Group Health Benefits

Benefits customized to meet the needs of virtually any small business.

Offer the benefits your employees want and help keep them affordable. Benefits can be bundled in a variety of employer or employee-paid combinations to best fit your needs.

As an independent agent with more than 30 years of experience, we pride ourselves on providing businesses with real insurance solutions. If you need an innovative broker that is focused on saving you money and providing high quality benefit plans, Benefit Concepts of Wausau can help.

2020 Survey – Employees rank health benefits as one of the most important things they look for in a job, surpassing payroll.

We perform a thorough analysis that considers employer goals, employee needs, financial objectives, benchmarking, claims experience, tax-advantaged benefit strategies, different funding options and more.
As your business evolves, we realize your needs may change. We work with you to re-evaluate needs annually to determine best renewal strategies.
Group Health Insurance

A Health Maintenance Organization (HMO)
An HMO group health plan requires employees to appoint a primary care physician who directs treatment utilizing service providers affiliated with the HMO. HMOs offer access to a comprehensive package of health care for a low monthly premium. A small co-payment is often required for services, depending upon the type provided.

Preferred Provider Organization
PPO group health plans offer a vast network of quality healthcare providers and facilities. Employees save the most money on healthcare if they use providers within the network, as some services may be only partially covered or not even covered at all when outside providers are used. Also, many services may not be covered if deductibles are not first met, however, the plan includes important wellness and preventative services provided outside of the deductible with a small co-pay.

Point of Service Plans (POS)
POS plans combine features of HMOs and PPOs. Most POS plans require members to choose a primary care physician from within the POS network, but allow them to use out-of-network specialists with a referral from a primary care physician. Co-payments will be higher for out-of-network services.

Federal Marketplace Plans (SHOP)
We can help you obtain the small business tax credit available to eligible employers through the Federal Marketplace, Small Business Health Options Program (SHOP). Eligible employers may have their premiums reduced by as much as 50%. You must cover at least 50 percent of the cost of employee-only health care coverage for each of your employees. You must also have fewer than 25 full-time equivalent employees (FTEs). Those employees must have average wages of less than $50,000 (as adjusted for inflation beginning in 2014) per year.

We suggest you use the Business Tax Calculator to find out if you qualify. Those who qualify will be able to purchase traditional group health plans as described above through SHOP.

Self Funded Plans & Partially (Level) Funded Health Plans

When employers self-fund their own group health plan, they will benefit from a significant savings in the overall cost of their benefit programs. For example, savings may be in premiums, increased cash flow and certain tax advantages. Additionally, employers have more control over the benefits that the plan offers. Typically, self-funding was not available to small employers in the past. However, today self-insured group health plans are considered to be good options for both small and large employers.

How Self-Funding Works
A self-funded group health plan requires the employer to become the insurer. Most often, employers will partner with a PPO to provide services for the plan. Then, a third party administrator (a TPA) is engaged to handle claims and processing. Self-insured employers run the risk of large catastrophic claims. As a result, they need to purchase stop-loss insurance to protect themselves in such an event. Even with the additional expense of stop-loss insurance, employers save a significant amount of money on premiums and other advantages.

Partially- Funded Health Plans

Shared Funding Plans allow small employers to take advantages of all the cost saving and benefit design features of a self-insured plan. Typically, these plans have been designed for larger groups. However, in today’s market, any small or large group could benefit greatly by the cost saving opportunities of a shared funding plan.

How Partial Funding Works
An employer will select any of the fully insured plans that the carrier offers. Then rates will be determined by the group’s claim history. Next, stop-loss insurance is added to protect against catastrophic claims. Since the carrier will handle the administration of the plan, there is no need to hire a separate vendor to handle claims and processing.

Advantages of Shared Funding
The premiums for shared funding plans are generally much lower than fully insured plans. That is because the employer shares some of the risk. Additionally, an employer may save even more by implementing wellness programs into the benefit programs. Our thorough plan analysis will help you determine if shared-funding is right for your company.

