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4 Solutions to Employee Benefits for
Small Businesses
Fresh, outside-the-box solutions for changing times
1
Presented by AC Forrest Insurance Group | www.acforrest.com
The problem with traditional benefits
• Rising Costs (for employers and employees)
• Complexities of the Affordable Care Act
• Decreasing benefits / 

increasing deductibles
• Rising Costs!
2
What follows are the Top 4 employee benefit solutions available to
small businesses, ranging from traditional solutions to innovative
new approaches to a changing marketplace.
There is no one-size-fits-all solution, but there
are innovative approaches that could make
employee benefits more affordable and/or
more simple.
3
Real World Case Study
• First, we implemented a partially self-funded health plan (Option 1 below). 

We raised their deductible from $2,000 to $5,000 to save even more money, but kept all
other benefits the same.
• Second, we set up a gap plan to cover the difference between the old
deductible and the new deductible (Option 2 below). 

The gap plan had a $2,000 deductible (to match their previous health plan) and a $3,000
benefit (to get them to the new deductible).
Our client, a small business with around 15 employees, got a renewal notice for their group health
insurance policy with Big Name Insurance Company. It was a significant price hike. The boss
genuinely wanted to continue providing benefits, but wasn’t sure that would be possible anymore. At
the very least, the benefits would have to be significantly cut back.
Or would they?
The Solution We Implemented
4 The Result…
Could your small business experience similar results?
We can help you find out!
Our client saved over $46,000 the next
year (almost $4,000/month!) without
compromising employee benefits.
The Result:
5
1. Partially Self-Funded Plans
• You pay your premiums just as you do now. A portion of those premiums goes into a claims fund that will be
used to pay the first portion of health claims that arise in your group. So as in a traditional self-funded plan,
you are actually paying your employees’ claims. But unlike a true self-funded plan…
• You have an “aggregate deductible” for claims. Once you’ve reached that number, the insurer takes over the
payment of claims. (The remainder of the premium you pay is the cost of this aggregate insurance.)
• There is no risk to you. Your premiums are calculated to fund the claims fund to the aggregate deductible
amount. So you are paying for your worst-cast scenario.
• You could actually get a refund at the end of the year. If you don’t use up the money in your claims fund
you’ll get it back (or apply it to next year). So while there’s no risk, there is a possibility of some reward if your
employees have a good health year.
• These plans are usually less expensive. Because of the way they are structured, these plans can still utilize
medical underwriting, so they won’t work for everyone, but many small employers realize significant savings.
A partially self funded health plan is an innovative solution that helps some
small businesses realize significant cost-savings. A partially self-funded health
insurance plan looks, sounds, smells, and tastes like a traditional health
insurance plan. Structured properly, there won’t be any risk to you.
Here’s How it Works:
6
2. Gap Plans
• First, we raise the deductible on your health insurance plan. The result of this
change is that we lower your monthly payment. In a typical scenario, we take a
$1,000-$2,000 deductible and change it to a $5,000 deductible.
• Set up a gap plan to cover the difference between the old deductible and the
new deductible. The gap plan will cover everything that the major medical
policy covers. So there is no difference in benefit levels at all - the only change
