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| Washington employers can choose medical coverage from one of several distinct market sources. Each year, the experienced staff at McGregor Benefits helps hundreds of employers find the medical coverage program that best suits their needs and budget. |
| Community Pool Washington insurance law established the community pool to provide open access for employers with 2 to 50 employees. Various insurers compete to provide medical insurance in compliance with the regulations. Access is guaranteed for employers that meet the definition for employer-group as specified in the law. The premium rates are primarily based on the average age of the group’s employees. Health conditions and medical claim costs do not affect the premium rates. Coverage in the Community Pool is the best fit for most employers providing lower rates and better coverage than would be available in other markets. |
| Association Plans Washington law allows business and professional associations to provide medical insurance coverage to member businesses. The associations contract with many of the same insurance companies that serve the Community Pool and offer many of the same plans and programs. Association plans are subject to a different set of insurance regulations that allow more flexibility with underwriting practices. Many employers benefit from such flexibility which can provide competitive rates to employers with predominately male employees, younger employees and employees in good health. Medical coverage underwriting is subject to many variables, so it is important to obtain quotes from association plans when comparing rates and benefits. |
| Self Insurance Plan Self-funded insurance plans are governed principally by the federal Employee Retirement Income Security Act (ERISA). They may be exempt from certain state law requirements and may not include all benefits furnished by fully insured health insurance plans. In return for lower premiums, the employer assumes claim payment costs for initial and smaller claims and then buys a “Stop-Loss” insurance plan from a carrier to cover large claims. Plan administration is performed by a licensed third party administrator. Companies with more than twenty employees benefit most from these plans and should at least consider the option. |
| Individual Coverage Self-employed individuals and small employers may seek coverage from one of Washington’s several individual insurers. Programs are now available that cover occupational illness and injury. Individual coverage is subject to health underwriting designed to screen out approximately 8% of applicants, thus protecting the pool from higher medical costs. The other 92% can then benefit from relatively lower rates. Individual medical contracts do not provide the same level of benefits typical of group medical contracts; however, they do provide good value and maximum flexibility. |
