Health Insurance Plans in
Oregon and Washington

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(503) 891-5793

Employer Group
Health Insurance

Health insurance for Oregon/Washington business owners and employees

Health benefits for employees is one of the top expenses for most business owners. Finding a quality product and a competitive price is one of today's most challenging processes for any business owner. Discover how a Fully Insured or Level Self-Funded plan may work for you.
Health benefits for employees is one of the top expenses for most business owners. Finding a quality product and a competitive price is one of today's most challenging processes for any business owner. Discover how a Fully Insured or Level Self-Funded plan may work for you.
Explore Two Types of Plans
  • Fully Insured

    Premium Payment

    The insurance company provides Fully Insured plans, where you the employer pay all or at least the required portion of the premium on behalf of your employees. Employers can ask their employees to pay a portion of their healthcare premium as well. The required employer premium percentage may vary between insurance companies.

    With Fully Insured plans you can also offer to pay some of the premium for your employee’s dependents, but you are not required to. Some employers will offer Employee Only plans. These plans are a good choice when you have a work force where more spouses are getting greater health benefits from individual plans purchased with tax credits in the Federal Marketplace. Tax credits are not available if spouses are offered a group health plan. 

    Deductibles, Co-Pays and Co-Insurance

    Fully Insured plans will offer a variety of options in deductibles, co-pays and co-insurance levels. Some plans will offer more than one plan design to choose from. The amount of plan designs may depend on the number of enrolling employees.

    Out-of-Pocket Maximums

    Each plan design will have an out of pocket maximum both at the individual and family level. When that amount has been met the insurance company pays 100% until the plan deductible resets which can be at renewal or January 1.

  • Level Self-Funded

    This plan comes out of the Self-Funded industry. A Level Self-Funded plan has a premium just like a Fully Insured plan. However, in a Level Self-Funded plan there is a possibility to get a return of premium if the group claim loss is less than what is predicted.

    These plans have lots of algorithms but the key point to remember is that you have the possibility of getting premium dollars back, which is not the case in a Fully Insured plan. A Level Self-Funded plan has a stop loss feature to protect the employer in case of a large loss claim. With a stop loss protection an employer can still be eligible for a return of premium even when a large claim was filed.

    In addition, if the employer wants to move back to a Fully Insured plan there is a seamless transition, unlike in years past where some Self-Funded plans were burdened with run off claims for months.

    This plan structure is not right for every employer but the sophistication of how these plans are priced and operate make them very competitive and worthy of consideration to employers who have a medium sized business.

Applying for Group Health Insurance

Different states have different regulations on the specifics of what constitutes a company for a small group plan, but one point is consistent: a company must have at least one employee who is receiving W2 wages. This employee must not be an owner or related such as a spouse. 

This criteria can be surprising to new business owners who are just starting out.  Washington State and Oregon State have different regulations on how the non-related and non-owner W2 employee must participate in the plan.

Call our office today to learn more.

Application Process Overview


Information Gathering

The key to employer group enrollment is a detailed census. Depending on the time in business or the size of the company additional documentation may be required such as payroll statements and other documents that establish the business as an active entity.

Complete Application Forms

Enrollment for groups varies greatly based on the insurance company.  Some companies have on-line tools to enter the required data, where other companies have paper applications.

Plan your Timing

Most companies require completed applications to be submitted for processing by the 15th of the month for coverage starting on the first of the following month.

Renewals

Your insurance company has guaranteed your group rate for the full year of your plan. They will notify you and your insurance agent at least 60 days prior to your renewal of the new rates and any benefits changes for the next plan year. You can choose to accept the new plan rate and benefits or you can work with your agent to get quotes from other insurance companies to make sure you get the product that is right for your business and employees.

Get Your Questions Answered Today

HEALTH BENEFITS 411 can answer all your questions, including the ones you don't even know to ask. Call today for a free consultation or request a quote online. We'll set a time to sit down with you, discuss your options and help you choose a plan that is just right for you.

(503) 891-5793

HEALTH BENEFITS 411 can answer all your questions, including the ones you don't even know to ask. Call today for a free consultation or request a quote online. We'll set a time to sit down with you, discuss your options and help you choose a plan that is just right for you.

(503) 891-5793

Your information resource for health insurance.

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