Group Health Insurance

Health Insurance is one of the most important Employee Benefits to your employees. Providing Health Insurance is a requirement to attract and retain employees in the current and competitive marketplace. Most likely, your company spends more money on Health Insurance than any other single benefit and the costs continue to rise. We can help you determine the best plan for you and your employees.

There are four types of Health Insurance coverage:

1. Indemnity or Fee-for-Service
2. Preferred Provider Organization (PPO)
3. Point-of-Service Plans (POS)
4. Health Maintenance Organizations (HMO)

Indemnity Plans: The earliest form of Group Health Insurance. Indemnity Plans do not require the insured to use network physicians or require a Gatekeeper or Primary Care Physician (PCP) to coordinate care. The participants select the doctors and the hospitals to treat them. Most Indemnity plans have Deductibles that must be met prior to the carrier incurs expenses. After a participant meets his or her deductible amount for the year, the participant shares the bill with the insurance company. For example, an insured might pay 20 percent while the insurer pays 80 percent. The participant’s portion is called coinsurance. Most fee-for-service plans have an out-of-pocket Maximum, the most one will have to pay for medical bills in any one year. The maximum is reached when the out-of-pocket expenses (deductible and coinsurance) total the Maximum. At that time, the Insurance Carrier will pay the remainder of the medical expenses for that year. While this plan offers the most flexibility and control to its participants, the cost is highest for the plan sponsor and also most always for the insured.

PPO: The "Preferred Provider Organization" is the first step into managed care. PPO’s offer the greatest flexibility within a network-based plan. Participants do not need to designate a Primary Care Physician (PCP). The insured is free to see any health care professional in the provider network without a referral and still have coverage at the highest level of benefits. PPO’s have co-pays for Doctors visits and Prescriptions. If a PPO member wants to use a Doctor or Hospital that is not part of the Network, they have the freedom to do so and have benefits paid at a lower level. The Out-of-Network coverage for a PPO works identically to Indemnity coverage.

POS: "Point-Of-Service" plans offer the benefits of an HMO plus the freedom to go outside of the managed care provider network and still receive coverage. Under a POS, the participant designates a PCP in the plan network to coordinate their care. Benefits are paid at the highest level when the participant’s PCP coordinates care including referrals to specialists. The participant can also choose to bypass the PCP and self-refer to other health care professionals for care. When the PCP does not direct care, benefits are paid at a lower level and the member will incur more out-of-pocket expenses.

HMO: "Health Maintenance Organization" plans provide the least flexibility at the lowest cost. Participants choose a PCP in the Network to provide routine care and to coordinate their care. The member’s PCP must coordinate all care, including referrals to specialists. HMO’s have co-pays for Doctors visits and Prescriptions. HMO’s provide no coverage for care received without a referral when a referral is necessary or for care received by a health care professional that is not in the network of physicians designated by the insurance company. This plan offers the least flexibility and control of care to its members.

Market Trends

• The pricing structure between insurance carriers and plans can vary greatly. Quite often, we are able to provide our clients with a PPO from one carrier for a significantly lower premium than a POS or HMO from one of our other carriers.
• Employees and employers are growing increasingly frustrated with the referral structure of POS and HMO plans. Many groups are making the move to PPO plans that eliminate the need for a referral. The good news is that we work with many PPO plans that are competitively priced. Getting a more flexible plan does not necessarily mean paying a higher premium.
• Many groups are becoming more receptive to different funding methods. The old fashioned fully insured Health Insurance plan is not always the most cost-effective option. Self-funding, Partially Self-funding and Medical Savings Accounts (MSA’s) are different funding vehicles that can provide tremendous cost savings.

What Can The Guard Group offer your Company?

We work with a variety of insurance carriers, including local carriers and prominent national carriers with a local presence.

In addition to presenting our clients with all of their available options, we assist our clients in developing goals for their benefits program, including defining what features their Health Plan should incorporate. This combination allows us to provide our clients with a program that achieve the goals of their benefits program.

We have been able to save many of them thousands of dollars while offering all of the benefits that are important to business owners and their employees.

Let us show your company:

• New plan designs
• Multiple plan design options
• Cost saving features
• New Insurance Companies and Benefits Programs that you have not seen before