Individuals

Not everyone is covered by a group health insurance plan. For many decades, these uninsured people were forced to bear the cost of healthcare on their own. But that has changed.

Government-sponsored health plans are an option for those left out of employer-sponsored group health insurance. The Affordable Care Act (ACA) adopted in 2010 created a marketplace for health insurance that provides coverage to 16.3 million people as of the 2022-2023 open enrollment season.

After the passage of the ACA, taxpayers were required to show they had health insurance coverage or qualified for an exemption, or else they were required to pay a penalty described as a “shared responsibility payment.” This mandated payment was eliminated with the passage of the Tax Cuts and Jobs Act beginning in the 2019 tax year.

Example of Group Health Insurance

United Healthcare, a division of UnitedHealth Group (UHC), is one of the nation's largest health insurers. It offers a buffet of group health insurance options for all types of businesses. Include are medical plans and specialty, supplemental plans, such as dental, vision, and pharmacy.

United Healthcare offers plans under the federally-sponsored Small Business Health Options (SHOP) program, a provision of the Affordable Care Act. In most states, employers must have 50 or fewer full-time employees, although some states allow for as many as 100 employees. Businesses that pay at least 50% of the insurance premium qualify for a 50% tax credit.

Midsize businesses, with between 51 and 2,999 employees, have various options available, including bundles. Large businesses, with 3,000 or more employees, qualify as national accounts, which have more services and healthcare features, including the ability to customize plan offerings.

What Is a Group Health Plan?

Group health plans are employer- or group-sponsored plans that provide healthcare to members and their families. The most common type of group health plan is group health insurance, which is health insurance extended to members, such as employees of a company or members of an organization.

What Is a Group Health Cooperative?

A group health cooperative, also known as mutual insurance, is a health insurance plan owned by the insured members . Insurance is offered at a reduced cost, and what they collect from members is based on claims paid. The cost of care is spread out across the insured population.

How Many Employees Do You Need to Qualify for Group Health Insurance?

Many group health insurers offer plans to companies with one or more employees. The type of plans available, however, may vary according to the size of the business . For example, United Healthcare provides various plans for small businesses with 1-50 employees , midsize businesses with 51-2,999, and large employers with 3,000 or more employees.

What Are Group Health Insurance Benefits?

Group health insurance plans offer medical coverage to members of an organization or employees of a company. They may also provide supplemental health plans—such as dental, vision, and pharmacy—separately or as a bundle. Risk is spread across the insured population, which allows the insurer to charge low premiums. And members enjoy low-cost insurance, which protects them from unexpected costs arising from medical events.

How Much Does Group Health Insurance Cost?

The average group health insurance policy costs roughly $7,400 annually for an individual, with the employee paying 17% of the premium. For family coverage, the average cost was about $21,000 per year, with the employee paying 27% of the premium.

The Bottom Line

Group health insurance plans are one of the most affordable types of health insurance plans available. Because risk is spread among insured persons, premiums are considerably lower than traditional individual health insurance plans. This is possible because the insurer assumes less risk as more people participate in the plan. For employees who ordinarily would not be able to afford individual health insurance, it is an attractive benefit.

U.S. Bureau of Labor Statistics, Monthly Labor Review. “ The Development and Growth of Employer-Provided Health Insurance ,” Pages 3-4.

Marilyn J. Field and Harold T. Shapiro. “ Employment and Health Benefits: A Connection at Risk ,” Chapter 2.

National Archives. “ Medicare and Medicaid Act (1965) .”

Kaiser Family Foundation. " Health Insurance Coverage for the Total Population ."

U.S. Department of Health and Human Services. “ Biden-Harris Administration Announces Record-Breaking 16.3 Million People Signed Up for Health Care Coverage in ACA Marketplaces During 2022-2023 Open Enrollment Season .”

Internal Revenue Service. “ Individual Shared Responsibility Provision .”

United HealthCare Services. “ Small Business Health Options Program (SHOP) .”

Kaiser Family Foundation. “ 2020 Employer Health Benefits Survey .”

  • Health Insurance: Definition, How It Works 1 of 30
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  • Affordable Care Act (ACA): What It Is, Key Features, and Updates 4 of 30
  • Choosing Bronze, Silver, Gold, or Platinum Health Plans 5 of 30
  • Buying Private Health Insurance 6 of 30
  • Health Maintenance Organization (HMO): What It Is, Pros and Cons 7 of 30
  • Preferred Provider Organization (PPO): Definition and Benefits 8 of 30
  • Point-of-Service (POS) Plan: Definition, Pros & Cons, Vs. HMO  9 of 30
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  • Coinsurance vs. Copays: What's the Difference? 11 of 30
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group health insurance for non employees

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Q1.  What are the consequences to the employer if the employer does not establish a health insurance plan for its own employees, but reimburses those employees for premiums they pay for health insurance (either through a qualified health plan in the Marketplace or outside the Marketplace)?

Under IRS Notice 2013-54 PDF , such arrangements are described as employer payment plans. An employer payment plan, as the term is used in this notice, generally does not include an arrangement under which an employee may have an after-tax amount applied toward health coverage or take that amount in cash compensation. As explained in Notice 2013-54, these employer payment plans are considered to be group health plans subject to the market reforms, including the prohibition on annual limits for essential health benefits and the requirement to provide certain preventive care without cost sharing.  Notice 2013-54 clarifies that such arrangements cannot be integrated with individual policies to satisfy the market reforms.  Consequently, such an arrangement fails to satisfy the market reforms and may be subject to a $100/day excise tax per applicable employee (which is $36,500 per year, per employee) under section 4980D of the Internal Revenue Code.

Q2.  Is there transition relief available from the excise tax under § 4980D for certain employers who offered their employees health coverage through arrangements that would constitute an employer payment plan as described in Notice 2013-54?

Yes.  On February 18, 2015, the IRS issued Notice 2015-17 PDF , which provides transition relief from the excise tax under § 4980D for failure to satisfy the market reforms in certain circumstances.  The transition relief applies to employer healthcare arrangements that are (1) employer payment plans, as described in Notice 2013-54, if the plan is sponsored by an employer that is not an Applicable Large Employer (ALE) under Code § 4980H(c)(2) and §§ 54.4980H-1(a)(4) and -2 of the regulations; (2) S corporation healthcare arrangements for 2-percent shareholder-employees; (3) Medicare premium reimbursement arrangements; or (4) TRICARE-related health reimbursement arrangements (HRAs).  

Notice 2015-17 provides temporary relief from the § 4980D excise tax for failure to satisfy the Affordable Care Act market reforms such as the prohibition on annual limits.  Under the notice, small employers with employer payment plans get relief for 2014 and up to July 1, 2015.  Small employers are employers that are not Applicable Large Employers under § 4980H (generally less than 50 full time and full time equivalent employees in prior year).

Notice 2015-17 also clarifies that S corporations may continue to report reimbursements of health insurance of 2 percent shareholders pursuant to Notice 2008-1.  Until further guidance is issued, and in any event through the end of 2015, the excise tax under Code § 4980D will not be asserted for any failure to satisfy the market reforms by a 2-percent shareholder-employee healthcare arrangement.

Q3. Where can I get more information?

