Group health insurance plans in Pennsylvania
Traditional group plans have been a common choice for employers since the end of World War II. With a group plan, the employer and employee usually split the cost of premiums. The employer usually pays a larger share of the monthly premiums. An employer can decide to offer coverage to spouses and dependents as well.
In Pennsylvania, group plans can come in one of the following forms:
- Preferred provider organization plans (PPOs): A PPO is the most common type of health plan. PPOs offer policyholders access to a network of preferred healthcare providers. Members can receive care from outside networks, but it comes at an extra cost.
- Health maintenance organization plans (HMOs): An HMO offers a wide range of healthcare services through specific provider networks. Members of an HMO need to choose a primary care physician (PCP). Their PCP will manage their healthcare needs and give referrals to specialists when needed.
- Exclusive provider organization plans (EPOs): An EPO includes features of both an HMO and a PPO. Members of an EPO have access to healthcare services from a specific network of providers. They can also see a specialist without needing a referral. However, an EPO doesn't cover care from out-of-network providers.
- Point of service plans (POSs): A POS plan offers cheaper in-network doctor visits, but it also covers out-of-network care. Members of a POS need a referral from a PCP to see a specialist, just like with an HMO.
The best plan for you and your employees will depend on your needs and budget.
Big companies usually get lower group health insurance rates since the risk is spread out. From there, they share the cost of premiums. KFF found that employers usually cover 83% of premiums for self-only plans and 72% for family insurance premiums. You also need around 70% of your employees to sign up to qualify.
If the standard group health plan is too expensive for your organization, you might want to consider a high deductible health plan (HDHP). These health plans offer cost savings since they provide lower monthly expenses for both employers and employees.
However, HDHPs have higher deductibles that your employees must pay before the health insurance company starts to cover their expenses. This can lead to increased costs for your workers.
In this situation, you can offer a group coverage HRA (GCHRA), also known as an integrated HRA, alongside an HDHP. With a GCHRA, you can reimburse your employees tax-free for their out-of-pocket costs, such as deductibles.
The Small Business Health Options Program (SHOP) marketplaces offer small group health insurance plans that can also you save money. However, Pennie, Pennsylvania’s state-run exchange, doesn’t operate a SHOP program. Employers in Pennsylvania with fewer than 50 FTEs can access small business plans through a broker or from a health insurance company. If you have fewer than 25 employees who earn less than $50,000 annually, you may qualify for the Small Business Health Care Tax Credit.
The following companies will offer small group health plans in Pennsylvania in 2025, according to HealthCare.gov’s rate review website.
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Health insurance company
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SHOP status
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Capital Advantage Assurance Company
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Off-exchange
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First Priority
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Off-exchange
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Geisinger Health Plan
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Off-exchange
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Geisinger Quality Options
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Off-exchange
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Highmark Benefits Group
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Off-exchange
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Highmark Coverage Advantage
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Off-exchange
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Highmark
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Off-exchange
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Keystone Health Plan Central
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Off-exchange
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UnitedHealthcare
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Off-exchange
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UnitedHealthcare of Pennsylvania
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Off-exchange
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How to take advantage of individual health insurance with an HRA
Is a group health plan too expensive for your business? Do you not have enough employees interested in enrolling in the plan? If so, you aren’t out of options. If you want to save money, small employers can forgo a traditional group health plan and use an HRA instead. HRAs allow you to reimburse employees for their medical expenses and individual health plan premiums.
Some examples of qualified medical expenses you can reimburse with an HRA include:
- Monthly premiums for health, vision, and dental plans
- Preventive care
- Emergency care
- Chiropractic care
- Mental health counseling
- Prescription drugs
- Over-the-counter medication
Two HRAs allow you to reimburse employees for their health insurance premiums:
