Does Your Group Offer A Monthly Reimbursement for Health Insurance Instead of a Group Plan?
That is a Ticking Time Bomb!
Many employers in North Carolina with 2-25 full-time employees offer employees a monthly amount of money, either through a QSEHRA, ICHRA, or as taxable income, to help pay for the employees’ health insurance cost.
This way of forgoing an employer-sponsored or “group” health insurance plan may have worked in the past….but as we head toward 2026 this model is going to fall apart in a big way.
The Trainwreck in Waiting….
2026 (Marketplace / Obamacare) individual plan health insurance premium costs are projected to rise on average 25% from 2025…and the tax credits that help lower the costs will be less, or maybe even ended.
Employees of these groups will soon receive information on these historic cost increases. People will either see that approximate 25% increase, or if their tax credit is smaller or missing, the dollar amount increase per month could be hundreds, or even thousands more than they pay today.
Employees will:
-Be very upset, and distracted from work, as thier family budget is in trouble.
-Be considering going without health insurance at all.
-Or, be looking to switch employers, focusing on opportunities where the employer offers group health insurance.
Employers will:
-Be spending a lot of time fielding questions about these increases.
-Be facing employees without financial help when they need medical services.
-And, be scrambling to keep their best employees from leaving for employers with employee insurance benefits.
Our Answer…An Easy Way to Fix This Without Extra Cost or Hassle
You Need to Implement a Group Health Insurance Plan ASAP
Employers with 2-25 full-time employees like their current reimbursement model for employee health insurance for two main reasons:
-They want to have a set amount of money they pay toward each employee, so their costs are easily budgeted for, with no surprises.
-And they want their time in administering the details kept to a minimum.
Chip Can Help You Offer an Employer-Sponsored Health Insurance Plan While Adhering to Those Two Main Parameters
Chip can help you implement the employer health insurance plan idea he has helped many local Triangle employers bring into their business or organization for their employees.
We offer 3 health insurance plan designs for each employee to choose from, and the employer offers to pay the same set dollar amount for each plan (even though the 3 plans cost different amounts).
And we help with much of the administration, and stand by to help and answer questions on the employer’s share of the administration tasks.
A Real Life Example
A medical practice with 10 full-time employees.
One of our newest clients is a niche medical practice in Chapel Hill that keeps growing with new patients, and thus new employees.
The two owners had been offering $350 monthly to any full-time employee to pay for the health insurance plan they choose. But this arrangement did not work well for all employees, and they had heard about the coming Marketplace plan price increases.
Chip offered the 3 health insurance plans in the chart. The middle plan, a Silver level copay plan, acts as the benchmark. A gold level copay plan is an option for those who feel they need lower copays and deductible. And the Bronze H.S.A. plan option works well for those who know they need health insurance, who want to pay the least in premium costs.
The practice still pays $350 monthly for each participating full-time employee…which is 95% of the cost of the Bronze level plan, 85% of the cost of the Silver level plan and 70% of the cost of the Gold level copay plan. Those are rich percentages compared to other employers’ offers!
Employees Are Excited About the New Group Health Insurance Plan
Everyone is a bit skeptical of change at first, but the medical practice employees are big fans of the new employee insurance benefits.
They have a choice of plans, and at a lower out of pocket premium cost.
Group health plan rates, when comparing same plan designs, cost approximately 20% less than individual plan rates. This difference will further widen in 2026.
Employer-sponsored health insurance offers employees plan choice, with the employer still contributing the majority of the employee only premium cost.
And employees get to pay their premium cost share pre-tax through payroll deduction.
The provider network is much better than with the Marketplace plans.
One of the weakest parts of Marketplace individual health insurance plans are smaller networks.
In the Triangle (Raleigh, Durham, Chapel Hill) these restricted networks force you to choose between using Duke Health and UNC Health!
But employer-sponsored health insurance plans offer PPO medical provider networks that count UNC Health and Duke Health as in network, along with doctors and hospitals in all 50 states.
And bonus…they now have a dental and vision insurance plan!
In addition to the group health insurance plan choices, we added a dental insurance and vision insurance option for employees.
The medical practice agreed to pay half of the employee only premium costs of these plans, making the extra coverages very affordable for employees.
Employees love having a dental and vision insurance coverage they can choose through work at much lower premium costs than individual plans.
Some of the Insurers We Partner With in Offering Employee Insurance Benefit Plan Designs
Free Detailed Quotes of Employer-Sponsored Insurance Benefits
Complete the form below and Chip will send you a detailed illustration of this idea, 3 health insurance plan options, a dental and vision insurance plan, for your employees. You can compare to your current premium reimbursement arrangement or group plan.
Note: Privacy is something we take seriously. The minimum of information is shared with an insurance company to put together a detailed free quote and illustration for you.