Tax Advantaged Benefit Strategies (HSA, HRA, FSA, POP, QSEHRA AND ICHRA).  Note these plans are also commonly referred to as Consumer Driven Health Plans (CDHPs) 

Flexible Spending Accounts (FSAs)
A Flexible Spending Account is a cafeteria plan under Section 125 of the tax code. It is a tax-favored savings account and is funded solely by the employee through regular pre-tax payroll deductions. The funds from the account can be withdrawn tax-free to pay for eligible medical, dental, vision, prescription and dependent daycare expenses. Additionally, employees elect how much they want withdrawn from each pay period, which can be changed annually or upon a qualifying event such as marriage or divorce. For example, the average working employee in America spends more than $1,000 annually on these types of benefits. By participating in a FSA, an employee always has cash to pay for these expenses, and as an added benefit, their taxable income is reduced which also increases the percentage of pay they take home.

Health Reimbursement Accounts (HRAs)
An Health Reimbursement Account pairs a high deductible, low premium health insurance plan (HDHP) with a tax-favored savings account to cover the high deductible. The plan requires that the employer contribute to the savings account. The account can be used to reimburse employees for co-pays and other qualified expenses submitted by the employee, prior to the deductible being met.

Health Savings Accounts (HSAs)
An HSA combines a high deductible, lower premium group health insurance plan (HDHP) with an employee owned savings account. Both employer and employee can contribute, with pre-taxed dollars, to the savings account. The account is used directly by employee to help fund the deductible and other qualified medical expenses.

Premium Only Plans (POPs)
A Premium-Only Plan allows employees to select, purchase and pay monthly premiums for their own individual insurance plan with pre-tax dollars. Employees elect a set amount of wages to be deducted from each payroll to be used by the employer to reimburse the employee for the monthly premium.

Qualified Small Employer Health Reimbursement Arrangement (QSEHRA)
A QSEHRA may be good for small businesses who do not offer health coverage to employees.  A QSEHRA is a health cost reimbursement plan that can be offered to employees to off-set medical premiums and costs.  The costs reimbursed are tax-deductible by businesses and tax-free for employees. The plan can be used to offset health insurance coverage or repay uncovered medical expenses, and typically helps employers budget and predict benefit costs more accurately.

Individual Coverage Health Reimbursement Account (ICHRA)
This type of health benefit is a newer insurance solution for employers and is a progression of an HRA (see above), and sometimes also called a “super-charged) QSEHRA (see above).  Both allow employers to reimburse employees tax-free for individual health insurance, but ICHRA has higher limits and greater design flexibility that may appeal to more employers who don’t offer fully sponsored benefit programs but are committed to helping employees have health coverage.

Dental Coverage

Employees always appreciate dental coverage as part of the benefits package or on a voluntary basis.

Dental Plans

Studies have shown that regular dental exams help employees to stay healthier and more productive in the work place.  Additionally, you can detect serious underlying conditions such as heart disease and diabetes, through regular dental exams.  In fact, dental insurance encourages preventive dental care, which saves an estimated $4 for every $1 spent. And since oral health affects overall health, encouraging your employees to take care of their teeth and gums could help reduce your medical costs.

Dental insurance offers a variety of diagnostic, preventative care and corrective services. This includes cleanings, exams, x-rays, fillings, root canals, orthodontia for children, and emergency care while traveling.

More on Dental Coverage:
Dental coverage comes in a wide variety of forms: from fully insured plans to employer-funded reimbursement accounts, to employee-paid voluntary programs, to individual or family plans. Whatever your needs and budget, we can design a dental benefits program that works for you. You can read more here about the options.

Types of Dental Plans
Most insurers offer managed care plans designed to encourage wise use of dental benefits, with lower out-of-pocket costs for preventive services such as exams, x-rays and cleanings. Many plans also offer benefits for orthodontics, but pay a lower percentage for orthodontics than for restorative services such as fillings, root canals, etc.

