Individual Health
4.) What is an HSA?
5.) What's best Health Insurance Plan for me?
Small Group
Your company will probably be eligible for a small business plan if it meets the following criteria:
1. Your company consists of at least two full-time owners, officers, partners and/or employees, as verified by officially-filed state quarterly wage and tax statements (e.g., DE-6 in California) or annual federal tax return documents
2. Your company is a legitimate business entity (i.e., your company was formed for a purpose other than to obtain insurance), as verified by one of the following documents:
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A business license or fictitious name filing (proprietorships and partnerships);
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Articles of incorporation (corporations); or
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Articles of organization (Limited Liability Company).
3. Your company meets the minimum employer contribution percentage set by the insurance company.
Please note that eligibility criteria may vary among insurance companies and by state. If you have any questions about your company's eligibility for a particular small business plan, please call one of our licensed representatives at 800-314-1433.
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We know it can be confusing and frustrating trying to find the right group health insurance plan for your business. Many people may not understand exactly how health insurance works and may not be familiar with health insurance terminology.
The best way to help yourself decide which plan is best for your business is to understand the health care needs and financial constraints that you and your employees face. To get started, you and your employees should answer these questions:
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How often do you utilize medical services?
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Will you need coverage for benefits such as prescription drugs, chiropractic care or maternity?
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Is coverage for preventive care checkups important to you or are you more concerned about coverage in case of a major injury or illness?
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What kind of monthly premium can you afford?
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What kind of deductible, if any, are you willing to pay on an annual basis before your coverage begins? Is it important to you to be able to see any doctor you want to, or are you willing to work within a provider network or through a primary care physician?
Once you have an understanding of your health care needs and your financial constraints, you'll be more prepared to examine the benefits and costs of the plans offered in your area. For example, you may want to avoid a health insurance plan that offers benefits that you and your employees never use since these unnecessary benefits may translate into higher premiums.
If you're looking at a health insurance plan that requires you to use the insurance company's network of doctors and hospitals, you may want to make sure that your current doctor --if you have one-- is on the list and that network facilities are located near your home or office.
If you're looking for an answer to a specific question, or if you just want some advice to help you narrow down your options, please contact us 800-314-1433. We have licensed professionals available to help you with just this kind of issue. If you prefer, you can also send us an email at
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It's no secret that employees value health insurance benefits. Surveys have shown that workers value health insurance coverage second only to monetary compensation. By offering group health insurance benefits to your employees, you may find it easier to hire and retain the best workers for your company.
As a business owner, you may not have health insurance coverage yourself. Perhaps you've considered shopping for an individual health insurance plan for yourself and your family, but did you know that by obtaining insurance through a company, you may get better rates than through the individual market?
Additionally, there are various tax incentives available to you and your employees when you participate in a group health insurance plan. For example, businesses can generally deduct 100% of the premiums they pay on qualifying group health plans and, by offering group health insurance as part of a total compensation package you may be able to reduce payroll taxes. Plus, your employees can pay their portion of the monthly insurance premium with pre-tax dollars. Make sure that you take these incentives into consideration when determining the affordability of a health insurance plan for you and your employees. Check with your accountant or tax advisor for specific tax benefits for your business and employees.
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Typically, an employer is required to cover 50% of the employee's monthly premium. In these cases, the employee covers the remainder of his or her own premium and then covers the full premium for any of his or her dependants. Minimum employer contribution levels may differ from state to state and from one insurance company to the next. Also, some employers opt to cover a higher percentage of the employee's monthly premium and sometimes a portion of the premium costs for an employee's dependants.
During the application process, you'll be able to indicate how much of your employees' (and their dependents') monthly premiums you would like to cover.
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Individual Health
1.) How does a PPO plan work?
As a member of a PPO (Preferred Provider Organization) plan, you'll be encouraged to use the insurance company's network of preferred doctors and hospitals. These healthcare providers have been contracted to provide services to the health insurance plan's members at a discounted rate. You typically won't be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion.
You will probably have an annual deductible to pay before the insurance company starts covering your medical bills. You may also have a co-payment for certain services or be required to cover a certain percentage of the total charges for your medical bills.
With a PPO plan, services rendered by an out-of-network physician are typically covered at a lower percentage than services rendered by a network physician.
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2.) How does an HMO plan work?
Though there are many variations, HMO (Health Maintenance Organizations) plans typically enable members to have lower out-of-picket healthcare espenses but also offer less flexibility in the choice of physicians or hospital than other health insurance plans. As a member of an HMO, you'll be required to choose a primary care physican (PCP). Your PCP will take care of most of your healthcare needs. Before you can see a specialist, you'll need to obtain a referral from your PCP.
With an HMO you'll likely have coverage for a broader range of preventive healthcare services than you would through another type of plan. You may not be required to pay a deductible before coverage starts and your co-payments will likely be minimal. With an HMO plan, you typically won't have to submit any of your own claims to the insurance company. However, keep in mind that you'll likely have no coverage whatsoever for services rendered by non-network providers or for services rendered without a proper referral from your PCP.
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3.) How does Health Insurance work?
