| Required to Pay Medical Bills (ACA) |
✔️ |
✔️ |
✔️ |
✔️ |
| Provides Reimbursement on Low-Claim Years |
✔️ |
❌ |
✔️ |
❌ |
| No Profits Generated by Denying Claims (ERISA) |
✔️ |
❌ |
✔️ |
❌ |
| Dedicated Account Manager |
❌ |
✔️ |
✔️ |
❌ |
| Strong Incentive to Fix Medical Billing Errors |
❌ |
❌ |
✔️ |
❌ |
| Free Teledoc and Price Comparison Shopping |
✔️ |
❌ |
✔️ |
❌ |
| Includes Comprehensive Dental and Vision |
✔️ |
❌ |
✔️ |
❌ |
| Makes Ancillary Benefits Available (e.g., 401k & LTD) |
❌ |
❌ |
✔️ |
❌ |
| No Payroll and Workers’ Comp Requirement |
✔️ |
❌ |
✔️ |
✔️ |
| Rates Are Not Medically Underwritten |
✔️ |
✔️ |
✔️ |
❌ |
| No Medical Health Questionnaires Required |
✔️ |
✔️ |
✔️ |
❌ |
| Renewal Increases Not Based on Claims History |
✔️ |
✔️ |
✔️ |
❌ |
| Enroll Dependents Without Certificates |
✔️ |
❌ |
❌ |
❌ |
| Can Cancel Month-to-Month |
✔️ |
❌ |
✔️ |
❌ |
| Network Size |
Generally Large |
Generally Large |
Blue Cross PPO |
Variable |
| Enrollment Minimum and Participation Requirements |
2+50% |
2+/5+w/50% |
2+w/50% |
1+w/50% |
| Valid Waivers Count |
Yes – 75% |
No |
Yes |
Yes (Except for NY and VT) |
| Multi-Plan Offering Available |
Yes – 2-3 |
Yes – Up to 5 |
No |
Yes |
| Age-Based Rates |
Yes |
Yes |
No |
Yes |
| Typical Relative Price |
$$ |
$$ |
$$$ |
$$$$ |