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Please click through to learn about the types of individual insurance we offer. Health Insurance Please click here for specific plan information. Health Insurance The major differences between indemnity and managed care plans concern choice of providers, out-of-pocket costs for covered services and how bills are paid. Usually indemnity plans offer more choice of doctors (including specialists), hospitals and other health care providers than managed care plans. Indemnity plans pay their share of the costs of a service only after they receive a bill. Managed care plans have agreements with certain doctors, hospitals and health care providers to give a range of services to plan members at reduced cost. In general, you will have less paperwork and lower out-of-pocket costs if you select a managed care plan and a broader choice of health care providers if you select an indemnity plan. The three basic kinds of managed care plans are PPO, HMO and POS. Preferred Provider Organization (PPO). A PPO combines elements of indemnity and managed care plans. Each time you need care, you choose among doctors who belong to the PPO network. You pay less when you use the network's "preferred providers." However, you can see any doctor not in the PPO network at any time you wish, but you will probably have to pay more for care. If you go to a doctor within the PPO network, you will pay a co-payment. If you choose to go outside the network, you will have to meet the deductible and pay coinsurance based on higher charges. In addition, you may have to pay the difference between what the provider charges and what the plan will pay. Health Maintenance Organization (HMO). HMOs require that you pay a small, set co-payment when you use the plan's HMO network doctors. You generally don't have to pay a deductible in an HMO. You usually select a primary care physician who manages all of your health care and serves as a gatekeeper for specialty care. If you go to doctors who are not in the HMO, you pay the full cost of the care (unless it's an emergency situation). Point-of-Service (POS) Plan. Many HMOs offer an indemnity-type option known as a POS plan, which adds an out-of-network benefit to HMOs. Like HMOs, you select a primary care physician who manages all of your care and is responsible for referring you to plan specialists. In a POS plan, however, you have the option of going outside the HMO network, although you'll pay more for care received outside of the network. Life Insurance Group life insurance is underwritten on a group as a whole, such as the employees of an organization, and is usually under term coverage. Group life insurance can provide benefits beyond term insurance as employees can usually retain coverage after retirement by paying premiums directly to the insurer. Dental Insurance Indemnity/Fee-for-Service/ Direct Reimbursement. Like with general health care, this type of policy allows you to choose any dentist and will reimburse you based on dollars spent on your dental treatment. Instead of paying monthly insurance premiums, employers pay a percentage of actual treatments received. Preferred Provider Organization. PPO dental programs are plans under which patients select a dentist from a network or list of providers who have agreed, by contract, to discount their fees. In PPOs that allow patients to receive treatment from a non-participating dentist, patients will have to pay higher deductibles and co-payments. PPOs are usually less expensive than comparable indemnity plans. Dental Health Maintenance Organization. DHMO plans pay contracted dentists a fixed amount (usually on a monthly basis) per enrolled family or individual, regardless of use. In return, the dentists agree to provide specific types of treatment to the patient at no charge (for other treatments, a co-payment is required). DHMO models typically offer the least expensive dental plans. Disability Insurance The risk of becoming disabled in America is growing, making disability insurance a necessity. According to the American Safety Council, among Americans disabled as adults, more than 82 percent have problems working due to their disability—62 percent are unable to work, while 38 percent are limited in the amount or type of work they can perform. Disability income policies are generally offered as part of an employee group benefit package. Disability income policies commonly provide 50 to 70 percent of an insured’s pre-disability income while an insured employee is unable to work due to accident or illness. Many policies also include benefits to help people return to work following a disability. Both individual and group disability income insurance pay benefits as an indemnity – usually weekly or monthly. Disability income insurance may be offered by employers, purchased individually or used to protect a business. Group disability insurance is generally offered as part of an employee group benefit package. Short-term group disability protects against the loss of income for employees unable to work because of a temporary illness or injury. This coverage will replace a portion of an employee’s earnings for a fixed amount of time. Long-term group disability covers occupational and non-occupational sickness and accidents. These benefits usually start when short-term benefits are exhausted. Long-term Care Insurance Long-term care insurance is traditionally sold to older Americans; however, more and more young people are buying long-term insurance because the younger the purchaser, the lower the premiums. Group long-term care insurance provides long-term care coverage from an insurance company or self-insure. Members of the group assume all risks and expenses of providing long-term care coverage. 125/Cafeteria Plans This plan can save both employers and employees money by reducing payroll taxes. One adjustment is made in the payroll process: employees pay their portion of insurance premiums, or contributions to a flexible spending account for reimbursement of qualified out-of-pocket medical expenses or dependent daycare, on a pre-tax basis rather than an after-tax basis. If employers are already providing health benefits to their employees, they can add voluntary benefits to the current benefit package at no additional cost. Employees receive the most for their money as they select only the benefits they need and desire. Qualified benefits under a cafeteria plan can include group medical insurance; long and short term disability income insurance; group term life insurance for employees only; specified disease coverage such as a cancer policy, dental and/or vision insurance; hospital indemnity insurance; accidental death and dismemberment insurance; a medical expense reimbursement plan; and a dependent care reimbursement plan. Health Reimbursement Arrangement |
