Employee Health Insurance For Small Business: The Do's And Don'ts

Natasha Chimphondah / Posted On: 26 June 2022 / Updated On: 29 November 2022 / Compensation and Benefits / 110

Search Blog Click here to search the site.
Employee Health Insurance For Small Business: The Do's And Don'ts



Most countries rely on small businesses to survive. Small businesses employ 47 percent of the U.S. private workforce. (Sana.)  This is also the same in Zimbabwe, where small businesses make up 94 percent of the country's business population (B. Sibanda). You are probably a part of a small business, and, as with many start-ups and small businesses, health insurance is likely to be a topic of discussion, with the cost of plans dominating.

 

In recent years, fewer smaller firms have offered health insurance. According to the non-profit Employee Benefit Research Institute (EBRI ), health insurance offer rates decreased. Between 2008 and 2015, the offer rates decreased from 35.6% to 22.7% for businesses with fewer than 10 employees (a 36 percent dip).   There was a decrease from 66.1 to 48.9 percent for businesses with between 10 and 24 employees (a 26 percent dip). Then from 81.3 to 73.5 percent for companies with 25 to 99 workers (a 10 percent dip).


Since employees could now purchase insurance on a public exchange, many small firms may have decided that the rising costs and risks involved with providing health coverage were no longer necessary in light of the adverse business environment. (Miller.2016).

 

However, there seems to be a shift in small firms' perspectives about offering health insurance to their employees. According to a MetLife study, 60% of companies believe that providing health insurance increases productivity. With coverage for wellness check-ups, prescription medications, emergencies, mental health benefits, and chronic disorders, health insurance can help safeguard employees and their families. Employees can remain content, healthy, and effective due to this.

 

The Do's and Don'ts

Today, small business owners must provide health insurance coverage to their employees to attract and keep talented employees. A healthier workforce is also more productive. Therefore, health benefits increase employees' likelihood of staying with their employers. Finding reasonably-priced health insurance coverage for small teams can be difficult. Fortunately, there are health insurance plans designed especially for small enterprises (Lile.2022).

 

Navigating small company health insurance can be one of the most challenging aspects of running your small business, as there are numerous alternatives and regulations to understand. If your small business doesn't have a full human resources department, you are left to sort it out on your own. Depending on the insurance provider and the options chosen, the small business health insurance plan may cover various expenses, but the law always covers some basic medical expenses.

 

Do Consider Bringing an insurance Agent

During your small business's start-up process, bringing an insurance agent to set up health insurance policies can be beneficial. Insurance agents and brokers are key in informing small businesses about their essential health insurance coverage alternatives.

 

Do Research on Health Insurance Providers

How much does health insurance for small businesses cost? It differs. Many employers have discovered that purchasing health insurance as a small business is more cost-effective than doing so on their own.

 

When looking for an insurance provider, small business owners should concentrate on coverage, the number of employees, employee premiums, and comparison shopping (Kuligowski.2021).

 

To qualify for small business health insurance coverage, you must have at least one employee on your payroll. However, some countries allow you to count yourself as both a business owner and an employee.

 

Small company owners can browse alternatives from several insurance providers, compare pricing and services, and sign up for a plan that best suits their requirements (Berger.2022).

 

Numerous plans are provided for small businesses by the majority of health insurance providers. With a small business health insurance option, the employer covers a portion of the cost as part of employee salaries. Each employer makes a payroll deduction to cover the remaining balance.

 

Do look into Various Healthcare Plans

Take care to evaluate all comparable plans on the market before selecting a health insurance plan for your employees. When purchasing online health insurance, you can quickly compare the plans. When purchasing health insurance online, consider the benefits of the plan, the services provided by the insurer, and finally, the cost of the policy (Team Acko.2022).

 

Historically, the best small business health insurance option was small-group insurance for many small employers looking to offer health benefits for their employees, but that's not the case anymore (Amy.2020).

 

Do read the policy's terms.

When you finally decide on a health care plan for your employees, ensure that you take a clear look at the terms and conditions. The terms and conditions listed in the policy paperwork are slightly different for each insurance company. To ensure that your employees have no trouble obtaining coverage, ensure you understand the terms and conditions of your insurer (Team Acko.2022).

 

Do Consider Employee Health Allotments

Instead of providing employees with a specific group health insurance plan, small and midsize enterprises are employing a "pure" defined contribution technique to allocate funds for health insurance. However, proper and improper ways to establish and manage health insurance allotments exist. (Merhar.2020)

 

Don't assume there is no solution to the expense

According to Kaiser Family Foundation survey data, 98 percent of employers believe that the high costs of providing healthcare to their employees are excessive. Small businesses are especially vulnerable to unsustainable costs.