On Sept. 13, 2013, the IRS issued Notice 2013-54 PDF , which explains how the Affordable Care Act’s market reforms apply to certain types of group health plans, including health reimbursement arrangements (HRAs), health flexible spending arrangements (health FSAs) and certain other employer healthcare arrangements, including arrangements under which an employer reimburses an employee for some or all of the premium expenses incurred for an individual health insurance policy. On February 18, 2015, the IRS issued Notice 2015-17 PDF , which reiterates the conclusion in previous guidance addressing employer payment plans, including Notice 2013-54, that employer payment plans are group health plans that will fail to comply with the market reforms that apply to group health plans under the Affordable Care Act.  Notice 2015-17 also provides transition relief from the assessment of the excise tax under § 4980D for failure to satisfy market reforms in certain circumstances.

DOL has issued a notice in substantially identical form to Notice 2013-54, DOL Technical Release 2013-03 . On Jan. 24, 2013, DOL PDF and HHS issued FAQs that address the application of the Affordable Care Act to HRAs. On Nov. 6, 2014, DOL issued additional FAQs PDF that address the application of the Affordable Care Act to HRAs and other payment arrangements.

More Information

For more information the latest legal guidance on this topic, see the Employer Health Care Arrangement section on our ACA Tax Provisions for Employers page . 

For more links to legal guidance on all ACA tax provisions see our legal guidance and other resources page.

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group health insurance for non employees

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Since you asked: can an employer offer health insurance to its board’s directors.

By Maureen Gammon , Anu Gogna , Benjamin Lupin and Kathleen Rosenow | December 21, 2022

Employers often have questions on practical considerations related to healthcare, retirement and other employee benefit regulations. In this “Since you asked” feature, we discuss the provision of health insurance to board members and their dependents.

Can our company provide benefits under our group health plan to members of the company’s board of directors who are not employees? We would like to provide coverage for retention and recruiting purposes.

Possibly, but various compliance concerns need to be addressed.

Multiple Employer Welfare Arrangement considerations

Covering non-employees (whether directors, board members or owners) under a company's benefit programs is likely to raise compliance concerns (assuming the written plan eligibility rules allow non-employees to enroll in coverage). For one, it is unclear whether a Multiple Employer Welfare Arrangement (MEWA) is created when health or other welfare benefits are provided to non-employee directors.

  • A MEWA is defined as an employee welfare benefit plan providing benefits to the employees of two or more employers (including one or more self-employed individuals). If the board of directors consists of members who are not current employees of the company, this would technically classify the benefit plan as a MEWA, as the non-employees would be considered self-employed individuals.
  • From a federal reporting standpoint, MEWAs are generally required to file an annual report with the federal government (Form M-1); however, the plan may qualify for an exemption to filing the annual Form M-1. More specifically, a group health plan is exempt if less than 1% of participants are non-employee directors, and the plan would not be a MEWA “but for” coverage of non-employee directors. This does not mean that the arrangement is not a MEWA but only that no Form M-1 filing is required.
  • MEWAs do not qualify for ERISA preemption from a state regulatory perspective, so the plan potentially would be subject to state laws specifically regulating MEWAs, including any filing and licensing requirements similar to rules imposed on insurers licensed to operate in the state. For example, California law requires self-funded MEWAs to obtain a certificate of compliance from the Department of Insurance in order to operate within the state. But under California law, the Department of Insurance ceased providing such certificates in 1995, effectively preventing the formation of any new MEWAs. In addition, since state law would likely apply, state mandated benefit rules may apply to the arrangement (e.g., requiring the plan to cover medical procedures it would not otherwise cover).

Tax considerations

Generally, the coverage for the non-employee director cannot be pre-tax under the cafeteria plan rules, although there is a special rule for certain "dual status" individuals (i.e., directors who are also employees).

  • If non-employees are permitted to participate in employer-sponsored benefits, they cannot participate on a tax-favored basis in the same way as employees.
  • Under the general rule, directors who are not employees of the company (“outside directors”) cannot participate in the company's cafeteria plan. This is the case whether or not the directors receive fees for their services as directors. The 2007 proposed cafeteria plan regulations expressly provide that the term “employee” does not include a “self-employed individual.” The regulations list examples of self-employed individuals: a sole proprietor, a partner in a partnership, and a director serving on a corporation's board of directors who does not otherwise provide services to the corporation as an employee. Contributions made by non-employees should be made on an after-tax basis, and contributions made by the employer should be treated as additional taxable compensation.
  • The regulations also provide a special rule for certain “dual status” individuals. Under the dual status rule, an individual who is an employee and provides services to his or her employer as a director or independent contractor (e.g., an individual who is both an employee and a director of a C corporation) is eligible to participate in the employer’s cafeteria plan, although solely in his or her capacity as an employee. For example, assume one of the company's employees also serves on the company's board of directors. Her annual compensation as an employee of the company is $80,000; she also receives $5,000 in directors' fees each year. She can participate in the company's cafeteria plan in her capacity as an employee and can elect to make salary reductions from her employee compensation for benefits under the plan; however, she cannot elect to reduce her directors' fees for benefits under the plan. Note that if the company is an S corporation, the dual-status rule will not apply to any employee-directors who are also shareholders owning more than 2% of company stock at any time during a year.
  • In addition, directors who are not employees cannot participate in a health reimbursement arrangement or health flexible spending account. Note: Non-employees may make contributions to health savings accounts (HSAs) as long as they are otherwise eligible (i.e., enrolled in a qualifying high-deductible health plan, have no other disqualifying coverage and cannot be claimed as a tax dependent). Any contributions made by the non-employee to an HSA should be made on an after-tax basis, which then may qualify for an above-the-line deduction on his or her individual tax return (Form 1040).
  • Companies offering coverage to directors and their dependents under their group health plan need to make sure they (or their third-party administrators) have the ability to do so on an after-tax basis.
  • MEWA considerations must be discussed with legal counsel, as such an arrangement may need to be registered in various states (assuming it is permitted by state law).
  • A possible alternative for directors would be the company paying taxable cash (with or without a gross-up) and helping them find individual health insurance coverage.

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Health Insurance Options for Small Nonprofits

by nawa | Dec 1, 2021 | Human Resources , Learn

A red, felt heart rests on a stethoscope on top of a cardiogram. A calculator is just out of focus on the left.

Q: We have fewer than 5 employees. How can we provide health insurance benefits for them?

A: Many of us have health on our minds. The health insurance market is confusing, so I asked three experts for their advice:

Ron Schmid Account Executive – Employee Benefits Conover Insurance

Chris Fountas Vice President of Client Services Nonstop Administration and Insurance Services, Inc.

Robert Ricciardelli Regional HR Consultant TriNet

With pressure on nonprofit staff higher than ever, conscientious organizations are looking for better ways to care for their people. Chris Fountas of Nonstop points out that employer-sponsored health insurance benefits boost recruitment, healthy organizational culture, and employee retention. Access to healthcare is an equity issue, too.

I hope this serves as a starting point for your own research. Let’s start small, with individual plans, and work our way up.

One Employee

Many small nonprofits choose to reimburse or pay the employee for their individual plan (partially or in full). The employee can use a stipend to purchase a plan. They may need to supplement the stipend to cover the full cost.