is that your employees have two insurance cards instead of one.
• How a gap plan saves you money. The bottom line is that the cost of the gap
plan is less (sometimes much less) than the amount of money you save by
switching from a low to a high deductible major medical policy.
A gap plan gives you medical coverage for a defined amount of potential
claims — usually a few thousand dollars. It works in conjunction with a high
deductible health plan to provide you the same benefits at a lower price.
Here’s How it Works:
7
3. Traditional Group Health Plans
• These are “Metal Plans.” Traditional major medical plans are now grouped
under the categories defined in the Affordable Care Act: Gold, Silver, and
Bronze.
• There is no underwriting with these plans. Again, because these plans are
now governed by the Affordable Care Act, the price is not affected by your
group’s medical history.
These are traditional group health plans. They are now governed by the
Affordable Care Act, which has a few advantages and disadvantages.
Here’s How it Works:
8
Hint: You can raise your deductible and add a Gap plan (solution #2) to lower
your monthly cost without compromising benefits.
4. Individual Health Insurance Plans
• Each employee is free to choose the plan he/she wants. The employer is no longer in the position of
choosing a one-size-fits-all health plan.
• Many employees are eligible for significant premium discounts. Under the Affordable Care Act,
those whose household income is between 100-400% of the Federal Poverty Limit could be eligible
for lower premiums. (That’s a LOT of your employees). If they are eligible to participate in an employer
plan, they cannot receive these discounts.
• The employer eliminates a major hassle. The employer no longer has to spend time figuring out the
best group plan, dealing with administrative and claims issues, and worrying about rising costs.
• The employer saves a lot of money. For many employers, group health insurance is one of the most
expensive costs of doing business. Some employers who take this path provide an increase in pay or
a bonus to offset some of the health insurance costs being absorbed by employees. Others put some
of the savings into more affordable employee benefits.
Many small employers have found they prefer to allow employees to purchase
their own individual health insurance plans - on or off the government
Marketplace - and then provide other benefits instead.
Here’s Why:
9
Alternatives to Group Health Insurance
• Dental Insurance. Dental plans are popular with both employers and employees because
they offer a tangible benefit that will be used at least twice a year.
• Telemedicine. A new but increasingly popular option, telemedicine provides access to
doctors 24 hours a day, 7 days a week via phone and/or video chat. The American Medical
Association has said the majority of doctor office visits could be adequately handled
through telemedicine, saving both time (missed work) and money.
• Vision Insurance. Vision plans are a very inexpensive benefit that will be useful to many
employees.
• Supplemental Plans. These include accident plans (pay a benefit for treating accidental
injury), critical illness and cancer plans,
• Disability Insurance. Long term disability is an important protection for workers living
paycheck to paycheck, and short term disability is a great way to handle maternity leave.
Many small businesses that choose to not have a group health insurance plan
still want to provide employee benefits to their team. Here are some popular
and much more affordable employee benefit options to consider:
10
www.ACForrest.com
In South Carolina: alex@ACForrest.com | 864-735-7707
In Georgia: art@ACForrest.com | 678-765-9765
11

