Employer Plans

Self Funding...Althought not widely used. With a self funding plan an employer, not an insurance company provides the funds to make claim payments for company employees and their dependents. In the event that claims are higher than predicted, a self funded insurance plan can be backed up by a stop-loss contract. A stop-loss contract is designed to limit the employer's liability for claims.

Small Employers

Small employers (usually those with fewer than 25 or 50 employees) have been especially hard hit by increases in health care insurance premiums. Many group plans are "experience rated" small employers see an immediate premium increase whenever claims are particularly high.

Several states have acted to ensure that health insurance coverages are available at a reasonable cost and under reasonable conditions for small employers.

Among the new requirements

• Standard benefit plans that must be offered to small employers
• Maximum waiting periods for preexisting conditions
• The insurer may not exclude particular individuals or medical conditions from coverage
• Carriers may only cancel or non renew small employer plans for nonpayment of premium, fraud, misrepresentation, or noncompliance with plan provisions

Cafeteria Plans

A cafeteria plan could be defined as a plan in which employees select health benefits from a variety of coverage options, based on their individual or family needs. Cafeteria plans tend to be more complex and more expensive than traditional plans, especially with administration, and usually make the most sense for larger employers.

Health Savings Accounts (HSAs)

A health savings account is an employer funded account linked to a high deductible medical indemnity plan. A portion of the premium contributes to the medical savings account to cover the deductible. Employers can use the contributions to pay for health care expenses throughout the year, and at the end of the year may withdraw whatever remains in the account in cash (as taxable income).

Group Health Insurance

For a group health insurance policy, the contract is between the insurer and the employer, union, trust or other sponsoring organization. Family members may generally be covered under both group health and individual policies. The individuals covered under the group policy are issued certificates of insurance. The certificate list what the policy covers, and explains to the insured such things as how to file a claim, the term of insurance, and the right to convert to an individual policy.

Group health insurance is generally subject to experience rating, under which the premium modification factor is determined by the experience of the group as a whole.

Employee Group...An employee group policy may be issued to an employer where insurance is secured for the benefit of the employees, or for persons other than the employer. Usually the classification will include all full-time employees. By classifying the employee group in this manner, the employer is legally able to exclude certain groups of employees, such as part-time, union, etc from the eligible class of covered employees.

Credit Health Insurance...Credit health insurance is usually written as a group disibility income contract although it could be written as an individual policy. The purpose of credit health is to provide payment of the insured's debt when he or she is disable due to an accident or sickness.

Disibility benefits equal to the insured's indebtedness are paid directly to the creditor in the event that the insured in totally disabled in accordance to the policy provisions. These benefits are usually paid on a monthly basis as long as the debt remains and the insured is totally disabled.