Fully-Insured Health Plan- The more traditional way to structure an employer-sponsored health plan. The company pays a premium to the insurance carrier. The premium rates are fixed for a year, based on the number of employees enrolled in the plan each month.
Level-Funded Health Plan - With Level Funding, and the proper use of Stop Loss Insurance, the employer pays a monthly cost that is the maximum cost. No matter how many claims occur in a month, the employer will never pay more than the maximum cost. After all claims are paid for the year, a portion of the unused money in the claim fund is returned to the employer according to the contract terms. Annual claim deficits are covered by the Stop Loss Insurance.
Minimum Essential Coverage (MEC Plan) - Under the Affordable Care Act (otherwise known as “ObamaCare”), everyone must have health insurance that covers their basic health care needs. This required coverage is called, “minimum essential coverage,” or MEC, and it covers 100% of the government’s mandated preventive services.
Types of Group Health Insurance
Health Insurance - Covers the cost of an individual's medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider.
Types of Individual Health Insurance
Comprehensive Health Insurance - Under the Affordable Care Act (otherwise known as “ObamaCare”), everyone must have health insurance that covers their basic health care needs. Your insurance plan must cover 10 minimum essential health care services. These are: outpatient services; emergency services; hospitalization; maternity/newborn care; mental health and substance abuse services; prescription drugs; rehabilitation (for injuries, disabilities or chronic conditions); lab services; preventive/wellness programs and chronic disease management; and pediatric services.
Short Term Health Insurance - Short Term Health Plans are designed to provide temporary insurance during unexpected coverage gaps. Short Term Health Plans cover a number of medical expenses, such as doctor visits (subject to deductible and coinsurance), urgent care, ambulance service, emergency room care, diagnostic testing, surgery, inpatient and outpatient hospital benefits, and hospital confinement benefits. However, Short Term Health Plans do not meet the minimum essential coverage requirements under the Affordable Care Act, also known as Obamacare, as they can exclude pre-existing conditions, preventive care, prescription drugs, mental health, maternity care etc.
Fixed Indemnity Plans - Fixed Indemnity Plans provide medical network discounts and offer cash back for specific services, such as doctors visits, x-rays and labs, hospitalization, and prescription drugs. They are considered supplemental plans and exclude pre-existing conditions for one year.
Medicare Supplement Plans - Medicare Supplement plans are offered through private insurance companies. These Medigap plans help pay some of the hospital and medical costs that Original Medicare doesn't cover, such as copayments, coinsurance, and yearly deductibles.
Prescription Drug Part D Plans - Prescription Drug Part D Plans can be added to Medicare Part A (Hospital) and Medicare Part B (Medical) to pay for medications.