Imagine you have a $100,000 heart surgery, which is a covered medical expense under your health insurance plan, and letıs say this health insurance plan has a $1,000 annual deductible, 20% coinsurance after deductible, $2,000 out-of-pocket limit per year and $5 Million lifetime maximum. *
*Not all health insurance plans feature deductible or coinsurance
Typically, a deductible is the amount of money you must pay each year before your health insurance plan starts to pay for covered medical expenses.
So with a $100,000 heart surgery bill, you are responsible for paying the first $1,000. After this $1,000 deductible is met, the insurance company will pay a percentage of the bill in what is called the coinsurance.
Typically, coinsurance is a cost-sharing requirement where you are responsible for paying a certain percentage and the insurance company will pay the remaining percentage of the covered medical expenses after your deductible is met.
For a health insurance plan with 20% coinsurance, once the deductible is met, the insurance company will pay 80% of the covered expenses while you pay the remaining 20% until your out-of-pocket limit is reached for the year.
Typically, a lifetime maximum is the amount your insurance plan will pay for covered medical expenses in the course of your lifetime.
Since the health insurance plan has a lifetime maximum of $5 million, and as you pay your deductible, coinsurance and out-of-pocket limit each year, the insurance company will pay for all remaining covered medical bills up to a maximum of $5,000,000 in your lifetime.
Here's one more concept... Some health insurance plans offer co-payment.
Typically, a co-payment or co-pay is a specific flat fee you pay for each medical service, such as $30 for an office visit, after which the insurance company often pays the remainder of the covered medical charges. Letıs say you are not feeling well and went to see your doctor who charges $200 for the office visit. If your insurance plan has an office visit co-payment of $30, then you will only be responsible for the $30 and the insurance company will cover the remaining $170.
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4.) What is an HSA?
"HSA" stands for Health Savings Account. HAS`S allow consumers to pay for qualified medical expenses with pre-tax dollarsımeaning income-tax freeıand save for retirement on a tax-deferred basis.
An HSA is tax-favored savings account that is used in conjunction with a high-deductible HSA-eligible health insurance plan to make healthcare more affordable and to save for retirement.
HAS`S are similar to individual retirement accounts (IRAs), but even better:
Pre-tax money is deposited each year into an HSA and can be easily withdrawn at any time with no penalty or taxes to pay for qualified medical expenses. Withdrawals can also be made for non-medical purposes, but will be taxed as normal income and are subject to a 10 percent penalty if done prior to age 65.
Any HSA funds not used each year remain in the account, and earn interest tax-free to supplement medical expenses at any time in the future.
Like an IRA, the account belongs to you, not your employer. But unlike an IRA, your employer CAN contribute to your HSA.
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5.) What's the best Health Insurance Plan for me?
Choosing between different health insurance plans isn't always easy. There is no one "best" plan for everyone. The best match for you and your family may be different than the best match for someone else. In order to help you answer this question, here are a few things to consider:
1) Are you going to need long-term coverage or just something for the short-term?
If you're between jobs for 1-6 months, you may want to look into our short-term coverage options. Alternatively, if you have no prospects of receiving group health insurance coverage through an employer, you may value the stability and increased benefits offered through an individual and family health insurance plan which will provide longer term coverage.
2) Are you looking for basic coverage or more comprehensive coverage?
Some insurance plans offer basic coverage (i.e., primarily inpatient hospitalization and outpatient surgery coverage) to cover you in case of a major accident or illness. These insurance plans typically have a lower monthly premium than plans with more comprehensive coverage, and may be appropriate for people who intend to use their insurance primarily in the event of a serious accident or illness.
Other insurance plans, in addition to offering coverage in case of a major accident or illness, offer more comprehensive coverage which MAY include benefits such as: preventative care, physician services, prescription drug benefits and routine office visits. These insurance plans typically have a higher monthly premium than plans that only offer basic coverage, and may be appropriate for people who intend to use their insurance on a regular basis.
3) Would you rather pay for your services before you use them or when you use them?
Typically, the higher the monthly premium that you pay, the less you will pay per doctor's visit in co-payments and deductibles. If you choose a health insurance plan with a low monthly premium, you're likely to have a higher co-payment or deductible. If you don't anticipate making frequent use of your health insurance coverage, a higher-deductible plan with a lower monthly premium may suit you best.
4) How important to you is easy access to specialists?
Health insurance plans that require you to coordinate your care through a primary care physician typically require that you obtain a referral before seeing a specialist. Thus, if you prefer easier access to specialists, you may wish to consider a different type of plan.
5) Do you have a specific doctor or hospital that you would like to visit for healthcare?
Some insurance plans utilize provider networks. Pay special attention to the network of doctors or facilities that each health insurance plan utilizes. You'll want to make sure that your favorite doctor or hospital is included on the list for the health insurance plan you choose. Also note that networks utilized by health insurance plans can change, so there is no guarantee that your doctor will always be contracted with your chosen health insurance plan.
6) What is the most you could pay out in case of a serious illness or injury?
Health insurance plans typically place limits on how much a member is required to pay out per year for his or her healthcare. This limit is often referred to as an out-of-pocket maximum. Once you've contributed this maximum amount toward your healthcare, the health insurance company typically covers all other costs for the remainder of the benefit year. If you're concerned about what may happen to you in case of a serious illness or injury, you may wish to pay special attention to the out-of-pocket maximums for the health insurance plans you're considering.
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