THINGS TO CONSIDER WHEN CHOOSING GROUP HEALTH INSURANCE

Choosing a health plan for your company can be a large responsibility. Our agents are here to assist you in this decision. They will guide you through the process, explain the different options available to you. The following are some of the things you need to consider when choosing a group plan:

* To qualify for group coverage, you may be required to provide a signed copy of your most recent UCT-6 (State Quarterly Wage Report). Some groups may be required to submit a current payroll and billing statement from thier current health insurance carrier. These forms will be used to verify eligible employees. For partnerships or corporations, you will need a business license, articles of incorporation, or other documents that can verify the legitimacy of business and the participation of all people to be covered under the group health plan.

* Minimum Employer Contribution is 50% of the single employee rate.

* Genrally, 75% of all eligible employees must enroll under the group plan.Eligible employees are those employees who are working a minimum of 25 hours per week and who have satisfied any waiting period as required by the employer. When determining if adequate participation levels are met, do not count as eligible any employee who has qualifying existing coverage in another employer-based group insurance plan or an ERISA qualified self-insured plan. If both husband and wife work for the same company, they must enroll separately as employees, not as an employee and spouse.

* Rates will vary based on the size of you group, age of employees, geographical location, as well as other factors. Many insurance companies offer a one-year rate guarantee on the monthly premium.

* No employee may be denied coverage due to pre-existing conditions for qualifying group health plans. Though, there are pre-existing limitations that will be discussed further by your agent.

* When you enroll in a new group health plan, you will need to decide the length of time that a new hire must be with your company before he/she can be added to the group health plan.

Health Maintenance Organizations (HMO)

An organization that provides a wide range of health services for a fixed, pre-paid premium. The HMO may provide all services or may contract with other sources for additional services. HMO's fall into four categories.

1. Group Model
2. Individual Practice Association (IPA)
3. Staff Model
4. Network Model Assoc. (IPA)

Point-of-Service Organizations (POS)

Each time health care services are needed, the patient can choose from different types of provider systems (indemnity plan, PPO or HMO); each choice may provide different benefit payments.

Preferred Provider Organizations (PPO)

An organization of participating providers that have agreed to provide their services at negotiated discount fees in exchange for prompt payment and increased patient volume.

Exclusive Provider Organizations (EPO)

A different type of Preferred Provider Organization (PPO) which requires the insured to use only the listed providers or to otherwise forfeit benefit reimbursement altogether.

Fee-For-Service (Traditional Health Insurance)

The traditional reimbursement system where the providers of medical care receive a benefit payment calculated on the basis of their billed charge. Under this arrangement Plans or Insurers have not established contracted or capitated rates of payment with providers prior to the insured's claim occurrence.