Health Insurance

Right next to the wages you offer employees, Health Insurance is one of the most important benefits employees look for from a company. Being able to recruit and retain the best employees can often times hinge on benefits you offer.

With our wide network of Carriers that we work with, we can tailor a health insurance plan that meets your company’s and your employee’s needs. We can offer you plans such as:

Traditional
Consumer-Driven Health Plan
PPO
POS
Self Insured

We strive to provide the best health insurance solutions that keep you Ahead of the Curve. Here is a brief look at each type of health insurance we can provide:

Traditional
With an indemnity plan - or "fee-for-service" plan - you can use any medical provider, i.e. doctors, hospitals, etc. Either you or your provider then sends send the bill directly to the insurance company, which pays a portion of it. In most cases, you have a deductible, which is the amount of the covered expenses you must pay each year before the insurer starts to reimburse you - for example, with a $200 deductible, you must pay up to $200 before your plan kicks in.

Once you meet the deductible, most indemnity plans pay a percentage of what they consider the usual and customary (U&C) charge for covered services.

Policies typically have an out-of-pocket maximum, meaning that once your expenses reach a certain amount in a given calendar year, the U&C fee for covered benefits will be paid in full by the insurer. You no longer pay the coinsurance. However, if your doctor charges you more than the U&C charge, you may still have to pay a portion of the bill.

There also may be lifetime limits on benefits paid under the policy.
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Consumer-Driven Health Plan (CDHP)
A CDHP is a High Deductible Health Plan, typically combined with one of two tax-advantaged spending accounts: a Health Savings Account or a Health Reimbursement Arrangement. These plans require a great degree more involvement on the participant's part in choosing when and where to seek care. By putting the consumer in control of their medical expense can help to bring medical costs down over time.

Plan members use money from their spending account to pay for medical care - including prescription drugs. After the account money is depleted, plan participants must pay out-of-pocket for their medical care until the plan's deductible is satisfied. The High Deductible Health Plan functions like a traditional major medical plan after the deductible has been met. Having a high deductible results in lower premiums. The combinations in a CDHP offers control to the consumer for minor medical expense, while having the safety net of a High Deductible Health Plan to help cover major medical expenses.
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Preferred Provider Organization (PPO)
A PPO plan is a form of managed care that closely resembles an indemnity plan. A PPO negotiates arrangements with doctors, hospitals, and other providers of care, who accept lower fees from the insurer for their services. Because of this, your cost sharing will be lower than if you seek care outside the network of providers.

If you go to a doctor within the PPO network, you will typically pay a copayment. In addition, your coinsurance will be based on the lower charges for PPO members. For example, the insurer may reimburse you for 90% of the cost if you go to a provider within the network. If you choose to go to a provider out of the network, the insurer might only reimburse you for only 70% of the cost. Additionally, with an out-of-network provider you may have to pay the difference between what the provider charges and what the plan will pay.

Another characteristic of a PPO is the ability for members to self-refer. In essence, plan members can refer themselves to the doctor of their choice, including specialists inside and outside the network. It is to be noted, however, that as described above, plan members may incur additional charges for using out-of-network providers.
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Point-of-Service (POS)
Many HMOs offer their members the option to self-direct care, as one would under an indemnity plan, rather than having to be referred from primary care physicians. An HMO with this opt-out provision is known as a Point-of-Service (POS) Plan. How the plan functions - like an HMO or like an indemnity plan, for instance - depends on what the individual plan member decides to do at the "point of service."

Because people who belong to POS plans are responsible for deciding where to seek care, it is very important that they understand the financial implications of the choices they make in choosing medical providers.
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Self-Insured Plans
In many employee benefit plans, the use of self-insurance or partial self-insurance makes a great deal of sense. Complete self-insurance - or even partial self-insurance - is not seen very frequently in areas such as group life, accidental death and dismemberment, long-term disability, long-term care, and specific disease policies. Complete or partial self-insurance is, however, seen frequently in group medical, dental, vision care, and short-term disability benefits.

The use of self-insurance is not meant to imply self-administration. Administration outsourcing of all types of benefit plans makes eminent sense as long as the costs for these services are reasonable. A properly administered plan creates cost-efficiency, as those businesses which specialize in the administration of specific coverage can be extremely effective in the management of claim costs.

There can be cash flow advantages to self-funding. Most self-funded plans are exempt from certain state-imposed benefits and insurance laws and can therefore result in further savings for the company. Recommending and establishing a self-funded benefits plan for any employer requires a comprehensive understanding of all the risks and rewards.
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