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"I have the ability to communicate the complexities of health insurance in a way my clients can understand."
- Larry Feinstein |
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As a small business owner, choosing the right health insurance benefits for your employees can be daunting. Larry makes it easy. With experience and expert guidance, he'll work with you in choosing the correct benefits plan for your business. Below are some of the different types of health benefits options Larry gives you access to.
HMO (Health Maintenance Organization)
This type of plan has a Primary Care Physician. You have to get referrals to Specialists from your Primary Care Physician. It is the least costly and most restrictive plan.
- Low cost doctor visit co-pays in network ranging from $0-$40.
- Usually pays 100% of hospital expenses.
- No paperwork or claim forms.
- Pre-existing conditions are covered.
- Preventive and wellness benefits are included.
- Usually provides a vision exam.
- Emergencies are covered at the same level as in network.
- No coverage out of network.
POS (Point of Service)
This type of plan combines the features of an HMO with those of a PPO. You have a Primary Care Physician, but you also can go out of network. You don't need a referral to see a Specialist. You pay more when you go out of Network. This plan is less restrictive than an HMO,
and it costs more than an HMO.
- Low cost doctor visit co-pays in network ranging from $0-$40.
- Same high level of hospital coverage as an HMO.
- No Paperwork or claim forms to fill out when you are in network.
- Pre-existing conditions are covered in network.
- Preventive and wellness benefits are included in network only.
- Usually provides a vision exam.
- Emergencies are covered at the same level as in network.
Open Access
This type of plan combines an HMO with a Traditional Plan. You still have a Primary Care Physician, but you don't need referrals to specialists. It is easier to go out of Network, and out of Network Benefits are Reimbursed at a Higher Level than in a POS Plan.
- Low cost doctor visit co-pays in network ranging from $0-$25.
- Same high level of hospital coverage as an HMO.
- No Paperwork or claim forms to fill out when you are in network.
- Pre-existing conditions are covered in network. Preventive and wellness benefits are included in network only.
- Usually provides a Vision Exam.
- Emergencies are covered at the same level as in network.
PPO (Preferred Provider Organization)
This type of plan has lower out-of-pocket expenses for benefits received in network. You do not have a Primary Care Physician, and you do not need referrals to specialists. You pay more for going out of network.
- You can go to any doctor in the network at any time without a referral, including all specialists.
- May include a doctor co-pay in Network of $10-$20 and out of network of $20-$30.
- Usually no paperwork or claim forms for in network benefits.
- Deductibles range from $250 to $5,000.
- Preventive and wellness benefits are normally optional benefits.
- Co-insurance in Network is usually 10% and out of network is usually 30% (other combinations are available)...
- Contains a Stop Loss to Limit maximum out of pocket expenses ranging from $500 to $2,000.
- Provides less benefits than a POS plan for a higher cost.
MSA (Medical Savings Account)
This type of plan is offered to businesses with 2-50 employees. It uses a high deductible where premium savings are funneled into a Medical Savings
Account. The idea of this plan is that if employees are spending their own money they will be more prudent in spending their health care dollars.
Defined Contribution
- Select a base plan (usually high deductible low benefit plan without doctor co-pay, or prescription drug card).
- Define employer contribution level (minimum 50% of employee premium).
- Give employees choices (employees can buy additional benefits, doctor co-pay, prescription drug card, dental, etc.).
Partial Self Funding
- Groups of greater that 50.
- Uses individual deductibles of $5,000 and up ( the greater the number of employees the higher the deductible). This is referred to as a specific stop loss (it limits individual exposure per claim).
- Uses an aggregate stop loss (it limits the exposure for the entire group).
- Uses a third party administrator to process claims.
- Employer pays all claims under the specific stop loss (these can be paid out of current cash flow or there can be a fund set up to pay claims).
- There is a reinsurance carrier (pays claims above the specific stop loss and aggregate stop loss).
- Comes under ERISA (bypasses state insurance laws, can tailor plan to fit your specific needs.
- Third party administrator provides accurate claims data that helps employer manage the plan.
- Contracts run from year to year and claims have to be paid during that year.
- Runoff Claims are claims that are incurred in one year but not paid till the next year.
Traditional
- You can go to any doctor and any hospital at any time without a referral.
- You have to satisfy the deductible before coverage begins.
- Usually involves paperwork and claim forms.
- Deductibles range from $250 to $10,000.
- Coinsurance is usually 20%, but does have a 50% option.
- Contains a Stop Loss to Limit maximum out of pocket expenses ranging from $1,000 to $5,000.
- The most expensive plan providing the least amount of benefits for the highest cost.
For more information on the products and services Larry and Leader's Group provides, call or e-mail them today.
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