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4 Different Approaches to Group Health Insurance for Small Businesses

  • 1. 4 Solutions to Employee Benefits for Small Businesses Fresh, outside-the-box solutions for changing times 1 Presented by AC Forrest Insurance Group | www.acforrest.com
  • 2. The problem with traditional benefits • Rising Costs (for employers and employees) • Complexities of the Affordable Care Act • Decreasing benefits / 
 increasing deductibles • Rising Costs! 2
  • 3. What follows are the Top 4 employee benefit solutions available to small businesses, ranging from traditional solutions to innovative new approaches to a changing marketplace. There is no one-size-fits-all solution, but there are innovative approaches that could make employee benefits more affordable and/or more simple. 3
  • 4. Real World Case Study • First, we implemented a partially self-funded health plan (Option 1 below). 
 We raised their deductible from $2,000 to $5,000 to save even more money, but kept all other benefits the same. • Second, we set up a gap plan to cover the difference between the old deductible and the new deductible (Option 2 below). 
 The gap plan had a $2,000 deductible (to match their previous health plan) and a $3,000 benefit (to get them to the new deductible). Our client, a small business with around 15 employees, got a renewal notice for their group health insurance policy with Big Name Insurance Company. It was a significant price hike. The boss genuinely wanted to continue providing benefits, but wasn’t sure that would be possible anymore. At the very least, the benefits would have to be significantly cut back. Or would they? The Solution We Implemented 4 The Result…
  • 5. Could your small business experience similar results? We can help you find out! Our client saved over $46,000 the next year (almost $4,000/month!) without compromising employee benefits. The Result: 5
  • 6. 1. Partially Self-Funded Plans • You pay your premiums just as you do now. A portion of those premiums goes into a claims fund that will be used to pay the first portion of health claims that arise in your group. So as in a traditional self-funded plan, you are actually paying your employees’ claims. But unlike a true self-funded plan… • You have an “aggregate deductible” for claims. Once you’ve reached that number, the insurer takes over the payment of claims. (The remainder of the premium you pay is the cost of this aggregate insurance.) • There is no risk to you. Your premiums are calculated to fund the claims fund to the aggregate deductible amount. So you are paying for your worst-cast scenario. • You could actually get a refund at the end of the year. If you don’t use up the money in your claims fund you’ll get it back (or apply it to next year). So while there’s no risk, there is a possibility of some reward if your employees have a good health year. • These plans are usually less expensive. Because of the way they are structured, these plans can still utilize medical underwriting, so they won’t work for everyone, but many small employers realize significant savings. A partially self funded health plan is an innovative solution that helps some small businesses realize significant cost-savings. A partially self-funded health insurance plan looks, sounds, smells, and tastes like a traditional health insurance plan. Structured properly, there won’t be any risk to you. Here’s How it Works: 6
  • 7. 2. Gap Plans • First, we raise the deductible on your health insurance plan. The result of this change is that we lower your monthly payment. In a typical scenario, we take a $1,000-$2,000 deductible and change it to a $5,000 deductible. • Set up a gap plan to cover the difference between the old deductible and the new deductible. The gap plan will cover everything that the major medical policy covers. So there is no difference in benefit levels at all - the only change is that your employees have two insurance cards instead of one. • How a gap plan saves you money. The bottom line is that the cost of the gap plan is less (sometimes much less) than the amount of money you save by switching from a low to a high deductible major medical policy. A gap plan gives you medical coverage for a defined amount of potential claims — usually a few thousand dollars. It works in conjunction with a high deductible health plan to provide you the same benefits at a lower price. Here’s How it Works: 7
  • 8. 3. Traditional Group Health Plans • These are “Metal Plans.” Traditional major medical plans are now grouped under the categories defined in the Affordable Care Act: Gold, Silver, and Bronze. • There is no underwriting with these plans. Again, because these plans are now governed by the Affordable Care Act, the price is not affected by your group’s medical history. These are traditional group health plans. They are now governed by the Affordable Care Act, which has a few advantages and disadvantages. Here’s How it Works: 8 Hint: You can raise your deductible and add a Gap plan (solution #2) to lower your monthly cost without compromising benefits.
  • 9. 4. Individual Health Insurance Plans • Each employee is free to choose the plan he/she wants. The employer is no longer in the position of choosing a one-size-fits-all health plan. • Many employees are eligible for significant premium discounts. Under the Affordable Care Act, those whose household income is between 100-400% of the Federal Poverty Limit could be eligible for lower premiums. (That’s a LOT of your employees). If they are eligible to participate in an employer plan, they cannot receive these discounts. • The employer eliminates a major hassle. The employer no longer has to spend time figuring out the best group plan, dealing with administrative and claims issues, and worrying about rising costs. • The employer saves a lot of money. For many employers, group health insurance is one of the most expensive costs of doing business. Some employers who take this path provide an increase in pay or a bonus to offset some of the health insurance costs being absorbed by employees. Others put some of the savings into more affordable employee benefits. Many small employers have found they prefer to allow employees to purchase their own individual health insurance plans - on or off the government Marketplace - and then provide other benefits instead. Here’s Why: 9
  • 10. Alternatives to Group Health Insurance • Dental Insurance. Dental plans are popular with both employers and employees because they offer a tangible benefit that will be used at least twice a year. • Telemedicine. A new but increasingly popular option, telemedicine provides access to doctors 24 hours a day, 7 days a week via phone and/or video chat. The American Medical Association has said the majority of doctor office visits could be adequately handled through telemedicine, saving both time (missed work) and money. • Vision Insurance. Vision plans are a very inexpensive benefit that will be useful to many employees. • Supplemental Plans. These include accident plans (pay a benefit for treating accidental injury), critical illness and cancer plans, • Disability Insurance. Long term disability is an important protection for workers living paycheck to paycheck, and short term disability is a great way to handle maternity leave. Many small businesses that choose to not have a group health insurance plan still want to provide employee benefits to their team. Here are some popular and much more affordable employee benefit options to consider: 10
  • 11. www.ACForrest.com In South Carolina: alex@ACForrest.com | 864-735-7707 In Georgia: art@ACForrest.com | 678-765-9765 11