Find individual plans on the open exchange, Washington Healthplan Finder . Now is a good time to do your research. Special enrollment has been extended through August 15, 2021 . The next open enrollment period opens on November 1, 2021. Some providers, such as Kaiser Permanente, offer individual plans directly.

Consult with a licensed tax professional to understand the IRS rules for documentation so that these payments are not taxable as income for the employee. As Robert Ricciardelli says, “The problem with reimbursement is it is taxable for the individual receiving it as income, and the organization will be paying some payroll taxes for dispersing it. Whereas with a group plan, there are no taxes for paying toward a plan or receiving a plan.”

One strategy for overcoming the tax issue is setting up a Health Reimbursement Arrangement (HRA). A Qualified Small Employer Health Reimbursement Arrangement ( QSEHRA ) helps small employers (fewer than 50 full-time employees) contribute to employee’s premiums and some other health care expenses.

Another downside of reimbursement is that costs are not averaged—older people, women, and people with pre-existing conditions pay more. In addition, individual plans are not legally required to provide as much coverage as group plans. 

One alternative is Gusto , a payroll and benefits platform that offers HR services with no minimum number of employees. Their services include consultation with a broker regarding health plan options or administration of health insurance reimbursement for employees. They offer a variety of services with administrative fees starting at about $45 per month ($39 per month plus $6 per person per month). They do not offer nonprofit discounts last we checked.

2-5 Employees

If your organization has two or more employees who are not related, consider group health insurance plans. A health insurance broker can identify plan options.

Ron Schmid recommends reaching out to other nonprofits to ask for referrals. He says that a broker should be able to name 2-3 nonprofit clients and demonstrate familiarity with plans specifically for nonprofit groups. Does the broker listen to your needs, understand your priorities, and provide good customer service? Will they present plans to employees? Fountas says, “A good broker should provide…comparative analysis…which clarify the difference in benefits (advantages and disadvantages of plan designs), pricing, and network (which doctors/facilities are included).”

Some people are wary of broker fees, but Schmid and Fountas agree: the fees are built into the product and cannot be removed, so the final cost is the same, whether the employer goes through a broker or not. Avoid brokers that charge smaller clients additional fees.

November 30, 2021 Update

Washington companies with two or more enrolled employees are eligible to participate in the Business Health Trust benefit program. Participation requires membership with Seattle Metropolitan Chamber of Commerce or one partner organizations:

  • Bellevue Chamber
  • Bellingham Regional Chamber of Commerce
  • Bothell Kenmore Chamber
  • OneRedmon d
  • Economic Alliance Snohomish County
  • Tacoma-Pierce County Chamber of Commerce
  • Thurston County Chamber of Commerce
  • Greater Yakima Chamber of Commerce

Your membership in any of the above organizations automatically qualifies the organization for one of 13 industry group memberships (at no additional cost), along with advocacy, resources and savings.

Another option is joining a Professional Employer Organization (PEO). A PEO acts as the employer of record on the nonprofit’s behalf. JustWorks is a PEO serving organizations with a minimum of 2 W-2 employees. JustWorks handles benefits, payroll, W-2 filings, training, paid time off, retirement plans, and more. They offer a nonprofit discount when your organization qualifies for the next tier’s pricing. You can save an additional 15% if you pay annually.

5+ Employees

Professional Employer Organizations (PEOs) allow organizations to bundle payroll, benefits, compliance, and HR. You join a bigger negotiating group, meaning you get access to pricing normally available to larger employers.

Choosing a PEO is like finding a broker. Fountas says nonprofits should consider:

  • the number of plans they offer,
  • administrative services,
  • the software platform,
  • customer service,
  • and whether the fees are included in the rates.

Trinet is a PEO that offers HR solutions, including affordable insurance, to organizations with 5 or more employees. If you have fewer than 5 employees, a representative can still connect you with a local broker. Ricciardelli adds, “in some cases we are now starting to do under 5 again on a case-by-case basis.” Members of Washington Nonprofits  save 25% on TriNet services (affiliate link).

A PEO may not be worth the cost if the organization does not use many of its services. Fountas points out another disadvantage: the PEO can make decisions without the employer’s input. For example, they may change from one healthcare provider to another. The employer’s only recourse is to leave, which may mean losing coverage and services.

For state-funded nonprofits with 5 or more employees, Washington Counties Insurance Fund is another option.

50+ Employees

Nonstop is one of our business members. Their plans are intended for larger organizations with 50 or more employees. Nonstop developed an executive guide to build equity into your health plan with strategies for reducing costs and improving employee benefits.

Other Resources

National Association of Socially Responsible Organizations (NASRO) list of health insurance options.

Remember, nonprofits are corporations: all the systems that support small businesses are also available if they fit your budget. Your local chamber of commerce may offer group health plans to business members. Find your nearest chamber using the Washington Chamber of Commerce Executives’ directory . Costco also offers group health plans to their business members in Washington state. Learn more here.

These are just some of the options we’re aware of. It’s not intended to be an exhaustive list. If you’re aware of other ways for nonprofit employees to access health insurance, please reach out.

Thank you for prioritizing your employees’ health and wellbeing!

group health insurance for non employees

HERE’S WHAT EVERY NONPROFIT SHOULD KNOW ABOUT OFFERING HEALTH INSURANCE

group health insurance for non employees

SHOP Marketplace Group Plan

If you have 50 or fewer employees, you may qualify to purchase state- or federally-run group health insurance through SHOP Marketplaces. If you choose the SHOP plan and have fewer than 25 employees, you may have access to a Small Business Health Care Tax Credit. For tax-exempt nonprofits, the credit is 35% of employer-paid health insurance premiums.

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group health insurance for non employees

Are You Covered Under a Group Health Insurance Plan?

Group health insurance refers to healthcare coverage provided through your employer. These plans may be an affordable health insurance option for individuals because their employers pay a portion of the cost. Also, those with preexisting conditions cannot be denied group healthcare.

Learn the cost of group health insurance and how you can enroll in coverage.

On This Page

How does group health insurance work, what is covered under group health insurance, what are the benefits of group health insurance plans, how much does group health insurance cost, how to enroll in group health insurance.

Group health insurance plans are usually offered by employers as part of their employee benefits package. After negotiating rates with the insurance company, the employer usually pays the monthly premium to the carrier but the employee may still pay a portion of the cost via a payroll deduction on each paycheck. [1]

Group health insurance plans typically have an annual deductible averaging $1,763 a year for single coverage. [2] Similar to any other type of health insurance policy, you are responsible for paying your coinsurance and any copays , which will both count toward your out-of-pocket annual limit. Once you reach this limit, the insurance company will cover the full cost of medical care for the rest of the year and you will no longer have to pay a copay or coinsurance.

If you are fired or quit your job, it is possible to continue your employer-sponsored health insurance for a limited time under the Consolidated Omnibus Budget Reconciliation Act (COBRA). However, you may be required to pay the full premium to maintain coverage. [3] Your employer should provide more information about this on or before your last day worked.

Who Is Eligible for Group Health Insurance?

In order to qualify for group health insurance, an employee usually must be full-time but temporary employees may still get group healthcare benefits if they're working at least 30 hours per week. Private or independent contractors are typically excluded from coverage. [4]

Whether your employer is required to provide group healthcare depends on the size of the business.

Any business under 50 full-time employees is not required to have group coverage for their workforce. However, businesses that employ over 50 full-time employees could be fined if they don't provide healthcare to their employees. Specifically, the IRS specifies that businesses that meet the following two conditions may be subject to a fine: [5]

  • Business of 50 workers does not offer group health insurance coverage OR it is offered but to less than 95% of its full-time employees
  • At least one full-time employee uses a premium tax credit to purchase health insurance through the ACA marketplace

Some exceptions may be available for smaller businesses that employ 50 or more workers so it’s best to consult a business tax attorney to learn what penalties, if any, will apply.

Some group health insurance plans may also cover the employee’s dependents, such as their children or spouse. Any plan that includes dependant coverage must provide coverage until the child reaches 26 years of age. [6] Also, keep in mind that you cannot be denied group healthcare because of preexisting conditions. [7]

Group healthcare plans typically cover a range of medical services and treatments, including preventive care, emergency services, hospitalization, prescription drugs and more. The specific coverage offered will vary depending on the plan and the employer offering it. However, all plans offered are required to cover essential health benefits such as: [8]

  • Preventive care: Services include annual check-ups, vaccinations and cancer screenings, routine physical exams, blood tests, immunizations, prostate exams, pap smears and more.
  • Emergency services: These services are designed to provide immediate medical attention in the event of a medical emergency and include ambulance rides, emergency room visits and hospitalization. Employees who are hospitalized can expect coverage for surgery, anesthesia and diagnostic tests, as well as room and board and nursing care.
  • Prescription drugs: Prescription drug coverage may be subject to a deductible, copayment or coinsurance . Remember that your plan may have a separate prescription drug deductible you'll need to meet before your plan will cover your drug costs. [9]
  • Mental health services: Services may include counseling, therapy and psychiatric care. As of 2008, there is no longer a separate deductible for your mental health coverage, meaning your physical health deductible and mental health deductible are the same. [10]
  • Rehabilitation services: This coverage may include services such as physical therapy, occupational therapy and speech therapy. These services are designed to help individuals recover from injuries, surgeries and other medical conditions.
  • Maternity and newborn care: Services like prenatal care, delivery and postnatal care for both the mother and the newborn will be covered by your group health plan.
  • Pediatric services: Involves routine check-ups, vaccinations and management of common childhood illnesses for children from birth to adolescence.

Dental and vision care are benefits that employers are not required to offer but may include in their employee benefits coverage. [11] If included, employees may enjoy coverage for dental services such as routine cleanings, braces and fillings. Vision coverage may cover the cost of eye exams, glasses and contact lenses.

What Isn’t Covered?

While group health insurance plans typically cover a wide range of medical services and treatments, some services are usually excluded from coverage. Here are some of the common exclusions and limitations that are often found in group health plans.

  • Cosmetic procedures: Procedures such as breast augmentation, rhinoplasty and liposuction or any other cosmetic service performed for purely aesthetic reasons.
  • Experimental treatments: Treatments that are still in the clinical trial phase or that have not been approved by the FDA.
  • Weight loss programs: Includes bariatric surgery or weight loss drugs . Some plans may cover these services if they are deemed medically necessary, such as in cases of obesity-related health conditions.
  • Alternative medicine group: Acupuncture, chiropractic care or naturopathy. Some plans may offer coverage for these services as an optional benefit.
  • Dental and vision care: Coverage is optional and offered at the employer's discretion.

Group health insurance is usually more cost-effective for employers than buying individual plans for each of their employees. This is partly due to the insurance company's risk being divided amongst the insured employees, as well as the cost being shared between the employer and the employee. [1][12]

In addition, employers may also be able to deduct the cost of group health insurance premiums as a business expense, resulting in tax savings. Making health insurance more accessible for employees can also lead to a healthier and more productive workforce.

Finally, including health insurance in the company’s benefits package can help attract and keep talented workers.

For employees, having access to health insurance ensures that they receive the care necessary to stay healthy. Also, the employer may also be responsible for a portion, if not all, of the monthly premium. [12] If there is a cost to the employee, it is usually made pre-tax, which can result in savings back in the employee’s wallet. [13]

According to the Kaiser Family Foundation, the average annual premium for family coverage in 2021 was $22,221, with employers contributing $16,253 (73%) and workers collectively paying the remaining $5,969. [14] The actual cost of will vary depending on several factors, such as the location of the business, the number of employees and the specific benefits included in the plan.

While the exact steps for enrolling in group health insurance can vary slightly between each business and their internal procedures, they will generally include the following:

  • Enrollment period: New employees typically have a 30-day window to enroll in an employer-sponsored healthcare plan. A human resources representative will usually explain the employee’s health insurance options as part of the new hire onboarding process. [15]
  • Review plan options: Consider factors such as the plan type, coverage options, deductibles, copays and coinsurance. Those who have few health concerns, such as the young and healthy, would benefit from a high-deductible plan with a low premium since they won’t be using medical services that often.
  • Choose a plan: Select a policy that best fits your coverage needs and budget. Don’t forget to choose coverage for any dependents, such as a spouse or children, if available.
  • Complete enrollment forms: This may include additional documentation, such as proof of dependent eligibility. Your employer will usually have a deadline for when you must submit the forms. If you have any questions or need assistance with the enrollment process, contact your employer's human resources department.
  • Start coverage: After paying your first premium, you can enjoy healthcare coverage on your policy’s start date.

What should I do if I lose my group health benefits?

Consider enrolling in a new plan through a spouse's employer or purchasing an individual health insurance plan. Losing your employment qualifies you for a special enrollment period so you will not have to wait until open enrollment usually in the fall.

What is the difference between individual and group health insurance?

Individual health insurance is purchased by individuals or families directly from an insurance company, while group health insurance is obtained through an employer.

Who is considered the primary on a group health insurance plan?

The primary of a group health insurance plan is the person who enrolled in the plan and is responsible for paying the premiums.

Do I have to enroll in group medical insurance?

You’re not legally obligated to accept your employee-based insurance when you begin working for an eligible company. If you already have health insurance, you can choose to remain with your current provider.

  • Physicians Health Plan. “ What Goes Into Pricing a Group Health Insurance Plan? ” Accessed April 7, 2023.
  • Kaiser Family Foundation. “ Employer Health Benefits ,” Page 10. Accessed April 7, 2023.
  • U.S. Department of Labor. “ Continuation of Health Coverage (COBRA) .” Accessed April 12, 2023.
  • KBI Benefits. “ Do Temporary Employees Get Benefits? ” Accessed April 11, 2023.
  • Internal Revenue Service. “ Types of Employer Payments and How They Are Calculated .” Accessed April 12, 2023.
  • National Archives. “ Young Adults and the Affordable Care Act: Protecting Young Adults and Eliminating Burdens on Businesses and Families, ” Page 1. Accessed April 11, 2023.
  • U.S. Department of Health & Human Services. “” Pre-Existing Conditions .” Accessed April 12, 2023.
  • HealthCare.gov. “ Health Benefits & Coverage .” Accessed April 7, 2023.
  • Nevada Insurance Enrollment. “ How Much Will My Prescriptions Be? ” Accessed April 7, 2023.
  • Centers for Medicare & Medicaid Services. “ The Mental Health Parity and Addiction Equity Act (MHPAEA) .” Accessed April 7, 2023.
  • Zenefits. “ Does My Company Need To Offer Dental Coverage Under the Affordable Care Act? ” Accessed April 12, 2023. 
  • eHealth. “ What Are the Advantages of Group Insurance? ” Accessed April 7, 2023.
  • Patriot Software. “ Are Payroll Deductions for Health Insurance Pre-Tax? The Answer You Need To Know. ” Accessed March 11, 2023.
  • Kaiser Family Foundation. “ 2021 Employer Health Benefits Survey .” Accessed April 7, 2023.
  • Kaiser Family Foundation. “ When Can I Enroll in My Employer Health Plan? ” Accessed April 7, 2023.

