The Great Transition: Healthcare Benefits & Defined Contribution

Note: **this is the third (3) of a series of four (4) blog posts that require some knowledge of previous posts to be understood. We recommend that you read them in order. Here is the suggested order of reading:

  1. Healthcare Reform: The Major Players
  2. Phrases Made Easy: “Defined Benefit” and “Defined Contribution”
  3. The Great Transition: Healthcare Benefits & Defined Contribution
  4. Health Reimbursement Arrangements (HRAs): The Employee Benefits Home Run


Until now, the “defined contribution” (HRA) concept as a health benefits solution has been used most frequently within smaller businesses. However, healthcare reform is paving the way for a massive transition from group health insurance plans (defined benefit), to Health Reimbursement Arrangements (defined contribution). The reason: starting on January 1st, 2014… anyone who applies for health insurance coverage (including individual applicants), must be accepted. In insurance lingo, this is known as “Guaranteed Issue.”

Much like we did in the last post, we are going to explain “defined benefit” and “defined contribution.” This time, we’re specifically referring to employer health benefits. Here we go.

Phrase #1 – “Defined Benefit”

  • Example of “Defined Benefit” in Employee Health Benefits: You’re an employee at a plastics manufacturing company. The company extends health insurance coverage to all eligible employees through a group health insurance plan! That’s a “defined benefit.” 
  • Simpler Terms: The benefit (health insurance), has been defined (the type of coverage the company allows you to select, typically a PPO or HMO).

Phrase #2 – “Defined Contribution”

  • Example of “Defined Contribution” in Employee Health Benefits: You’re an employee at an occupational medical center. The medical center gives employees a monthly $300 HRA (health reimbursement arrangement) allowance. That’s a “defined contribution.” 
  • Simpler Terms: The contribution (funds to the HRA), have been defined ($300 per month).


Starting post-2014, employer health benefits (especially in groups of under 50 employees), will begin to make the change from the defined benefit (group health insurance plan) model, to the defined contribution (HRA) model.

Gone will be the days of “minimum participation requirements” and “minimum contribution requirements” (as were seen in group health insurance plans). Instead, employers will begin to decide how much money they would like to contribute to each employee’s HRA (the defined contribution), and then let employees make their own purchasing decisions.

We’ll get into further detail in a later blog post, but HRAs will be the “vehicle” that facilitates this transition. Policy Advantage Insurance Services partners with HRA third party administrators that make this a simple transition. A few things that we’ll talk about in future blog posts:

  1. How HRAs will work on their own (referred to as: private health exchanges)
  2. How HRAs will integrate with state health benefits exchanges (there is much to be announced)
  3. How (regardless of either above scenario), HRAs will be a valuable employee benefit for attraction and retention of employees

Important Editor’s Note 11/22/2013: Since these original blog posts, federal guidance regarding “Stand-Alone HRAs” (which are addressed in-depth throughout these articles) has undergone significant changes. In order to stay in full compliance, please be advised that there are now many additional considerations when adopting this type of benefits planning strategy. Consult with a proper broker or insurance professional before utilizing employer dollars to purchase individual health insurance policies. 

Thanks for stopping by, we hope you found this information to be informative and valuable.


Facebook: PAIS Facebook Page

Google+: PAIS Google+ Page