Key Elements of a Good Health Benefit Plan for Small Companies

January 31, 2020

The cost of providing health insurance for employees and their families is expected to be five percent higher this year than in 2019.

The National Business Group on Health estimates that the average cost of coverage for an employee and their family will be $15,375. This is obviously bad news for small employers, even though they are not required by the federal employer mandate to offer coverage if they have 50 or fewer full-time equivalent employees. However, many small employers feel that offering health benefits is necessary as a way to attract and retain valuable employees.

Another advantage of offering group health insurance is that it’s usually less expensive to spend money on employees’ coverage than using the same money to provide higher wages. Payroll and income taxes are not assessed on employers or employees on funds used to purchase health insurance. Generally, taxes also are not assessed on the portion of premiums that employees pay.

Most employers assume that traditional group health insurance is their only option, and many employees like traditional health insurance because they’re familiar with how it works. Employers purchase coverage through an insurance broker and pay a fixed premium to the insurance provider. Employees who are participating in the plan usually pay a portion of the premium and are responsible for the copays and deductibles.

The downside to traditional insurance is that group health insurance premiums have increased significantly in recent years. The least expensive policies usually have higher deductibles, which can be difficult for employees to pay.

In this environment, many small employers are looking beyond traditional coverage for affordable options, which include:


A Qualified Small Employer Health Care Reimbursement Arrangement (QSEHRA) allows companies with fewer than 50 full-time equivalent employees to contribute tax-deductible funds to a health reimbursement account (HRA). Employees purchase the health care they need, like individual insurance policies, prescriptions, medical services and dental services and then are reimbursed. Expenses that are reimbursed through a QSEHRA are free of payroll taxes for businesses and their employees, including social security, Medicare and unemployment tax.

A small business that qualifies and chooses to offer a QSEHRA cannot offer a group health plan to its employees. Also, it can limit the benefit to only full-time employees.


New and effective Jan. 1, 2020, is a plan called Individual Coverage Health Reimbursement Arrangement (ICHRA). Similar to a QSEHRAs, an ICHRA is a company-funded, tax-free health benefit that allows businesses to reimburse their employees for personal health care expenses. The difference is that this arrangement is available to businesses of any size. With no annual allowance caps, businesses may offer different amounts of tax-free money based on different classes of employees: full-time, part-time or seasonal.

Self-funded Health Insurance

Self-funding is when a company pays for employees’ out-of-pocket health care claims as they arise instead of paying fixed premiums to an insurance provider. The Self-Insurance Educational Foundation says cost savings in non-claims expenses alone can range from 10 to 25 percent. You will probably also want to contract with a third-party administrator (TPA) to handle claims management. 

Previously, self-funding only was an option for large businesses that could afford potentially high claims. To reduce the possibility of high claims depleting a claims fund or risking unknown monthly costs, many companies opt to do level funding by pairing the fund with a stop-loss policy limiting the potential financial burden. Self-funding, or level funding allows employers to keep unused money from their fund.

Taxable stipends

Another option for employers is to give employees an informal wage increase (taxable stipend) to purchase health care services. The downside is that the funds are taxable for both the employees and the business and employees might not use the funds for health care premiums.

Association Health Plans

Some states allow companies to band together to purchase health insurance at lower prices than purchased separately. However, the rules for Association Health Plans (AHPs) are up in the air. A federal judge ruled in March 2019 that several key aspects of the Trump Administration’s 2018 rules relating to AHPs are unlawful. The Trump Administration could appeal that ruling, but the judge also granted the option to revise the new rules. Some observers are concerned that increased access to AHPs could destabilize the ACA-compliant individual and small group markets

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