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Five Things You May Not Know About Small Group Health Insurance

This past September (2006), America’s Health Insurance Plans (AHIP) Center for Policy and Research published a survey about the state of small group health insurance in the U.S. as of January 2006. The study was very comprehensive with many interesting results. Of the many findings, this article will touch on five that are most likely to shed some light on this subject for those in the small group health insurance market.

First, of the 650,000 small groups surveyed, it was found that for small group plans, premiums decreased as group size increased. On average, companies with between 26 and 50 employees paid about 13% less for single coverage than companies with 10 or fewer employees.

For those familiar with health insurance in general, this disparity probably does not come as a surprise. As group size increases, underwriters are able to spread risk more effectively. So, unfortunately, if you are looking for small group health insurance with say 10 employees, be prepared to pay more per employee than if you had say 30 employees.

Second, the amount of cost sharing by the employee typically is higher with small group health insurance plans. The average deductible for small groups (50 or fewer employees) was 9 while a survey by The Kaiser Family Foundation and Health Research and Educational Trust showed an average deductible of 9 for mostly medium size companies (up to 199 employees), a nearly 45% difference.

This disparity is most likely related to the higher cost for small group health insurance. Couple this with the fact that small firms may not have the resources of their larger counterparts, and you can more clearly understand this higher level of cost sharing for small group employee plans.

Third, among the companies surveyed with small group coverage, PPO plans enjoyed the most popularity. Fifty-seven per cent of employees with small group coverage chose a PPO plan, followed by HMO coverage with 39%. It’s interesting to note that the oldest type of health insurance, indemnity health insurance, was barely a blip in the survey with less than 0.5%.

The recent popularity of PPO’s is reflective of the changes in the health insurance market, changes brought on mostly by spiraling costs. Indeed, PPO’s allow for the cost savings of an HMO, with the freedom to go out of your network if necessary and still have coverage, albeit at a reduced rate.

Fourth, just over 10% of small group employees had a choice of two or more insurance plans. This number seemed low until it was viewed in light of the popularity of PPO plans. That is, one PPO plan is more likely to offer coverage that addresses the needs of a larger number of individuals.

More significantly, perhaps, is the fact that more than 80% of the small groups surveyed had 10 or fewer employees. With such small groups to begin with, it would be very difficult to offer affordable group health insurance to any subset of such groups.

Fifth and last, is an issue that is mentioned in the survey results but was not a finding of the survey. That is, while small group health insurance is mostly regulated by the states, it is federal law that requires small group health insurance be offered as “guaranteed issue”. This means that small businesses cannot be denied coverage due the health problems of its employees or dependents. However, even though the health status of a company’s employees and dependents cannot be used to deny coverage, it can be used to determine rates. This varies by state, but will typically result in higher premiums.

The small group health insurance market can be a frustrating place for many. By gaining a greater understanding of the current state of this market, one can approach the subject in a more realistic manner. For those in the small group health insurance market, there are many factors to consider that can affect cost. These include, but are not limited to, the size of your small group, the state in which the company is located, and the level of benefits offered to employees.


About the Author: Jonathon James has been working in the health industry for nearly twenty years. To view additional articles and resources related to small group health insurance plans, please visit
LearningAboutHealthInsurance.com




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