Plan types include:

Indemnity Plans
Under this “traditional” insurance plan, the plan pays dentists ac­cording to a formula—usually a percentage of the dentist’s fee, up to a “usual and customary” maximum. The dentist can bill insureds for the difference, or copayment. Most plans also have patients pay a deductible per visit or per series of treatments as well. Preferred provider organizations (PPOs): A dental PPO consists of a network of providers who agree to accept a certain discounted payment for their services. PPO plans give insureds financial incentives to use these “preferred providers” by paying higher percentages of claims they submit than for those submitted by non-preferred providers. Insureds pay the uncovered portion out of pocket.

Dental health maintenance organizations (HMOs): In an HMO, dentists agree to provide specified dental services to members in re­turn for a periodic per-capita payment—usually monthly. Payments do not depend on the number or type of services rendered, and the HMO accepts the financial risk for providing covered dental services to members.

Most plans require participants to use an HMO dentist, but some plans provide reduced benefits for members who use out-of network dentists. A participant may have to pay a deductible, co-payment, or any amount exceeding plan coverage levels.

Group Dental Insurance
We can set up a group dental insurance plan on an employer-paid or volun­tary basis for your group. Under a voluntary plan, employees pay 100 percent of premiums through payroll deduction. They get the cost advantages of a group plan, plus the convenience of payroll deduction. If the plan is set up under a premium conversion cafeteria plan, the employees’ contributions are made with tax-free dollars. We can tailor plans to meet your employees’ needs, with options rang­ing from including or omitting orthodontic coverage to using either larger or smaller PPO (preferred provider organization) networks.

Employer-Funded Dental Plans
Some employers opt to self-fund their employees’ dental benefits. A self-funded plan can give you more control over your benefit program.

A direct reimbursement plan, or dental health reimbursement arrangement (HRA), the employer re­imburses employees directly for their dental care expenses, eliminating the role of the insurance company. Under a reimbursement plan, 90-95 cents of each dental benefit dollar pays for benefits. This compares to about 70-85 cents under a traditional insured program, which also must cover insurer overhead and profit.

Dental reimbursement plans give employers greater control over their benefit program and cash flow. As with an insured plan, your costs for qualified dental expenses (which excludes cosmetic procedures) and administration are tax-deductible, and employees receive reimbursements tax-free. Under a direct reimbursement plan, the employer reviews claims, makes payments and handles compliance with benefit laws. Alternatively, you can hire a third-party administrator to handle administration. If you’re interested in exploring dental reimbursement plans, we can evaluate your company’s needs and design a plan for you.

Dental Discount Plans
Not insurance, discount plans typically give participants discounted rates for dental care in exchange for an annual fee. Depending on the plan, members can save 15 to 20 percent off average costs for a variety of dental services, such as fillings, braces, exams and routine cleanings. Plans often discount the cost of cosmetic procedures, which most dental insurance plans exclude. Members must go to a participating dentist who has agreed to offer services at a discounted price.

Vision Coverage

Similar to dental policies, vision plans are inexpensive and save employees money on routine eye care. Examples of care include exams, eyeglass frames and lenses, contacts, and even discounts on procedures like LASIK.  Additionally, monitoring your eye health with regular exams helps to prevent serious eye diseases like glaucoma and cataracts.  In fact, vision disorders cost U.S. businesses an estimated $8 billion annually in lost productivity. How much do they cost your company? With costs starting at as little as $5 per month per employee, vision benefits pay big dividends in improved morale, health and productivity.

Regular eye examinations can also identify other health conditions, such as diabetes, that can affect the eyes even before the individual experiences noticeable symptoms.

More on Vision Coverage: 
Employers can provide vision benefits through group vision insurance or a discount vision plan.

Group vision insurance works like other employer-provided qualified benefits. Most plans cover exams, glasses, contact lenses and more. You can also opt to include dependent coverage as well as coverage for popular vision-correction services, such as LASIK.

A discount vision plan is not insurance, but gives members discounts on eye care services from participating providers. Members (or their employers) pay an annual membership fee and receive a card that entitles them to discounts.

