Group health Insurance Guidelines

• One Life Groups: In Florida, one life groups can be written one time out of the year on a simple plan offering. Starting in August, all applications must be received by the insurance carrier by September for an October 1 effective date.
  
  
• Groups of two or more employees can have any 1st of the month effective date and sometimes a 15th of the month effective date. Groups of two or more can be written with most national carriers including Aetna, Blue Cross Blue Shield, Cigna, Humana, and United Healthcare. Husband and wife can constitute a two person group.
  
  
• Eligible employees are those that work a minimum of 25 hours.
  
  
• 75% participation of the eligible employees is standard for most carriers.
  
  
• 50% contribution is expected of most employers to pay the employee-only rate or the cheapest plan being offered.
  
  
• Those employees who are considered VALID WAIVERS are those employees that are covered through a group plan under their spouses employer of those covered by Medicare Part A & B.
  
  
• Coverage does not have to be offered to part time, seasonal or 1099 employees.
  
  
• COBRA is handled differently by the insurance carrier depending on the number of employees in your company.

Ancillary Benefits

Dental Insurance

• DMO – specific network of providers that you can use for services to covered
• PPO – Use in-network dentists for a higher level of coverage or see out-of-network dentists at a lower level of coverage.
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Life and AD&D Insurance

• Life insurance policies that usually have a guaranteed issue limit and can be bought in increments of $10,000 or $25,000. Accidental Death and Dismemberment (AD&D) means that if you lose a limb or limb function there is a financial amount for the loss.

Disability (STD/LTD)

• If you are injured and cannot work, this assists in supplying a portion of your normal rate of pay for a short or long period of time.

Vision Insurance

• Offers co-pay or discounts for eye exams, testing, glasses or contacts

Transitional Medical

Transitional Medical insurance offers individuals and families a short term solution to their health insurance needs. This type of insurance is extremely affordable and can be purchased for specific time frames from one month to one year. In fact in some states it can be rewritten for up to three years.

Transition Medical is the perfect solution for:

• Individuals who can't afford COBRA
• Individuals who are waiting for their group insurance coverage to start
• Individuals who can't afford major medical

Health Savings Account (HSA)

These plans are perfect for a person who rarely uses health insurance but wants protection. A Health Savings Account is a special tax-sheltered savings account designed to be used for certain qualified medical expenses. Individual contributions to the HSA may be tax deductible from your gross income. Think of it as a Medical IRA because the interest earned is tax-deferred and withdrawals for your qualified medical expenses are tax-free.

PPO

In health insurance, a preferred provider organization (or "PPO", sometimes referred to as a participating provider organization or preferred provider option) is a managed care organization of medical doctors, hospitals, and other health care providers who have covenanted with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.

The idea of a preferred provider organization is that the providers will provide the insured members of the group a substantial discount below their regularly-charged rates. This will be mutually beneficial in theory, as the insurer will be billed at a reduced rate when its insured utilize the services of the "preferred" provider and the provider will see an increase in its business as almost all insureds in the organization will use only providers who are members. Even the insured should benefit, as lower costs to the insurer should result in lower rates of increase in premiums.

Health Maintenance Organization (HMO)

An HMO is a health care organization created in an effort to lower health care costs for you and for whomever is helping you pay for your health care, such as an employer or the government. If you join an HMO, you get to use their services at a very low cost, much less than if you went to the doctor and paid for them.

HMOs are also appealing to those who pay for health care services, because HMOs are usually large organizations that can buy services for thousands of people and, at the same time, decide what type of care they will receive. Both of these allow HMOs to lower the cost of health care and give companies cheaper health care rates for their employees.

While all HMOs will provide you with written material about how their program works, they all have a few things in common. They all require you to use doctors and hospitals that are "in-network" or part of their HMO plan. Your HMO will provide you with a list of in-network doctors. Also, HMOs usually require you to choose a primary care physician who will be in charge of your health care. If you need other types of care, such as seeing a specialist or going to the hospital, you are first required to get approval from your primary care provider.

The most obvious advantage to belonging to an HMO is cost. First, the premiums of managed care are usually lower than traditional health insurance, which can end up saving you money if you are now paying any of your own insurance costs. Secondly, HMOs and most other types of managed care do not require that you pay for your medical care up front, so there are no claim forms to fill out or waiting periods for repayment. Lastly, many HMOs require only a small co-payment for a visit to the doctor, a hospital stay, or a prescription. This is far less expensive than the usual 80 percent reimbursement of traditional health care insurance.

But there are disadvantages as well. What most people dislike is the requirement that you use only doctors and hospitals that are part of the HMO plan. Also, HMOs operate on the concept of capitation — they receive a flat fee each month for each person they cover. While this creates a good mechanism for cost control, it can also lead to restrictive practices such as difficulty in assessing specialists or special drugs. If you do need specialists care, an HMO will require that you first get approval from your primary care physician, which can be time-consuming and difficult for someone with cancer.