Building a Health Insurance Plan for Your Employees 

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When it comes to taking care of your team, providing a strong health insurance plan is one of the best ways to show you value their well-being. A well-designed plan can help you attract top talent, boost retention, and foster a healthier, more productive workforce. But with all the options, how do you know where to start? 

Here’s a step-by-step guide to building an employee health insurance plan. 

Step 1: Assess your budget and goals.

Before diving into plan types and coverage options, determine your budget and primary objectives. Here are a few questions to guide you: 

• What’s your goal for offering health insurance? Attracting top talent? Increasing retention? Boosting employee satisfaction? 

• How much can your business afford to contribute toward premiums? 

• Do you want to fully or partially fund premiums for employees? 

• What benefits do you want to make available?  

By setting clear financial and strategic goals, you can ensure your plan aligns with your company’s vision and avoid overspending. 

Step 2: Understand your employees’ needs.  

Your employees’ health needs and priorities should guide your decisions. The easiest way to learn what’s important is to ask!  

Conduct a survey or host informal discussions to get input on things like: 

• What benefits are/would be the most and least important.

• Include everything from physical and mental health coverage to ancillary such as dental, vision, life, flexible spending accounts, short and long-term care, telehealth, behavioral telehealth, and lower pharmaceutical costs. 

• The desire for assistance with retirement saving. 

• What's working/not working with time off and flexible work policies. 

• What offerings, programs, or perks would help them feel more connected to and engaged with the company. 

This feedback will help you design a meaningful and personalized plan for your employees. 

Step 3: Research plan types. 

There are several health insurance plan structures to consider: 

• Fully insured plans: Traditional plans with fixed premiums. You purchase the plan from a carrier and pay a premium to the insurance company. The insurance company handles the administrative tasks, including claims.  

• Self-funded plans: You take on the financial responsibility of paying claims (with the help of a plan administrator), giving you more control but also more responsibility. 

• Level-funded plans: A hybrid option that offers the predictability of fixed payments with some flexibility of self-funding. 

• Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs): Tax-advantaged accounts paired with a plan that helps employees manage out-of-pocket expenses. 

Partner with a broker to learn about and navigate these options. 

Step 4: Select a plan type. 

Once you’ve chosen your funding type, decide on a network structure: 

• HMO (Health Maintenance Organization): Lower costs but limited to in-network providers. 

• PPO (Preferred Provider Organization): Higher costs but more flexibility to see out-of-network providers. 

• POS (Point of Service): A blend of HMO and PPO with in-network requirements but some out-of-network flexibility. 

• EPO (Exclusive Provider Organization): Requires employees to use in-network providers (except in an emergency).  

Each structure has different implications for cost and access, so choose the one that fits your team’s preferences and your budget. 

Step 5: Communicate plan details effectively. 

Transparency and clear communication ensure employees understand and take full advantage of their benefits. Be sure to: 

• Let them know how they can access information about their benefits.  

• Give a summary of coverage, including premiums, deductibles, and copay information. 

• Explain terms such as in-network vs. out-of-network costs, deductibles, and copays. 

• Provide resources that explain how to access telehealth services, schedule preventive visits, and use wellness programs. 

The more informed your team is, the more value they’ll get from the plan. 

Best practices for a strong health insurance plan  

Keep these best practices in mind while building your health insurance plan to make it a success

Prioritize preventive care 

Preventive care is one of the most proactive steps employees can take for their well-being. Encourage employees to use their benefits for annual check-ups, screenings, and vaccinations to stay proactive about their health. 

Incorporate mental health support 

Mental health remains a top priority for employees and the government. Include access to therapy, mental health specialists, and Employee Assistance Programs (EAPs). Addressing mental health needs can improve workplace morale and productivity. 

Offer tiered options 

Different employees have different needs. Providing options—from basic to premium coverage—allows them to choose what works for their family and budget. 

Include wellness programs 

Wellness incentives, such as gym reimbursements, smoking cessation programs, and wellness challenges, can help your team adopt healthier habits. 

Stay compliant 

Make sure your plan follows the Affordable Care Act (ACA), state laws, and COBRA requirements for departing employees. 

Review annually 

Employee needs and plan costs can change. Conduct yearly reviews and re-negotiate with carriers if needed to ensure your plan stays competitive. 

Support employee choice 

Consider including add-ons like dental and vision coverage or options for multiple plan structures to meet a broad range of needs. 

Give your employees value  

Designing a health insurance plan doesn’t have to be overwhelming. By understanding your goals, listening to your employees, and partnering with a knowledgeable broker, you can build a plan that supports your team and strengthens your business. 

Health insurance is a statement about how much you value your employees. Take the time to build something meaningful, and your team will feel it every step of the way. 

Content published by Q4intelligence

Photo by ufabizphoto