No-cost benefits with voluntary plans! You can structure your vision benefits to be either employer-paid or voluntary, in which participating employees pay the entire cost. A voluntary plan gives your employees the advantage of group pricing and convenient payroll deduction payments, at absolutely no cost to your firm.

Vision insurance plans have a yearly deductible for each enrolled member, and a co-payment each time a member accesses a service. Vision insurance generally covers the following basic services:

Annual eye examinations, including dilation
-Eyeglass frames
-Eyeglass lenses
-Contact lenses
-LASIK and PRK vision correction at discounted rates.

For those who don’t have employer-provided medical benefits, many individual medical plans offer vision coverage as an add-on. You can also buy a separate individual vision insurance policy.

Voluntary Group Vision Insurance 
Group vision insurance costs vary for employers, depending on the size of the company and how the program is designed. Typically, vision plan premiums range between $5 and $15 per employee per month, depending on benefits selected.

A voluntary vision insurance plan gives your employees the advantage of group pricing and convenient payroll deduction payments, at absolutely no cost to your firm. Vision benefits are by far one of the most popular voluntary benefits among both employers and employees!

As with employer-paid group vision insurance, a voluntary plan covers annual eye examinations, eyeglass frames and lenses and contact lenses. Plans can also offer discounts on LASIK and PRK vision correction.

Discount Vision Plans
A discount vision plan gives members access to discounts on eyecare services at fixed discounted rates after an annual premium or membership fee. The participant pays the total bill, less the applicable discount, at the time of service. Members must use eyecare providers who agree to discount fees. Unlike insurance plans, discount plans do not contract with providers, who may decline to accept the card at any time. For those who do not have vision insurance, however, a discount vision plan can offer valuable savings.

Group Life Insurance

Employees are more productive when they feel secure that their loved ones will be taken care of, in the event of illness or an untimely death. Thus, you should consider life insurance a key part of the benefit package for your employees. And, also a valuable tool in attracting top talent.

Whether employer paid or voluntary, a good life insurance policy provides for an employee’s final expenses, taxes, and mortgage. Additionally, it may even pay for their children’s education.

Many insurance experts advise purchasing life insurance equal to five to eight times the individual’s income. Offering group life insurance to your employees allows even employees with medical conditions to buy some life insurance protection.

Types of Life Insurance 

Permanent Life Insurance
This type of life insurance builds cash value which is sometimes used as collateral for loans, if needed. However, most employers only offer basic term life insurance (see below), but also offer permanent life insurance on a voluntary basis. Even so, employees appreciate the opportunity to widen their safety net.

Term Life Insurance
This type of life insurance does not build cash value. However, it will pay a set amount to the named beneficiary upon the death of insured within the stated term. Additionally, some policies may also make payments upon terminal or critical illness.

Group Disability Plans

National surveys have shown that Short Term Disability and Long Term Disability remain of high importance for most employees.  That’s because by age 45, an individual has a 50 percent chance of having at least one disability that lasts 90 days or more. In fact, workers have a higher chance of suffering a long-term disability than of premature death during their career. Disability benefits protect your employees from a catastrophic loss of income when a disability makes them unable to work, or unable to work full-time.

Here’s How Disability Plans Work

Short Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), STD generally allows for income payments to the employee to begin after about a two-week waiting period and will continue to pay the employee until he/she recovers or maxes out the benefits–usually anywhere between one month to two years, depending on the policy.

Long Term Disability

During the time an employee is unable to work due to a qualifying disability (illness or injury), LTD generally allows for income payments to the employee to begin after about a 90-day waiting period. However, it could be much longer depending on the policy. The policy will pay the employee far longer than STD–for a few years, up to age 65, or even for life.

Usually, group plans have very streamlined or no underwriting requirements so employees do not have to answer a lot of health questions. Your less-than-healthy employees will find it easier to obtain coverage through the group market than through individual policies. In addition, group coverage usually costs less than an individual policy.