What Are Employee Health Benefits?

Employee health benefits help your team pay for medical care through an employer-sponsored plan or arrangement.

What Do Employee Health Benefits Cover?

Employee health benefits help eligible employees pay for medical care through an employer-sponsored plan or arrangement. ^1,²

Health Care Within a Benefits Program

Medical plans describe which care they help pay for, such as doctor visits, hospital services and prescriptions, and how costs are shared. ¹ A benefits program can include medical, dental and vision coverage alongside separate life, disability and retirement benefits. Compare each part on its own terms. ³

Who Needs Employee Health Benefits?

Use this comparison when introducing employee benefits, renewing a plan or deciding how much your business will contribute to employees' care. ^10,⁸

Coverage Examples

These are examples, not coverage guarantees. Your policy terms and the facts of the claim determine what is covered.

What happened

An Employee Wants to Keep Their Doctor

You're changing health plans, and an employee asks whether they can keep seeing their current doctor.

How coverage may help

The answer depends on the exact plan's network and out-of-network benefits. The provider directory and Summary of Benefits and Coverage help you explain the options and costs. ^1,^2,^9,^5,⁶

What happened

You Consider a Self-Funded Plan

A benefits proposal includes an administrator and separate stop-loss insurance.

How coverage may help

With self-funding, your business bears medical-claim costs even if an administrator handles the paperwork. Stop-loss may reimburse eligible costs above its attachment points. ^1,^2,⁴

How Is the Plan Funded and Managed?

Claims Responsibility and Administration

With a fully insured plan, the insurer assumes covered medical-claim costs for a premium. With self-funding, the employer takes on the claims responsibility. ¹ An administrator can handle enrollment and claims without taking on the employer’s claims risk. Ask who pays claims and who handles day-to-day administration. ⁴

Stop-Loss and Reimbursement Arrangements

If considering self-funding, examine stop-loss protection separately: attachment points, exclusions and claim timing affect what the employer can recover. ⁴ A health reimbursement arrangement is another way for an employer to help with medical expenses; compare its rules with a group insurance offer. ²

How Do You Compare Coverage and Costs?

Benefits, Access and Total Cost

Use each plan’s Summary of Benefits and Coverage to compare costs and benefits, then examine the full terms for details. ^5,⁶

Compare what the employer contributes, what employees pay in premiums, and what they pay when they use care. Deductibles, copayments, coinsurance and out-of-pocket limits all affect that last amount. A cheaper premium can still mean a more expensive year for an employee who needs regular treatment. ^7,⁸

Check the exact plan’s doctor and hospital network and prescription list. Out-of-network care can cost more or have limited coverage. ⁹

Comparison	Questions to bring to the adviser
Employer and employee spending	What does the employer contribute, and what premium does the employee pay?
Costs when care is used	What deductibles, copayments and coinsurance apply?
Access to care	Are the doctors, hospitals and prescriptions employees want included in this plan?
Out-of-pocket limits	Which expenses count toward the limit, and which do not?
Restrictions	Which services are excluded, and when are referrals or prior authorization needed?

^7,⁸ ⁹ ⁶

Restrictions and Other Health Care Benefits

Compare excluded services, referral and prior-authorization rules, and which expenses count toward the out-of-pocket limit. ⁶ Check whether dental and vision benefits are included or offered separately, and compare their limits and cost-sharing independently. ^3,⁸

What Do You Need for a Quote?

Workforce and Budget

Prepare your workforce locations and headcount, who you want to offer coverage to, the employer budget and intended start date. ^10,⁸

Information to organize	What it helps you discuss
Workforce locations and headcount	The employees and worksites the proposal should address
Intended recipients	Who you want to offer benefits to
Employer budget	The contribution you want to compare across options
Intended start date	Planning the transition and enrollment work

^10,⁸

Enrollment and Ongoing Administration

Ask how enrollment, new hires, dependent changes, payroll deductions and renewals will be handled, and what information the administrator needs. ^8,¹

Key Terms in Plain English

Self-Funding

An arrangement in which the employer takes on medical-claim responsibility rather than paying an insurer to assume it. ¹

Stop-Loss

Separate protection to review with a self-funded plan, including the point at which it responds and its exclusions. ⁴

Frequently Asked Questions

Does Hiring an Administrator Transfer Claims Risk?

No. An administrator can handle enrollment and claims while the employer retains responsibility for medical-claim costs. ⁴

Are Dental and Vision Benefits Included?

They may be included or offered separately. Compare their limits and employee cost-sharing independently from the medical plan. ^3,⁸

Which Document Helps Compare Employee Health Plans?

Start with each plan's Summary of Benefits and Coverage. It lets you compare benefits and costs in a consistent format; then check the full plan terms for the details. ^5,⁶

Is the Lowest-Premium Employee Health Plan the Cheapest Overall?

Not necessarily. Compare employer and employee premium contributions alongside deductibles, copayments, coinsurance and out-of-pocket limits. The monthly premium is only part of the cost. ^7,⁸

Which Insurance Providers Offer Employee health and benefits?

