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| Group and Individual Health Insurance | Life Insurance and Estate Planning | Annuities |
| Retirement Planning and Employee Benefits | Long Term Care and Disability Insurance | Small Business Specialy Insurance |
Group and Individual Health Insurance
When purchasing an insurance or financial product, the client must be well informed. The sole presentation of quotes and numbers do not give the complete picture of the purchase. The role of our agents is to inform our clients of all the options available for them to choose a product that meets their needs, expectations and budget. We refuse to be an online volume seller. Our unique and personalized service has been the key to our success for the past 15 years.
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Group Health Insurance:
Fulfilling your insurance needs may prove relatively simple if your employer offers a group plan or a choice of plans. Group plans cover several people or groups under one policy. Most group policies are suitable for the average person and may include provisions to cover family members.
Businesses with 2 to 50 eligible employees have access to guaranteed-issue group plans, often referred to as small group health coverage. Coverage for a one-life group is only available during the month of August each year, with the policy being effective on October 1st. These plans are available to all small business employers regardless of the health claims experience of an employee group or the health status of an employee. -
Individual Health Insurance:
Individual plans cover one person or all members of a family under one policy. Usually people buy individual plans because they lack access to employer based group policies. Others use individual health policies during periods of unemployment when they lack coverage under group policies. Individual health insurance is usually medically underwritten, meaning that the applicant’s health status will be considered during the underwriting process. -
Components of Health Insurance Policies:
Premium: The amount the policy-holder pays to the health plan each month to purchase health coverage.
Deductible: The amount that the policy-holder must pay out-of-pocket before the health plan pays its share. For example, a policy-holder might have to pay a $500 deductible per year, before any of their health care is covered by the health plan. It may take several doctor's visits or prescription refills before the policy-holder reaches the deductible and the health plan starts to pay for care.
Copayment: The amount that the policy-holder must pay out of pocket before the health plan pays for a particular visit or service. For example, a policy-holder might pay a $25 copayment for a doctor's visit, or to obtain a prescription. A copayment must be paid each time a particular service is obtained.
Coinsurance: Instead of paying a fixed amount up front (a copayment), the policy-holder must pay a percentage of the total cost. For example, the member might have to pay 20% of the cost of a surgery, while the health plan pays the other 80%. Mostly, there is a limit on the amount of co-insurance to be paid by the plan member. Co-insurance is usually the payment made by the plan member after the deductible.
Exclusions: Not all services are covered. The policy-holder is generally expected to pay the full cost of non-covered services out of their own pocket.
Coverage limits: Some health plans only pay for health care up to a certain dollar amount. The policy-holder may be expected to pay any charges in excess of the health plan's maximum payment for a specific service. In addition, some plans have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when they reach the benefit maximum and the policy-holder must pay all remaining costs.
Out-of-pocket maximums: In most cases, the member's payment obligation ends when they reach the out-of-pocket maximum, and the health plan pays all further covered costs. Some plans include Deductible and/or Co-insurance and/or Co-payments in the Out of pocket maximums. Your agent must be clear on this very important concept. Also, Out-of-pocket maximums can be limited to a specific benefit category (such as prescription drugs) or can apply to all coverage provided during a specific benefit year.
In-Network Provider: A health care provider on a list of providers preselected by the insurer. The insurer will offer discounted coinsurance or copayments if the plan member sees an in-network provider. Generally, providers in-network are providers who have a contract with the insurer to accept rates further discounted from the "usual and customary" charges the insurer pays to out-of-network providers. It generally costs the patient less to use an in-network provider.