Health Care Benefits
Page Contents
- Federal
- Summary
- Introduction
- Choice and Flexibility in Health Care Coverage
- Fully-Insured Plans
- Self-Insured Plans
- Fee-for-Service/Traditional Indemnity Plans
- Fixed Fee Schedule
- Usual, Customary and Reasonable Fees
- Managed Care Plans
- Health Maintenance Organizations
- Preferred Provider Organizations
- Point of Service Plans
- Consumer Driven Health Plans
- Advantages
- Eligibility
- Benefit Elections
- Payments
- Eligible Expenses
- Standard Health Care Packages
- Basic Health Insurance
- Major Medical Benefits
- Prescription Drug Plans (Pharmacy Plans)
- Dental Plans
- Scheduled Plans
- Nonscheduled Plans
- Vision Care Plans
- Section 125 Flexible Benefit Plans
- Eligibility
- Funding Mechanisms
- Section 125 Requirements
- Qualified Benefits
- Advantages and Disadvantages of Flexible Benefit Plans
- Advantages
- Disadvantages
- Types of Cafeteria Plans
- Premium-Only Plans
- Comprehensive (Full) Flex Plans
- Core Plus Plans
- Modular Plan Approach
- Flexible Spending Accounts
- Advantages of FSAs
- Qualified Expenses
- Limit on Salary Reductions
- Use It or Lose It
- Distributions for Reservists
- Archer Medical Savings Accounts
- Eligibility
- Limits on Contributions
- Health Savings Accounts
- Eligibility
- Qualifying for HSA
- Benefits Offered Under HSAs
- Nondiscrimination
- Distributions
- Health Reimbursement Arrangements
- Advantages of HRAs
- Eligibility
- Nondiscrimination Rules
- Meeting the Needs of a Diverse Workforce
- Future Developments
- Additional Resources
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Federal
Author: Jayne Zanglein, Western Carolina University
Summary
- Employer-sponsored health care benefits are an important part of the overall compensation package. See Introduction.
- Employee benefit plans may purchase health insurance products that are subject to state insurance regulations and federal and state health mandates. See Choice and Flexibility in Health Care Coverage.
- Self-insured plans are generally not subject to state insurance laws or mandates, but are subject to some of the Patient Protection and Affordable Care Act (PPACA) mandates. See Self-Insured Plans.
- Health plans may be traditional indemnity plans or managed care plans. See Fee-for-Service/Traditional Indemnity Plans; Managed Care Plans.
- Fee-for-service (FFS) plans offer employees more freedom to choose health care providers. See Fee-for-Service/Traditional Indemnity Plans; Standard Health Care Packages.
- Managed care plans include preferred provider organizations (PPOs), health maintenance organizations (HMOs), and point-of-service (POS) plans. See Managed Care Plans.
- Consumer driven health plans (CDHPs) allow employees to combine a high-deductible plan with flexible benefits tailored to their individual needs. See Consumer Driven Health Plans.
- Employers may offer comprehensive medical coverage as well as prescription drug, dental and vision coverage. See Standard Health Care Packages.
- Cafeteria plans give employees the flexibility to tailor benefit packages according to individual needs and reduce their federal income tax. See Section 125 Flexible Benefit Plans.
- Cafeteria Plans must meet the requirements of the Internal Revenue Code (IRC). See Section 125 Flexible Benefit Plans.
- Flexible spending accounts (FSAs) allow employees to pay for eligible medical and dependent care expenses with pre-tax dollars. See Flexible Spending Accounts.
- Employers may design benefit packages to meet the needs of a multigenerational workforce. See Meeting the Needs of a Diverse Workforce.
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State Requirements
The following states have additional requirements for this topic under applicable state law.
- Alabama
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Florida
- Georgia
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Louisiana
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming