Do you need health care protection because you’re self-employed, or
not insured through your employer?
Or are you paying too much for your current health coverage?
Let us help you review all of the plans available at affordable
rates to individuals and families!
Representing many fine companies!
Group Health Plans
You are an employer, faced with rising health care costs…
how can you keep costs down?
- Understand your options. Learn all you can.
- Gather employee census data.
- Submit census data to our agency for a complete evaluation of your
We will work with you to determine the best course of action for
you and your company. The savings to you and your employees could be
Let’s work together to save you money!
The information below is from a report by the Agency for Healthcare Research and Quality, a division of DHHS. www.ahrq.gov
The Agency for Healthcare Research and Quality Web site provides
practical health care information, research findings, and data to help
consumers, health providers, health insurers, researchers, and
policymakers make informed decisions about health care issues. Their
web site does not endorse any commercial web site, and the information
below is for educational purposes only.
What are my health plan choices?
Choosing between health plans is not as easy as it once was. Although
there is no one “best” plan, there are some plans that will be better
than others for you and your family’s health needs. Plans differ, both
in how much you have to pay and how easy it is to get the services you
need. Although no plan will pay for all the costs associated with your
medical care, some plans will cover more than others.
Indemnity and managed care plans differ in their basic approach.
Put broadly, the major differences concern choice of providers,
out-of-pocket costs for covered services, and how bills are paid.
Usually, indemnity plans offer more choice of doctors (including
specialists, such as cardiologists and surgeons), hospitals, and other
health care providers than managed care plans. Indemnity plans pay
their share of the costs of a service only after they receive a
Managed care plans have agreements with certain doctors, hospitals,
and health care providers to give a range of services to plan members
at reduced cost. In general, you will have less paperwork and lower
out-of-pocket costs if you select a managed care type plan and a
broader choice of health care providers if you select an
With an indemnity plan (sometimes called fee-for-service), you can
use any medical provider (such as a doctor and hospital). You or they
send the bill to the insurance company, which pays part of it.
Usually, you have a deductible—such as $200—to pay each year before
the insurer starts paying.
Once you meet the deductible, most indemnity plans pay a percentage
of what they consider the “Usual and Customary” charge for covered
services. The insurer generally pays 80 percent of the Usual and
Customary costs and you pay the other 20 percent, which is known as
coinsurance. If the provider charges more than the Usual and Customary
rates, you will have to pay both the coinsurance and the
The plan will pay for charges for medical tests and prescriptions
as well as from doctors and hospitals. It may not pay for some
preventive care, like checkups.
Preferred Provider Organization (PPO). A PPO is a form of managed
care closest to an indemnity plan. A PPO has arrangements with
doctors, hospitals, and other providers of care who have agreed to
accept lower fees from the insurer for their services. As a result,
your cost sharing should be lower than if you go outside the network.
In addition to the PPO doctors making referrals, plan members can
refer themselves to other doctors, including ones outside the
If you go to a doctor within the PPO network, you will pay a
copayment (a set amount you pay for certain services—say $10 for a
doctor or $5 for a prescription). Your coinsurance will be based on
lower charges for PPO members.
If you choose to go outside the network, you will have to meet the
deductible and pay coinsurance based on higher charges. In addition,
you may have to pay the difference between what the provider charges
and what the plan will pay.
Health Maintenance Organization (HMO). HMOs are the oldest form of
managed care plan. HMOs offer members a range of health benefits,
including preventive care, for a set monthly fee. There are many kinds
of HMOs. If doctors are employees of the health plan and you visit
them at central medical offices or clinics, it is a staff or group
model HMO. Other HMOs contract with physician groups or individual
doctors who have private offices. These are called individual practice
associations (IPAs) or networks.
HMOs will give you a list of doctors from which to choose a primary
care doctor. This doctor coordinates your care, which means that
generally you must contact him or her to be referred to a
With some HMOs, you will pay nothing when you visit doctors. With
other HMOs there may be a copayment, like $5 or $10, for various
If you belong to an HMO, the plan only covers the cost of charges
for doctors in that HMO. If you go outside the HMO, you will pay the
bill. This is not the case with point-of-service plans.
Point-of-Service (POS) Plan. Many HMOs offer an indemnity-type
option known as a POS plan. The primary care doctors in a POS plan
usually make referrals to other providers in the plan. But in a POS
plan, members can refer themselves outside the plan and still get some
If the doctor makes a referral out of the network, the plan pays
all or most of the bill. If you refer yourself to a provider outside
the network and the service is covered by the plan, you will have to
Your primary care doctor will serve as your regular doctor,
managing your care and working with you to make most of the medical
decisions about your care as a patient. In many plans, care by
specialists is only paid for if your are referred by your primary care
An HMO or a POS plan will provide you with a list of doctors from
which you will choose your primary care doctor (usually a family
physician, internists, obstetrician-gynecologist, or pedicatrician).
This could mean you might have to choose a new primary care doctor if
your current one does not belong to the plan.
PPOs allow members to use primary care doctors outside the PPO
network (at a higher cost). Indemnity plans allow any doctor to be
Courtesy: The Agency for Healthcare Research and Quality Web site
provides practical health care information, research findings, and
data to help consumers, health providers, health insurers,
researchers, and policymakers make informed decisions about health
HIPAA Plans (if you do not qualify for one of our other plans)
Title I of the Health Insurance Portability and Accountability Act
of 1996 (HIPAA) protects health insurance coverage for workers and their families when they change or lose jobs.
Short Term Coverage
- Are you graduating from college?
- Are you between jobs?
- Have you been laid-off?
If you’ve lost your health insurance, there is a low-cost solution available for you, and it is doesn’t involve a lot of paperwork or time.
Ask us about short-term health insurance. There are deductibles to
help keep the premiums low. And of course, pre-existing conditions are
not covered. But if you need a little piece of mind between jobs-
this can help!
Health Savings Account
Everyone with a high deductible medical plan can now save for
medical expenses in a tax-deductible savings account!
The Medical Savings Account (MSA) plan of the past was expanded to the
new Health Savings Account (HSA) on December 8, 2003. If you have
never looked at using
PRE-TAX dollars to help pay your out-of-pocket medical expenses, you
may wish to look now.
Contact us for more information!