When choosing a health plan, many employers and employees look for one that goes beyond the basics. That’s where comprehensive health insurance coverage comes in. Comprehensive coverage protects individuals from high medical costs by covering a broad range of healthcare services, helping people get the care they need without unexpected financial surprises.
In this article, we’ll break down what comprehensive coverage includes, how it works, and why it matters for organizations exploring personalized benefits solutions, like a health reimbursement arrangement (HRA).
In this blog post, you'll learn:
Comprehensive health insurance, also known as major medical health insurance, provides extensive protection across a wide range of medical services, from routine preventive care to major medical events.
Unlike limited-benefit or supplemental plans, which only cover specific conditions or services, comprehensive plans aim to cover most essential healthcare needs.
Individual and small group comprehensive health insurance plans must cover the Affordable Care Act’s (ACA) 10 essential health benefits at no cost:
While large group health plans don’t necessarily have to cover the essential health benefits. But if they do, there are rules they must follow. Under the Public Health Services Act section 27111, group and individual plans can’t impose lifetime or annual dollar limits on any essential health benefits they cover. However, the ACA requires all “non-grandfathered” group and individual plans to cover preventive care without cost-sharing.
Even if a large group plan or a self-insured plan doesn’t have to cover the EHBs, most comprehensive health plans do.
While comprehensive coverage is extensive, it isn’t unlimited.
Most health plans don’t cover:
It’s important for employers and employees to review plan documents to understand what is and isn’t included.
Various types of health plans provide comprehensive coverage, including:
PeopleKeep’s 2024 Employee Benefits Survey found that 81% of employees consider an employer’s benefits package a key factor when deciding whether to accept a job. Health benefits stand out even more, with 92% of employees saying they’re an important part of that package.
Offering comprehensive health insurance can help employers:
But for many organizations, especially small businesses, the rising cost of group health insurance can make comprehensive plans feel out of reach.
That’s where stand-alone HRAs come in.
A stand-alone health reimbursement arrangement (HRA), sometimes mistakenly referred to as a health reimbursement account, allows employers to reimburse employees tax-free for their individual health insurance premiums and more than 200 eligible out-of-pocket expenses.
Some of those eligible expenses include:
Unlike a health savings account (HSA), only the employer funds an HRA. You set an allowance for your employees to spend on their own health plans instead of purchasing one for them. This way, you can provide access to comprehensive coverage without administering a traditional group plan.
The two most popular stand-alone HRAs are:
The employer gets cost control and predictability, as they’ll never spend more than their offered allowance. Plus, employees get to choose the plan that best fits their needs.
Comprehensive health insurance plans give employees peace of mind by covering a full scope of essential medical services and protecting them from major financial risk. While traditional group insurance is one way to provide comprehensive benefits, cost barriers can make it challenging, especially for small and mid-sized organizations.
HRAs provide an affordable and customizable alternative that empowers employees to choose the comprehensive plan that best suits their needs, while helping employers remain competitive and cost-effective.
To get started with offering a QSEHRA or ICHRA at your organization, contact a PeopleKeep HRA specialist. We’ll help you understand your options and design a benefit that works for your needs.