According to the Society of Human Resource Management (SHRM), 92 percent of employees believe benefits are important to their overall job satisfaction. Another survey shows that 56 percent of adults with employer-sponsored health benefits health coverage is a key factor in deciding to stay at their current job

Employee retention is very important for small businesses. These figures demonstrate that benefits are a significant factor in talent acquisition and retention. Happy, healthy, and well-cared for employees are more loyal, productive, and supportive of your growing company.

Yes, health insurance plans can be expensive, but with so many small businesses (your competition) providing health insurance, can you afford not to? Consider health insurance benefits an investment rather than a cost that will result in higher-quality employees.

 

Employees and potential employees are demanding healthcare coverage, often prompting SMBs to balance the advantages and disadvantages of providing this highly desired incentive (O'Donnell. 2019).

 

Types of Employee Healthcare Plans for Small Businesses

There is no escaping the fact that healthcare costs are high in general. However, there are ways to lower your health insurance rates while giving your staff members fantastic benefits.

 

Group health insurance for small businesses

Employers purchase small group health insurance plans, which are made available to employees. (Amy.2020). Small company group health insurance, often known as fully-funded insurance, has traditionally been the top choice for many small businesses wishing to provide health benefits for their employees. It is designed for companies with fewer than 50 full-time workers. In some countries, it is also available for small businesses with up to 10 employees.

 

56 percent of small firms with 3 to 199 employees offer health insurance, according to the Kaiser Family Foundation. One type of plan is provided by 81 percent of these businesses.

 

Group members can accept or reject the coverage after the corporation selects a plan. Plans might offer basic coverage or advanced insurance with add-ons in specific locations, with tiers (like gold, silver, and bronze) to choose from. Compared to individual health insurance, group insurance has several benefits, including being generally more economical and providing wider coverage.

 

Self-funded Health Insurance Plans

There will always be a solution where there is a demand. Although conventional, fully funded plans are more typical. Many small firms avoid them because of their expense and unreliability.

 

Small businesses around the nation are becoming more interested in self-funded plans for employee health insurance as an alternative to conventional plans. Understanding the distinction between a fully-funded health plan and a self-funded health plan is crucial.

 

Self-funding allows a group of as small as 25 employees to see and understand where their health dollars are going. The group can also potentially take some control over this significant investment. (Sena Meilleur.2022)

 

Self-funding one's health plan, as the name suggests, involves paying the employees' health claims as they occur. (Sena Meilleur.2022). A fully-insured health plan requires the employer to pay a monthly payment to the health insurance carrier. In exchange, the insurance company pays for the employees' medical expenses. There is no additional risk to the employer with a fully-insured plan.

 

Under the above plan, the employer knows what their plan will cost each year. The healthier the employees are, the lower the plan costs will be. The downside is if the employees are healthy and don't use much health care, the employer has spent a significant sum and doesn't get any of the money back. With self-funded plans, the opposite occurs. Another advantage of a self-funded health insurance plan is that your employees won't be obliged to select "in-network" providers, regardless of the type of plan they choose.

 

Stop-loss Health Insurance

Stop-loss insurance is designed for employers who self-fund their health benefit plans for their employees but want to hedge against the risk of assuming 100 percent liability for losses that stem from catastrophic claims, (Ross.2021). When an employer sets a stop-loss employee health insurance policy deductible, the insurer is responsible for any losses exceeding that level.

 

Consider a scenario where a virus affects several employees at a corporation, leading to a huge volume of claims, or two or three employees contract a serious illness or condition, such as cancer or kidney disease, requiring medical care costing each hundred thousand dollars. In both scenarios, an employer is shielded from these damages by a stop-loss insurance coverage. Stop-loss insurance is essentially a mechanism organizations utilize to reduce the danger of a catastrophic financial loss. Losses are limited to a particular level, and stop-loss insurance is responsible for paying any expenses that exceed the stipulated restrictions.

 

Level-Funding Plan

A level-funded plan is a particularly attractive self-paid option for smaller firms. In the form of self-funding, known as level financing, the insurance provider combines all the necessary costs—administration, stop loss, and claims—into a manageable monthly charge that the business can afford (Sena Meilleur). The employer is certain of their monthly cost per employee, which resembles a fully insured premium. The difference is that with a level-funded plan, the insurance carrier tracks the claims the employer pays in, and if there is a claims surplus at the end of the year, the employer can receive some or all of the surplus back.

