Employer Group Plans

Employers with 50+ employees are mandated by ACA guidelines to pay 50% of their employee only policies; however, they are not obligated to pay any portion of the rest of a family policy.

If your employee only plan is within 9.61% of your household income, this would make you ineligible to receive a premium tax credit through the marketplace no matter the cost of the rest of the family’s plan. Usually the best option for single individuals or the employee is to take advantage of their employee only policy. In rare cases the employer will pay a portion of the family’s premium, but in most cases it is more advantageous to and a more affordable option for the rest of the family.

COST SHARING PLANS
Commonly organized under a ministry or other religious organizations, these faith-based programs are not insurance, nor do they claim to be. They simply facilitate voluntary sharing among members for eligible medical expenses.

Members send in monthly ‘shares’ (i.e., premiums) which are distributed to or on behalf of other members with medical expenses (i.e., benefits payments) in accordance with program guidelines.
They are built upon the principle of people with similar beliefs and values coming together to share each other’s burdens, not unlike the risk-pooling nature of health insurance.

There is no actual binding contract between a member and the program or between members to receive payment. These organizations do not guarantee or promise that your medical bills will be shared or assigned to others for financial gifts. Whether any member chooses to share the burden of your medical bills will be entirely voluntary. You are ultimately liable for any unpaid bills.

– These plans should not be considered as a substitute for an insurance policy.

– Typically exclude coverage for pre-existing conditions for the first 12 months.

– Tend to be less expensive than traditional health insurance. Their coverage may also be more limited; they typically do not cover many health-related costs deemed to be ‘unbiblical’ – which the programs define in their guidelines – and may exclude payments for birth control, abortions, injuries related to alcohol or drugs, and injuries from certain hazardous activities (or even failure to wear helmets or seat belts in some situations).

– You must file your own claims and submit the correct documentation to be eligible to receive a reimbursement from fellow members.

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