In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families.
Small business health insurance is provided for organizations or businesses with 2 – 50 employees. Groups with 51 or more are considered large group where the rules and rates change drastically. Starting in 2017 family health statements will no longer be required at all on any plans, either existing or new, for any employee either coming on for the first time or a new employee already on the plan, they will not be required anymore, only the enrollment form.
Employer contributions to a small business health insurance plan are generally 100% tax deductible, no changes there.
PPO – A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
POS - A type of plan in which you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. Similar to a PPO, you can use providers outside of the network but will cost more.
HMO - A type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won't cover out-of-network care except in an emergency.
HSA (Health Savings Account) - A medical savings account available to taxpayers who are enrolled in a High Deductible Health Plan. The funds contributed to the account aren't subject to federal income tax at the time of deposit. Funds must be used to pay for qualified medical expenses. Unlike a Flexible Spending Account (FSA), funds roll over year to year if you don't spend them.
Copayment - A fixed amount (for example, $30) you pay for a covered health care service, usually when you get the service. The amount can vary by the type of covered health care service.
Deductible - The amount you owe for covered health care services before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve met your $1,000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
Co-Insurance - Your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the allowed amount for the service. You pay coinsurance plus any deductibles you owe. For example, if the health insurance or plan’s allowed amount for an office visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20. The health insurance or plan pays the rest of the allowed amount.
Preferred (In- Network) Provider - A provider who has a contract with your health insurer or plan to provide services to you at a discount.
*Always check either the provider directory, or call your doctor to make sure they accept the insurance you are planning on going into*
Non-Preferred (Out-of-Network) Provider - A provider who doesn’t have a contract with your health insurer or plan to provide services to you. You’ll pay more to see a non-preferred provider.
*Always check either the provider directory, or call your doctor to make sure they accept the insurance you are planning on going into*
Max Out-of-Pocket - The most you pay during a policy period (usually one year) before your health insurance or plan starts to pay 100% for covered essential health benefits. This limit must include deductibles, coinsurance, copayments, or similar charges and any other expenditure required of an individual which is a qualified medical expense for the essential health benefits. This limit does not have to count premiums, balance billing amounts for non-network providers and other out-of-network cost-sharing.
The maximum out-of-pocket cost limit for any group plan for 2017 in-network can be no more than $7,150 for an individual and $14,300 for a family.