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When do group health plan benefits terminate for an employee on a non-FMLA leave of absence?

Continuation of group health plan benefits during periods of leave may depend on the type of leave an employee is on. When an employee is on Family and Medical Leave Act (FMLA) leave, a covered employer is required to maintain group health insurance coverage for an employee and his or her family under the same terms and conditions held prior to the leave. However, when an employee is not on FMLA leave, an employer may need to determine if the leave falls under other federal or state leave laws.

Some states have leave laws that provide time off similar to the federal FMLA leave. For example, Wisconsin has its own family and medical leave law that has different eligibility requirements from the federal FMLA. An employee could be eligible for Wisconsin Family and Medical Leave Act leave but not for FMLA leave. When an employee is on Wisconsin FMLA leave, health insurance should continue under the same conditions as for active employees. Employers should review applicable state leave laws to determine obligations to continue benefits during periods of leave.

If an employee is on leave as a reasonable accommodation under the Americans with Disabilities Act (ADA), an employer must continue an employee's health insurance benefits during the leave if it does so for other employees on similar leave. For example, if an employee is permitted to continue health benefits during periods of unpaid, personal leave, an employee on unpaid leave under the ADA should be able to continue health benefits too.

The Pregnancy Discrimination Act (PDA) does not provide leave benefits, but it does require employers to treat employees the same as other temporarily disabled employees with regard to benefits. Therefore, if an employer allows an employee to take leave due to a temporary disability and that employee is permitted to maintain health benefits during that leave, an employee on leave due to pregnancy must also be permitted to maintain health benefits while on leave.

If an employee is not eligible for federal or state leave but is eligible for an employer-provided leave of absence, the continuation of health benefits is based on the language in the benefits plan. An employee may continue health benefits during periods of employer-provided leave as allowed by the insurance plan documents and approved by the health plan insurer. Employers should address in the written plan documents how long an employee can be absent from work on unprotected leave before health benefits will be terminated and ensure these plan rules are followed consistently.

If benefits are not continued, an employee may elect health care continuation under COBRA due to the qualifying event of a reduction in hours. 

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Explore plans

Health coverage, dental, vision and supplemental, member support, the health guide, additional resources.

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Healthy savings for a healthier you

Being healthy can be affordable, too. We offer discounts to help you save on a variety of health-related products and services. See what’s available to you as an Aetna ® member.

Discover discounts for your mind and body

No matter your health goal, we’re here to help you get there with discounts on health coaching, mental health support, medical supplies and more.

Choosing the right health plan can be daunting. Many plans have benefits that members don’t know about.  

Let’s explore a few of the fitness-related perks and discounts available to Aetna members.  

Eating healthier and managing your hectic daily life have never been easier with some of the discounted food and grocery delivery services, home meal kits and meal plans available.  

Take care of body and mind with online fitness classes, health coaching, weight-loss programs and mental health services at lower or even no cost.  

Aetna members may also receive discounts on prescriptions, medical supplies, vision and hearing products, and vitamins and supplements.  

You might not have to pay full price for that smart watch, pedometer or other fitness tracker: You’ll have access to a range of wearable fitness devices and exercise gear at a discount.  

No matter your overall health goal, you can get there more easily with some of the discounts available to Aetna members. Learn more today.   Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Health benefits and health insurance plans contain exclusions and limitations. Information is believed to be accurate as of the production date; however, it is subject to change.

Discount offers are not insurance . They are not benefits under your insurance plan. You get access to discounts off the regular charge on products and services offered by third party vendors and providers. Aetna makes no payment to the third parties — you are responsible for the full cost. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. Not available to NY policyholders.

Weight management

You’ve got support to manage your weight with great savings on today’s most popular weight-loss programs and meal plans. These discounts are included with your Aetna health benefits and insurance plan. And your family members can use them, too. Once you’re an Aetna member, just log in to your member website  to sign up.

Online health coaching

The Simple Steps To A Healthier Life ®  online health coaching programs let you choose the area of your health that you’d like to focus on. And they’re part of your health benefits, so it won’t cost you a penny. Once you’re an Aetna member, just log in to  your member website  to take your health assessment and get started.  

You'll get:  

  • A personalized plan. It’s created just for you, based on information you shared at the start of the program.
  • Convenient tools, tips and features to help you succeed and have fun. Set reminders to help you stay on track and get important information about your health choices.
  • Online coaching sessions that fit your schedule. You set the pace, and you can work on sessions where and when you want.

And you get to choose a health direction:  

  • Be tobacco free
  • Manage diabetes
  • Have a healthy back
  • Get heart-healthy by managing cholesterol
  • Stress less
  • Achieve a healthy weight
  • Live well with asthma
  • Eat healthier

Fitness services

Getting fit doesn’t have to be costly. You can save on gym memberships, health coaches and nutrition products. All the things you need to support a healthy lifestyle. These discounts are included with your Aetna health benefits. And your family members can use them, too. Once you’re an Aetna member, just log in to  your member website  to sign up.

Natural products and services

Relax and recharge with discounts on massage therapy, acupuncture, chiropractic visits and nutrition services. It’s a nice perk that comes automatically with your Aetna benefits. And the discounts are instant, so you save on the spot. Once you’re an Aetna member, just log in to  your member website  to find participating professionals, order products and more.

Vision care

Once you become an Aetna member, you can see for yourself how easy it is to enjoy vision discounts. No approvals or referrals. No claims form to complete. And no waiting for reimbursement. Just show your Aetna ID card to receive discounts instantly on:  

  • Eyeglass frames and lenses
  • Contact lenses and solutions
  • LASIK surgery
  • Sunglasses (prescription and non-prescription)  

No vision coverage? No problem. If you don’t have other vision coverage, you can still get discounts and great rates on eye exams, eyeglasses, contact lenses and more.

Hearing care

If you need a little help with your hearing, we can help you save on the essentials: hearing aids, exams, follow-ups, even batteries. It’s a nice perk that already comes with your Aetna benefits and insurance plan. And the discounts are instant, so you save on the spot. You won’t have to worry about referrals or claims forms. And your covered family members can take advantage of these discounts, too.

Two ways to save

Option 1: Hearing Care Solutions

Special features:

  • Discounts on a large choice of hearing aids
  • A three-year supply of batteries and a discount mail-order program
  • Free in-office service of hearing aids for one year
  • Free routine cleanings, checks and battery door replacements for one year

How to save:

To get the discount and more information, just call Hearing Care Solutions at  1-866-344-7756 .