 

Advantages and Disadvantages

Group Health Insurance

Group insurance has several benefits, such as employees getting basic protection without providing proof of their insurability, reducing costs by a large margin, and sharing expenses with the employer. Group health and dental insurance and group disability insurance can help you protect your investment in your employees in the event of an employee's illness or injury.

 

Maintain productivity: The best method to guarantee that employees stay focused on their work, reduce absenteeism, and encourage the return to work as soon as possible is to offer a group insurance plan that includes an employee assistance program.

Encourage employee attraction and retention: A sizable portion of an employee's overall remuneration goes into group insurance. Employee dedication and satisfaction increase as a result.

Increase after-tax pay: Without a benefit plan, employees must pay for their own medical and dental treatment out-of-pocket with after-tax money.

 

So what are the disadvantages of Group Health insurance for small businesses? The primary worry when deciding whether to offer healthcare coverage to employees (and frequently for themselves or their families) is the expense. According to one study, the cost of employer-sponsored healthcare for a family plan is close to $20,000 annually, while the cost for single employee coverage is close to $7,000 annually. That sum can be a difficult barrier for many organizations, even with possible tax advantages and savings.

 

Furthermore, it is not easy to manage healthcare coverage. Employers worry about the duties they'll be responsible for and the resources they'll need to invest when offering coverage to staff members (O'Donnell. 2019).

Premium payments must be withdrawn and made monthly in addition to providing benefits information and enrolling employees initially and at annual enrolment. Small business owners frequently receive complaints and issues from their staff.

 

Self-funding plan

The potential for cost reduction is a self-funded plan's greatest benefit. Employer expenditures will be lower than if the plan were fully covered if employees are generally healthy and don't utilize the health plan frequently. By self-funding, you also avoid paying premium taxes and boost the profit margin of the insurance provider. In contrast to fully-insured, bundled arrangements, self-funding offers virtually limitless creative options for controlling the health care expenditures of the plan, (Sana).

 

According to the Healthgram, population management measures like weight reduction or smoking cessation programs can be easily adopted because self-funding enables greater involvement at the corporate level. Preventive care and medication adherence programs are high-value services that allow companies more control over successful results while raising workers' quality of life and lowering expenses. Self-funding gives businesses control by enabling them to use claims data to find and more effectively use low-cost suppliers.

 

So what reasons could hold back an employer from funding themselves? Some organizations still find that a fully-insured plan is the best option. Employers should go with a straightforward plan like a fully insured plan if they lack the time or resources to manage a more involved, complex plan. Self-funding involves several compliance requirements that are not usually present for a fully-insured plan, including non-discrimination laws. Additionally, a company without a consistent cash flow may feel that self-potential funding's cost swings each month place an undue burden on its resources (Sena Meilleur).

 

Level-funded plans

One of the main benefits of a level-funded health insurance plan is that you only pay for legitimate claims filed by your employees, as opposed to all other types of plans. You are not paying premiums based on local rates, which may be higher than the risk faced by your employee group. You have a set monthly premium payment capped at a certain amount. This means that stop-loss insurance will cover any claims made by your employees that exceed the amount you contributed to the plan (Sana).

 

Before selecting whether level funding is the best option, make sure you know the prices and terms related to your organization (Sana). The amount you will pay and other aspects of the level-funded plan depend on your company's size, geography, and general employee health. Larger organizations are better suited for fully-funded plans. This option can be more appealing to you than a fully-funded plan if you are the founder of a start-up or small business, an HR manager, or the CEO.

 

The amount you will pay and other elements of the level-funded plan will depend on the size of your company and the state in which you are located. Before deciding whether level funding is the best option, make sure you comprehend your fees and terms based on your particular firm. The cost of level funding, a form of partially self-paying, may be higher than that of other healthcare financing strategies.

You also still have to pay the claims. Level financing costs you money in exchange for the ease of receiving equal payments throughout the year and the safety of stop-loss insurance (Sana).

 

The contract's conditions are another obstacle to level funding that you should consider. You should be aware of how they will affect a company your size because those with fewer employees may profit differently from those with more.

 

Group health plans don't come in a one-size-fits-all variety. Considering all options before deciding whether they would be a good fit for your company is crucial.

Research the many funding options and choose the one that is ideal for your business based on your money and resources.

 

Natasha Chimphondah is an organizational development consultant at Industrial Psychology Consultants (Pvt) Ltd, a business management and human resources consulting firm.

LinkedIn: https://www.linkedin.com/in/natasha-chikondi-chimphondah-9b62a9159/

Phone: (0242) 481946-9/481950

Mobile: (+263) 783836901

Email: [email protected]

Main website: www.ipcconsultants.com


Natasha Chimphondah
      View Natasha Chimphondah's full profile



Related Articles






Popular Categories