Sources

Health Insurance Basics. Centers for Medicare & Medicaid Services; PDF p.1: What is health insurance? What is a health insurance plan?; PDF p.2: Self-Insured Employer Plans vs. Fully-Insured Plans. Version: Revision Date 9/2023. Accessed 2026-09-16.
Health Insurance for Businesses. HealthCare.gov / CMS; Group health insurance coverage; Health reimbursement arrangements. Accessed 2026-09-16.
National Compensation Survey: Glossary of Employee Benefit Terms. US Bureau of Labor Statistics; Overview; Healthcare Benefits; Life Insurance; Disability Benefits; Healthcare Benefits: Dental care; Vision care. Version: September 2025. Accessed 2026-09-16.
Employer Self-Funding of Employee Health Benefits. Texas Department of Insurance; Administrative responsibilities; TPAs - what you should know; Stop-loss insurance; Stop-loss issues to consider: Benefits and exclusions; Timing issues and claim lags. Version: Updated February 6, 2024. Accessed 2026-09-16.
Summary of Benefits and Coverage. HealthCare.gov / CMS; Where can I find a Summary?; Summary of Benefits and Coverage. Accessed 2026-09-16.
Summary of Benefits and Coverage Completed Example. Centers for Medicare & Medicaid Services; PDF p.1: note below important questions; PDF pp.1–4: Important Questions; Limitations, Exceptions & Other Important Information; Excluded Services. Version: Coverage period 01/01/2025–12/31/2025. Accessed 2026-09-16.
Your Total Costs for Health Care: Premium, Deductible, and Out-of-Pocket Costs. HealthCare.gov / CMS; Your total costs for health care; Compare estimated total costs for plans. Accessed 2026-09-16.
How to Offer SHOP Health Insurance to Your Employees. HealthCare.gov / CMS; Making a SHOP health insurance decision; Choosing a stand-alone dental plan; How to enroll through SHOP; Paying premiums & managing coverage; How to renew. Accessed 2026-09-16.
3 Things to Know Before You Pick a Health Insurance Plan. HealthCare.gov / CMS; How do I get details on plans?; Plan and network types. Accessed 2026-09-16.
Find Out If Your Small Business Qualifies for SHOP. HealthCare.gov / CMS; Eligibility, worksite and participation discussion. Accessed 2026-09-16.
Coverage. Founder Shield; Core Coverage: Crime Insurance, Cyber Liability, Directors & Officers, Employment Practices Liability, Fiduciary Liability, General Liability, Property Insurance; Specialized Coverage: Digital Asset Insurance, ERISA Fidelity Bond, Hired & Non-Owned Auto, Intellectual Property, Key Person & Contract Frustration, Last-Mile Delivery Insurance, Transit & Transportation; product cards: Errors & Omissions, Product Liability, Representations and Warranties, Umbrella Insurance, VCAP, Virtual Care & Telehealth Insurance, Workers Compensation; Health & Benefits: Employee Health & Benefits; Get a Quote and Learn More links. Accessed 2026-09-16.
Alternative Health Insurance Solutions for Small Businesses. Gallagher Small Business; Alternative health insurance and ICHRA overview; Let’s build a better benefits strategy together; Connect With An Advisor. Accessed 2026-09-16.
Health Insurance services. Heffernan Insurance Brokers; Heffernan Benefit Advisors; Health Insurance / Let us help you find the ideal program: large and small group employee benefits, group dental, group vision, medical, life and disability, voluntary benefits, Medicare; Administration and Advocacy. Accessed 2026-09-16.
Employee Benefits Brokers and Consulting Services. HUB International; An Employee Benefits Broker for Changing Times: employee-benefits brokerage and multi-year planning services; tailored solutions; Talk to an Employee Benefits Broker; plan-design FAQ. Accessed 2026-09-16.
Insurance Broker San Francisco. HUB International; Page metadata naming HUB International Limited as parent; About Us office copy for 201 Mission Street; products and industries blocks. Accessed 2026-09-16.
Lockton People Solutions. Lockton; Introducing Lockton People Solutions; integrated health and risk programs; FAQ on products (employee experiences, total rewards and benefits, management and measurement) and private ownership. Accessed 2026-09-16.
Employee Health & Benefits Group Insurance | MMA. Marsh McLennan Agency; Opening employee-benefits broker positioning; Our Solutions: benefits consulting and implementation; FAQ on negotiating with carriers and selecting and implementing plans. Accessed 2026-09-16.
Who We Are | MMA. Marsh McLennan Agency; Business of Marsh (NYSE: MRSH); business insurance, employee health & benefits, retirement & wealth, and private client solutions across the US and Canada. Accessed 2026-09-16.
Compensation guide for US clients. Marsh; US broking segments; broker role; retail commissions, client fees, wholesale, insurer consulting, contingent and supplemental commissions; Marsh LLC and Marsh USA LLC; page 3: broker role and Marsh & McLennan Agency segment; page 7: copyright © 2024 Marsh LLC. Accessed 2026-09-16.
Small Group Benefits. Mylo; Hero for employers with 2–99 employees; health, dental and vision benefit categories; enrollment, HR portal and licensed benefits advisor; Get My Quote. Accessed 2026-09-16.
Employee Benefits. Newfront; Employee Benefits heading; Tailored Solutions; Comprehensive Expertise: Benefits, Global Benefits, Compensation and Retirement. Accessed 2026-09-16.
Strategic Planning. Newfront; Funding Approach; Pharmacy Solutions; Renewal Negotiations & Proprietary Programs. Accessed 2026-09-16.
Employee Benefits. USI Insurance Services; Employer benefit consulting services and EBsolutions@usi.com contact. Accessed 2026-09-16.