MARSHALL TWP, Allegheny County — The evolving nature of the health care industry means businesses must constantly be proactive when planning to control health insurance costs.

However, the actions that can be taken differ based on the size of the business, with small businesses often caught in the middle.

Craig Pritts of JRG Advisors this week presented health insurance plan ideas and addressed questions from about 20 business owners, self-employed individuals and administrative professionals at the Four Points by Sheraton Pittsburgh North.

Based in Pine Township, Allegheny County, JRG Advisors is an insurance broker, employee benefits consultant and service company. It also manages ChamberChoice, which provides health insurance and other services to members of chambers of commerce in the region.

“Health care reform is good for some businesses. It hurts others. It's a shift in the industry of who's paying for what,” Pritts said.Compromise is necessary to select the plan that best serves a business and its employees, he said.“Let's be real. The best plan for the business is going to be the least expensive. The best plan for the employees is going to be the most expensive. You've got to try to find the happy medium,” he said.Pritts said some businesses do not offer health insurance to save money. However, he said those businesses should at least encourage their employees to seek help to enroll in health insurance plans through the public exchange for individuals, which the federal government created last year through the implementation of the Patient Protection and Affordable Care Act.The open enrollment period to select a 2015 plan on www.healthcare.gov begins Nov. 15 and runs through Feb. 15. Individuals might be eligible for government assistance to pay for health insurance, based on income and family size.

For small businesses that do offer group health insurance plans — or for ones that want to consider offering a plan — Pritts said they might want to consider the federal government's Small Business Health Options Program, or SHOP.SHOP is the public exchange available for businesses with 50 or fewer full-time employees who make an annual average wage of $50,000 or less. To be eligible, employers also must contribute at least 50 percent toward the premiums their employees pay.For-profit organizations that provide health insurance through SHOP are eligible to receive a tax credit worth up to 50 percent of their costs. Nonprofit organizations are eligible to receive a tax credit of up to 35 percent of their costs.Pritts said few businesses are able to take full advantage of the program based on the eligibility requirements. However, the businesses that can benefit most from the program are those with fewer than 10 employees who make an average annual salary of $30,000 or less, he said.Pritts said the plan options SHOP offers are limited in both insurance providers and plan designs, meaning a qualifying business still might not be interested in an available plan.Employers must apply for the program through their insurance brokers, but Pritts said the program should expand during the next year or so as more insurers participate and the application process switches to the healthcare.gov website as it is with the individual marketplace.Despite these limitations, Pritts said every small business should at least take a look at SHOP to make sure it is taking advantage of tax credits.

Pritts said one strategy gaining popularity is the concept of “private exchanges.”In this strategy, which also is referred to as the “defined contribution model,” the employer determines how much it wants to spend on benefits, and employees get to choose from a list of plans the employer has negotiated with insurers.For example, a company could give $300 to each employee every month to spend on an array of employee benefits, including health insurance. If an employee would want to spend more than the allocated amount, he would then make up the difference out of pocket.Pritts said large employers have traditionally used this model, but smaller businesses have been adopting it to control costs while increasing the freedom employees have in selecting benefits plans. The model also frees up administrative time for the employer, he said.Businesses with as few as 10 employees — or as few as two for ChamberChoice members — may create a private exchange, he said.“As an employer, you don't care what your employees take,” he said.“What you care about is you've given them money to pick what's best for them.”

Pritts said another model traditionally used by large employers that smaller employers are now adopting to save money is the self-funded health care plan.In the self-funded model, the business pays its own claims, meaning it pays only for the health care its employees use. A third party, usually a health insurer, administers the plan, typically at a lower cost than what would be collected in a fully insured model, he said.To guard against catastrophic claims, which could be caused by an employee receiving treatment for cancer, for example, the employer would buy stop-loss insurance that covers the remainder of the company's claims after a predetermined limit.The Pittsburgh North Regional Chamber hosted the workshop.