Option 2: Amplifon Hearing Health Care

Special features: 

  • Discounts on many hearing aid styles from leading brands
  • Savings on exams and repairs
  • Free follow-up services for one year
  • A two-year supply of batteries

To get the discount and more information, just call Amplifon Hearing Health Care at  1-877-301-0840 .

Tip:  If your health plan covers any of this equipment or these services, check those costs before using these discounts. You could even pay less that way.

Ready to enroll?

Review the enrollment checklist with 4 to-do's before you choose a health plan.

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Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

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The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

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Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.

Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.

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  • The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members.
  • Applies to: Aetna Choice ® POS, Aetna Choice POS II, Aetna Medicare ℠ Plan (PPO), Aetna Medicare Plan (HMO), all Aetna HealthFund ® products, Aetna Health Network Only ℠ , Aetna Health Network Option ℠ , Aetna Open Access ® Elect Choice ® , Aetna Open Access HMO, Aetna Open Access Managed Choice ® , Open Access Aetna Select ℠ , Elect Choice, HMO, Managed Choice POS, Open Choice ® , Quality Point-of-Service ® (QPOS ® ), and Aetna Select ℠ benefits plans and all products that may include the Aexcel ® , Choose and Save ℠ , Aetna Performance Network or Savings Plus networks. Not all plans are offered in all service areas.
  • All services deemed "never effective" are excluded from coverage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Visit the secure website, available through www.aetna.com, for more information. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search."
  • The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT ® ), copyright 2023 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
  • The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT ® ")

  • CPT only Copyright 2023 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.

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This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.

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Dental clinical policy bulletins

  • Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Treating providers are solely responsible for dental advice and treatment of members. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider.
  • While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Your benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government.
  • Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change.
  • Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.
  • Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met.

Medical clinical policy bulletins

  • Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider.
  • While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors).
  • Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error.
  • CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided.
  • Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern.
  • In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 

See CMS's Medicare Coverage Center

  • Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change.
  • Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies. Under certain circumstances, your physician may request a peer to peer review if they have a question or wish to discuss a medical necessity precertification determination made by our medical director in accordance with Aetna’s Clinical Policy Bulletin.
  • While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans.

See Aetna's External Review Program

  • The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
  • The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.

LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®")

CPT only copyright 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.

You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.

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Can a business pay for employees' individual health insurance plans?

Health Benefits • May 14, 2024 at 9:58 AM • Written by: Holly Bengfort

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In today's ever-evolving workforce, business owners are constantly looking for new ways to attract and retain top talent . Instead of offering a costly group health plan, one tactic they may consider is offering to pay employees' individual health insurance costs .

While it may seem like a generous and attractive perk for employees, employers need to consider several factors before deciding to pay for individual health insurance plans. From costs and tax implications to legal requirements and employee preferences, navigating this benefit option can be complex.

In this article, we'll go over a better type of employer-sponsored health benefit that allows you to reimburse your employees for their healthcare costs instead of paying premiums directly.

Takeaways from this blog post: Under the ACA, an employer cannot directly pay for an employee’s health insurance premiums. Employers do have the option to reimburse employees on a tax-free basis for more than 200 eligible medical costs, including healthcare premiums, through an HRA. By offering to reimburse employees for their individual health plan coverage, businesses can provide a valuable benefit that helps boost recruitment and retention.

Are you a small employer? Get our guide on how to offer health benefits with a tight budget.

How business owners can pay for individual health insurance plans

Historically, organizations could pay for employees’ individual health insurance premiums directly. However, the Affordable Care Act (ACA) changed this. IRS Notice 2015-17 1 clarified information about employer payment plans (EPPs) and whether employers could pay for employees’ individual health insurance plans.

Because the IRS and ACA consider EPPs group plans, they must meet ACA standards. Since EPPs can’t integrate with individual health insurance plans, they don’t satisfy the ACA. Offering an EPP could subject you to fines if you have 50 or more full-time equivalent employees (FTEs).

Thankfully, federal law allows employers to reimburse employees for their monthly premiums for individual health insurance policies, as long as it's done through a compliant health reimbursement arrangement (HRA). This allows employees to choose a health insurance plan that best fits their individual needs while still receiving financial assistance from their employer.

HRA vs. traditional group health insurance

Employers often associate employee health insurance with a group health plan. When employers purchase a group policy, they offer their employees and dependents coverage. Employees have the option to enroll or decline coverage, with most plans requiring a minimum participation rate of 70%. From there, the employer and employee split the health insurance premiums . This isn't always a problem for larger companies with big budgets, but it can put a strain on small business owners.

HRAs are the more cost-effective health insurance option. An HRA is an employer-funded health benefit that reimburses employees tax-free for out-of-pocket medical expenses . With a stand-alone HRA, employers can reimburse employees for their insurance premium costs instead of buying the health plan coverage for them. This is especially beneficial in states where individual coverage is cheaper than group coverage.

How an HRA works

HRAs aren't as complicated as they may seem. Each type of HRA follows the same basic steps.

Here's a breakdown of the HRA process:

  • The employer sets aside a specific amount of tax-free money for each employee.
  • Employees pay for medical expenses such as health insurance, doctor visits, prescriptions, and other healthcare services using their own money.
  • They submit proof of those out-of-pocket costs to their employer for reimbursement.
  • Once the employer or third-party administrator approves the expense, employers reimburse employees up to their allowance amount. Employers can reimburse employees on a pre-tax basis for more than 200 medical expenses listed in IRS Publication 502 and the CARES Act.

Common types of HRAs

There are a few different types of HRAs that businesses can offer to reimburse employees for their individual health insurance plans, including the qualified small employer HRA (QSEHRA) and the individual coverage HRA (ICHRA).

This chart shows how they compare.

How HRAs benefit employers

HRAs are employer-friendly for two reasons: they offer tax advantages and work with all budgets.

Under an HRA, reimbursements are exempt from payroll taxes for employers. Employees enrolled in a policy that meets minimum essential coverage (MEC) requirements, such as a plan from state or federal health insurance marketplaces, can participate in the HRA, meaning they also receive tax-free reimbursements.

Unlike a traditional group health plan, an HRA isn't subject to unpredictable rate increases or strict participation requirements. They're a more affordable alternative since employers control their own budgets. They set a monthly allowance that they can afford, so they can offer employees as much or as little as they choose.

John F. Pace is a CPA at Pace & Associates 2 with more than 40 years of experience. He's observed various business insurance structuring scenarios, including the intricate ways employers handle health insurance. He finds HRAs beneficial because they offer greater flexibility and tax benefits.

"For example, in one instance at my firm, we transitioned a client from a traditional group insurance plan to an HRA," Pace said. "This change not only streamlined their benefits administration but also resulted in notable cost savings, echoing similar benefits to the ones I managed during my tenure overseeing family trusts and associated commercial properties, where every financial decision impacted broader estate and tax planning strategies."

How HRAs benefit employees

In today's competitive labor market, offering competitive benefits is crucial for attracting top talent. Employers also need to keep job satisfaction high if they want to discourage their current employees from looking for better opportunities elsewhere.

PeopleKeep's 2024 Employee Benefits Survey found that 81% of employees said an employer’s benefits package is an important factor in whether or not they accept a job. Another 92% of employees said that health benefits are an important employee benefit.

