A Journey Across the U.S.: Unpacking Medical Insurance and Employment Benefits

As European companies expand into the U.S., navigating the intricacies of employee benefits – especially group health insurance – becomes a critical challenge. This seminar offers a practical guide to understanding the decentralized U.S. healthcare system, key compliance obligations under the Affordable Care Act, and the strategic role of health insurance in talent acquisition. From defining group plans and managing multi-state coverage to exploring emerging funding models, the role of PEOs, and special arrangements for European expats, participants will gain essential insights into building compliant, competitive benefits programs across the American landscape.

Our panel will explore the following topics:

Setting the Stage
• The U.S. is a leading destination for European companies expanding operations, but one of the most complex aspects of entry is establishing compliant, cost-effective employee benefits, particularly group health insurance.
• Unlike Europe, the U.S. healthcare system is private, decentralized, and regulated at both federal and state levels, creating complexity for new employers.
• Health insurance is a key part of total compensation and plays a major role in attracting and retaining talent in the U.S. market.
• Under the Affordable Care Act (ACA), certain employers are required to offer health insurance based on company size, making compliance an essential part of any U.S. hiring strategy.
• Goal: To educate companies on how to enter and manage the U.S. group health insurance market—understanding its structure, compliance requirements, and available strategies.

Establishing a Group Plan
• Definition of a “group”
• Minimum participation and contribution requirements
• Varies by carrier, state, and ACA rules

The U.S. Market Landscape
• Each state controls its own group insurance marketplace, leading to variations in:
> Carrier options (local vs. national networks)
> Pricing and contribution
> State-mandated benefits
> Definitions of small vs. large group coverage
> Funding options (fully insured, self-insured, level-funded, captives, PEOs, etc.)
• Market challenges:
> Rising premiums
> Increasing employee demand for flexibility — ancillary insurance, mental health access, telemedicine, and personalized benefits
> Multi-state operation lends itself to inconsistent plan availability
> Employers must also coordinate payroll, carrier processing, and HR technology systems.

Emerging Strategies and Trends
• Alternative funding models such as:
> self-funding, level-funding, and captives
> ICHRA (Individual Coverage Health Reimbursement Arrangement)
• The role of PEOs in helping smaller companies streamline entry into the U.S. market by combining payroll, benefits, compliance, and HR under one platform
• Special arrangements for European expats: keep paying social securities into the home country and get an exemption from paying into US social security

SPEAKERS:
• Bryan Erdheim, Managing Partner, THE MEDICAL LINK
• Carolina Spera, Principal, GRASSI
• Jacob Willemsen, President, TABS Inc.
• Malcolm Pobjoy, Executive Director – US Market Management, OSBORNE CLARKE [Moderator]