While a traditional group health plan can satisfy this need, it's a one-size-fits-all approach that groups your employees together. HRAs promote individuality since your employees can pick the health insurance plans that meet their specific wants and needs. In addition to having their health insurance premiums reimbursed, they can also submit other eligible healthcare expenses for reimbursement, resulting in additional savings.

How PeopleKeep can help

If you’re new to offering HRAs, PeopleKeep can help. We specialize in HRA administration, helping thousands of employers easily reimburse their employees with our hassle-free software. Our team of experts generates legal plan documents, reviews employee expenses based on IRS guidelines, and sends necessary notices automatically for your convenience. This frees up more time for you to focus on running your business.

Healthcare costs are on the rise, and many employers are seeking out more affordable healthcare coverage options for their employees. An HRA is an excellent alternative to a costly group health plan. With a QSEHRA or an ICHRA, employers can reimburse employees for their individual health insurance coverage on a pre-tax basis. Providing reimbursement for employees' individual health insurance plans can be a cost-effective and attractive benefit for businesses looking to take care of their employees' well-being while staying within their budgets.

This article is for information purposes only. It's important for businesses to consult with legal and financial professionals to ensure compliance with applicable laws and regulations when implementing this type of benefit.

This article was originally published on April 23, 2013. It was last updated on May 14, 2024.

  • https://www.irs.gov/pub/irs-drop/n-15-17.pdf
  • https://pace.cpa/

New to HRAs? Learn which is best for you in our comparison chart.

group health insurance for non employees

Holly Bengfort

Holly is a content marketing specialist for PeopleKeep. Before joining the team in 2023, Holly worked in television news as a broadcast journalist. As an anchor and reporter, she communicated complex stories to the vast communities she served on a daily basis. Her background has given her a greater understanding of people and the issues that affect our lives. When Holly isn’t writing, she enjoys reading, exercising, and spending time at the beach.

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​​​​​IRS Releases 2025 HSA Contribution Limits and HDHP Deductible and Out-of-Pocket Limits

​In Rev. Proc. 2024-25 , the IRS released the inflation adjusted amounts for 2025 relevant to Health Savings Accounts (HSAs) and high deductible health plans (HDHPs).

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 The table below summarizes those adjustments and other applicable limits. 

​Out-of-Pocket Limits Applicable to Non-Grandfathered Plans

​The ACA’s out-of-pocket limits for in-network essential health benefits have also been announced and have decreased for 2025. 

​Note that all non-grandfathered group health plans must contain an embedded individual out-of-pocket limit within family coverage if the family out-of-pocket limit is above $9,200 (2025 plan years) or $9,450 (2024 plan years). Exceptions to the ACA’s out-of-pocket limit rule have been available for certain non-grandfathered small group plans eligible for transition relief (referred to as “Grandmothered” plans) since policy years renewed on or after January 1, 2014. Each year, CMS has extended this transition relief for any Grandmothered plans that have been continually renewed since on or after January 1, 2014.  However, in its March 23, 2022 Insurance Standards Bulletin , CMS announced that the limited nonenforcement policy will remain in effect until CMS announces that such coverage must come into compliance with relevant requirements.   Thus, we will no longer see annual transition relief announced.

​Next Steps for Employers 

​As employers prepare for the 2025 plan year , they should keep in mind the following rules and ensure that any plan materials and participant communications reflect the new limits:   

  • ​HSA-qualified family HDHPs cannot have an embedded individual deductible that is lower than the minimum family deductible of $3,300. 
  • ​The out-of-pocket maximum for family coverage for an HSA-qualified HDHP cannot be higher than $16,600. 

​All non-grandfathered plans (whether HDHP or non-HDHP) must cap out-of-pocket spending at $9,200 for any covered person. A family plan with an out-of-pocket maximum in excess of $9,200 can satisfy this rule by embedding an individual out-of-pocket maximum in the plan that is no higher than $9,200. This means that for the 2025 plan year, an HDHP subject to the ACA out-of-pocket limit rules may have a $8,300 (self-only) / $16,600 (family) out-of-pocket limit (and be HSA-compliant) so long as there is an embedded individual out-of-pocket limit in the family tier no greater than $9,200 (so that it is also ACA-compliant). ​ ​​

About the Author. This alert was prepared for Woodruff Sawyer by Barrow Weatherhead Lent LLP, a national law firm with recognized experts on the Affordable Care Act. Contact Stacy Barrow or Nicole Quinn-Gato at [email protected] or [email protected] .

The information provided in this alert is not, is not intended to be, and shall not be construed to be, either the provision of legal advice or an offer to provide legal services, nor does it necessarily reflect the opinions of the agency, our lawyers, or our clients. This is not legal advice. No client-lawyer relationship between you and our lawyers is or may be created by your use of this information. Rather, the content is intended as a general overview of the subject matter covered. This agency and Barrow Weatherhead Lent LLP are not obligated to provide updates on the information presented herein. Those reading this alert are encouraged to seek direct counsel on legal questions.  

©2024 Barrow Weatherhead Lent LLP. All Rights Reserved. 

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IMAGES

  1. Two Ways For Non-Employees To Get A Group Health Insurance

    group health insurance for non employees

  2. What Is Group Health Insurance?

    group health insurance for non employees

  3. Group Health Insurance Benefits For Employers And Employees

    group health insurance for non employees

  4. Group Health Insurance: Coverage & Claim

    group health insurance for non employees

  5. Group Health Insurance

    group health insurance for non employees

  6. How Do Group Insurance Benefits Employees And Employers?

    group health insurance for non employees

VIDEO

  1. Corporate Health Insurance

  2. The Truth About Health Insurance

  3. Employer group health insurance explained!

  4. 22 Group Health Insurance

  5. Benefits of Group health insurance for employees and employer

  6. We help make health insurance affordable

COMMENTS

  1. What Is Group Health Insurance & How Does it Work?

    Group health insurance—sometimes called employer-based coverage—is a type of health insurance plan offered by an employer of a member organization. Members of a group health insurance plan ...

  2. Group Health Plans: Owners, Non-Employees & Domestic Partners

    Non-Employees. The theme that should be starting to recur is that only employees can participate in the group health plan on a pre-tax basis. Non-employees cannot pay for their group health insurance coverage through the corporation's Cafeteria Plan nor would they be eligible to participate in an employer's FSA, HRA or HSA. Domestic ...

  3. Who is Eligible for Group Health Insurance?

    According to the Affordable Care Act (ACA), a small business is defined as a business having between 1 to 50 employees. By having at least one qualified employee (who is neither yourself nor a spouse), your business would likely be eligible for group health insurance. While the definition of a group or employee varies by state, it is important ...

  4. Guide to Group Health Insurance

    A group health plan is most commonly a medical insurance policy an employer offers its employees. The plans are usually the cheapest insurance options if you have access to them. Federal law requires all businesses with 50 or more full-time employees offer a health insurance plan that meets the Affordable Care Act's minimum essential coverage ...

  5. How to provide health insurance for non-employees

    If you opt to offer contract medical insurance, there are four points to keep in mind: 1. Employers can offer the same group plan. As noted above, you can offer contractors the same group plan as your part and full-time employees. You don't have to select a different plan for contractors to access. 2.

  6. SHOP health insurance overview

    The Small Business Health Options Program (SHOP) is for small employers who want to provide health and/or dental insurance to their employees — affordably, flexibly, and conveniently. To purchase SHOP insurance, your business or non-profit organization generally must have 1 to 50 employees. See if your business qualifies for SHOP.

  7. Best Small-Business Group Health Insurance Plans

    Best overall: Blue Cross Blue Shield. Best for low-cost plan options: Kaiser Permanente. Best for transparency: UnitedHealthcare. Best for customer service: Humana. Best for health expense funds ...

  8. Health insurance for businesses

    A group health insurance plan, like a plan purchased through the Small Business Health Options Program (SHOP) or otherwise from a private insurance company, provides coverage to eligible employees. Business owners can offer their employees one plan or a selection of plans to choose from. Small employers (generally those with 1-50 employees) may ...

  9. Small Business Health Options Program

    Learn how to get health insurance for employees. Marketplace for Small Business, 50 employees or fewer. Small Business Health Options Program details

  10. What is Group Health Insurance & How do Plans Work?

    Group health insurance plans refer to healthcare coverage that is purchased for a group, typically by employers, business owners, or association heads. As opposed to individual health insurance plans that allow anyone to enroll through a marketplace insurance provider, group medical insurance only permits select members or employees of the ...

  11. Group Health Insurance: What It Is, How It Works, Benefits

    Group Health Insurance Plan: A group health insurance plan is an insurance plan that provides healthcare coverage to a select group of people. Group health insurance plans are one of the major ...

  12. What Is Group Health Insurance & How Does It Work?

    Group health insurance plans refer to the health coverage benefits that apply to a group of members, typically employees of a business or organization. The Social Security Administration (SSA)states that a group health plan (GHP) is based on current employment. Moreover, employers with 20 or more employees must legally offer current workers and ...

  13. Group vs. Individual Health Insurance: How They Differ

    Key Takeaways. Group insurance is a health insurance plan that you provide to your employees and their dependents.; Individual health insurance is obtained by an employee or provided by their family member and is not obtained through your business.; Group insurance is typically offered through employers and provides coverage to a group of employees, while individual insurance is purchased by ...

  14. How to Buy Group Health Insurance for Self-Employed Workers

    You can only buy group health insurance when you are self-employed through an insurance company or agent in certain states. Check with your state insurance department to verify if group health insurance policies are sold to small groups of one. In most cases, however, a self-employed person with no employees would have to buy an individual ...

  15. Employer Health Care Arrangements

    The transition relief applies to employer healthcare arrangements that are (1) employer payment plans, as described in Notice 2013-54, if the plan is sponsored by an employer that is not an Applicable Large Employer (ALE) under Code § 4980H (c) (2) and §§ 54.4980H-1 (a) (4) and -2 of the regulations; (2) S corporation healthcare arrangements ...

  16. Group health insurance for employers

    Employers. Group health insurance plans for large and small businesses. When you choose UnitedHealthcare, you'll get group benefit solutions designed to deliver more health care value for your business and your employees. Informed by the most robust data and insights in the industry, UnitedHealthcare plans are built to lower your total cost ...

  17. Can an employer offer health insurance to its board's directors?

    For one, it is unclear whether a Multiple Employer Welfare Arrangement (MEWA) is created when health or other welfare benefits are provided to non-employee directors. A MEWA is defined as an employee welfare benefit plan providing benefits to the employees of two or more employers (including one or more self-employed individuals). If the board ...

  18. Health Insurance Options for Small Nonprofits

    Costco also offers group health plans to their business members in Washington state. ... If you're aware of other ways for nonprofit employees to access health insurance, please reach out. Thank you for prioritizing your employees' health and wellbeing! Reach Out. Nonprofit Association of Washington. 5601 6th Ave. S, Suite 150 Seattle, WA 98108

  19. Here's What Every Nonprofit Should Know About Offering Health Insurance

    About half of U.S. companies offer health insurance. Among nonprofits with fewer than 50 employers (two-thirds of all nonprofits), 47% offer health insurance benefits to their employees. Sure, health insurance benefits cost money. On average, employers pay $5,179 annually (83 percent of the premium) to cover a single employee and $12,591 ...

  20. How nonprofits can offer health insurance

    Like a QSEHRA, nonprofits and other businesses can use an ICHRA to reimburse employees tax-free for individual health insurance premiums and other medical expenses. All employers with at least one W-2 employee can offer an ICHRA. This includes businesses, nonprofits, government entities, and religious organizations.

  21. Group Health Insurance How-To for Employers

    Health insurance continues to rank as the most important voluntary benefit among employees, making it a powerful tool for employers to attract and retain talent. In fact in 2022, approximately 70% of private-sector employees had access to employer-sponsored medical care benefits, according to the Bureau of Labor Statistics.. One of the most cost-effective ways for employers to provide medical ...

  22. Are You Covered Under a Group Health Insurance Plan?

    In order to qualify for group health insurance, an employee usually must be full-time but temporary employees may still get group healthcare benefits if they're working at least 30 hours per week ...

  23. Group Health Insurance and Benefits

    We offer a variety of healthcare benefit options to help your employees make the best choices for their continued health and wellness. Whatever the size of your business, our health plans can help you create a healthier and more productive workforce that attracts and retains top talent. Humana's Employer Group Specialty plans (dental, vision ...

  24. When do group health plan benefits terminate for an employee on a non

    An employee may continue health benefits during periods of employer-provided leave as allowed by the insurance plan documents and approved by the health plan insurer. Employers should address in ...

  25. Small Group vs Large Group Health Insurance

    Understanding Group Health Insurance. Lets kick it off - group health insurance is distinct from individual coverage that a particular person or family would purchase on their own. Group health insurance is an employee benefit that allows employers to offer health benefits to their employees and their dependents, which can lead to a healthier ...

  26. Health Insurance Costs Are Squeezing Workers and Employers

    Health insurance is one of the main benefits employees look for when considering a firm's compensation package. 1 Offering robust health insurance is an important recruitment and retention tool ...

  27. Health Product & Service Discounts for Aetna Members

    No matter your overall health goal, you can get there more easily with some of the discounts available to Aetna members. Learn more today. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).

  28. The Most Common Mistakes Small Businesses Make With Insurance

    They add employees to the payroll, move to a new location, buy more equipment, modify their stores, and so on. These can change the type of insurance policy you need, as well as the level of coverage.

  29. Can a business pay for employees' individual health insurance plans?

    In today's ever-evolving workforce, business owners are constantly looking for new ways to attract and retain top talent.Instead of offering a costly group health plan, one tactic they may consider is offering to pay employees' individual health insurance costs. While it may seem like a generous and attractive perk for employees, employers need to consider several factors before deciding to ...

  30. IRS Releases 2025 HSA Contribution Limits and HDHP Deductible and Out

    The Essential Guide to D&O Insurance Placement for Foreign Filers Going Public on a US Exchange ... Employee Benefits Compliance Alert ... Note that all non-grandfathered group health plans must contain an embedded individual out-of-pocket limit within family coverage if the family out-of-pocket limit is above $9,200 (2025 plan years) or $9,450 ...